Candidates For Adenotonsillectomy Research Articles

Clinical Characteristics of Primary Snoring vs Mild Obstructive Sleep Apnea in Children

It is unknown whether children with primary snoring and children with mild obstructive sleep apnea (OSA) represent populations with substantially different clinical characteristics. Nonetheless, an obstructive apnea-hypopnea index (AHI) of 1 or greater is often used to define OSA and plan for adenotonsillectomy (AT). To assess whether a combination of clinical characteristics differentiates children with primary snoring from children with mild OSA. Baseline data from the Pediatric Adenotonsillectomy Trial for Snoring (PATS) study, a multicenter, single-blind, randomized clinical trial conducted at 6 academic sleep centers from June 2016 to January 2021, were analyzed. Children aged 3.0 to 12.9 years with polysomnography-diagnosed (AHI <3) mild obstructive sleep-disordered breathing who were considered candidates for AT were included. Data analysis was performed from July 2022 to October 2023. Logistic regression models were fitted to identify which demographic, clinical, and caregiver reports distinguished children with primary snoring (AHI <1; 311 patients [67.8%]) from children with mild OSA (AHI 1-3; 148 patients [32.2%]). A total of 459 children were included. The median (IQR) age was 6.0 (4.0-7.5) years, 230 (50.1%) were female, and 88 (19.2%) had obesity. A total of 121 (26.4%) were Black, 75 (16.4%) were Hispanic, 236 (51.5%) were White, and 26 (5.7%) were other race and ethnicity. Black race (odds ratio [OR], 2.08; 95% CI, 1.32-3.30), obesity (OR, 1.80; 95% CI, 1.12-2.91), and high urinary cotinine levels (>5 µg/L) (OR, 1.88; 95% CI, 1.15-3.06) were associated with greater odds of mild OSA rather than primary snoring. Other demographic characteristics, clinical examination findings, and questionnaire reports did not distinguish between primary snoring and mild OSA. A weighted combination of the statistically significant clinical predictors had limited ability to differentiate children with mild OSA from children with primary snoring. In this analysis of baseline data from the PATS randomized clinical trial, primary snoring and mild OSA were difficult to distinguish without polysomnography. Mild OSA vs snoring alone did not identify a clinical group of children who may stand to benefit from AT for obstructive sleep-disordered breathing. ClinicalTrials.gov Identifier: NCT02562040.

Symptoms of allergic rhinitis in children with adenotonsillar hypertrophy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; A few studies have been performed on whether allergic rhinitis is a cause of adenotonsillar hypertrophy. The aim of this study was to determine the symptoms of allergic rhinitis in children with hypertrophy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; This descriptive cross-sectional study has been conducted on 150 patients’ candidates for adenotonsillectomy. The necessary information was collected through checklists and patient records. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; A total of 150 patients were included in the study. In terms of gender, the highest frequency was related to boys (66.7%). Most of patients lived in the Ardabil (66.7%). The mean age of the subjects was 7.55 years. The highest frequency was related to the history of recurrent middle ear infection in children with 73 cases (48.7%). The lowest frequency was jointly assigned to the history of taking anti-allergy drugs and the history of recurrent itching in the child each with 21 cases (14%). There was no significant relationship between any of the studied symptoms and age and gender of patients. Most of patients with 90.7% had allergic rhinitis symptoms.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Results showed that frequency of symptoms of allergic rhinitis in patients with adenotonsillar hypertrophy was in moderate level and the rate of it in studied patients was similar to its rate among general population.&lt;/p&gt;

Effects of the Two Doses of Dexmedetomidine on Sedation, Agitation, and Bleeding During Pediatric Adenotonsillectomy

BackgroundDue to the importance of dexmedetomidine and its different dosages, here, we aimed to investigate and compare the effectiveness of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine in sedation, agitation, and bleeding in pediatrics undergoing adenotonsillectomy.MethodsThis double-blinded randomized clinical trial was performed on 105 pediatric patients that were candidates for adenotonsillectomy. Then, the patients were divided into three groups receiving dexmedetomidine at a dose of 2 µg/kg, diluted dexmedetomidine at 1 µg/kg, and normal saline. The drugs were administered 15 minutes before operations via the intravenous method. The duration of extubation, mean arterial pressure (MAP), heart rate (HR), and SPO2 in the recovery were recorded. We also collected data regarding patients’ sedation and agitation every 15 minutes.ResultsOur data showed no significant differences between the groups of patients regarding MAP, HR, and SPO2. However, the mean sedation score was significantly higher in patients receiving dexmedetomidine (2 µg/kg), and this score was lowest in the control group at the time of entrance to the recovery room. The patients that received dexmedetomidine at a dose of 1 µg/kg had the lowest agitation score after 45 minutes of being in the recovery room, and the patients treated with dexmedetomidine at a dose of 2 µg/kg had the lowest agitation score after 60 minutes of being in the recovery compared to other groups of patients.ConclusionsThe use of the doses of 1 µg/kg and 2 µg/kg of dexmedetomidine was associated with proper sedation and a significant reduction in agitation. The patients also had lower amounts of bleeding. We recommend that anesthesiologists should pay more attention to dexmedetomidine at a dose of 2 µg/kg, especially in pediatric surgical procedures.

Multidisciplinary clinic for care of children with complex obstructive sleep apnea

ObjectiveWhile adenotonsillectomy (AT) remains first line therapy for pediatric obstructive sleep apnea (OSA), management of children who are not candidates for AT or who have residual OSA post AT varies and spans across multiple specialties. We aim to report our experience in managing this population through a multidisciplinary sleep clinic composed of specialists in pediatric dentistry, otolaryngology, plastic surgery, and pulmonary/sleep medicine. Study designRetrospective chart review. MethodThe medical records of children attending our complex sleep apnea clinic were reviewed. Data pertaining to demographics, underlying diagnoses, prior evaluation and treatment, recommendations, and initial therapy were collected. ResultTwo-hundred and thirty patients (mean age 10.7 ± 5.1 years, 62.2% male) were assessed. Underlying conditions included Trisomy 21 (n = 65, 28.2%), other genetic syndromes (n = 37, 16.1%), obesity in an otherwise typically developing child (n = 36, 15.2%), cerebral palsy (n = 27, 11.7%), and craniofacial syndromes (n = 7, 3.0%). Mean obstructive apnea hypopnea index (OAHI) was 14.2 events/hour at first clinic visit, and the majority of children had previously undergone at least one upper airway surgery (n = 168, 73.0%), primarily adenotonsillectomy. Recommended initial treatment plans included positive airway pressure (PAP) therapy (n = 108, 47.0%), surgery (n = 75, 32.6%), allergy management (n = 52, 22.6%), and/or weight loss (n = 34, 14.8%). Patients prescribed PAP therapy with follow up data were found to be adherent 43.9% of the time. Surgical patients with post-operative polysomnography had pre-operative OAHI 15.6 ± SD13.4 decrease to 10.7 ± 14.2 events/hour (p = 0.61). ConclusionGenetic conditions and obesity were the most common underlying diagnoses cared for in the complex sleep apnea clinic. Patients presented with severe OSA, most having already had upper airway surgery. Management plans were frequently adjusted, and we observed improvement in SDB in a sub-segment of patients, suggesting benefit to a coordinated, multi-disciplinary approach.

Surgical treatment for sleep disorders breathing in children and teenagers

Adenotonsillectomy is the standard surgery for moderate and severe sleep disorders breathing (SDB) in 2 to 6-year-old children, often due to tonsillar and adenoidal hypertrophy. Recently, partial subtotal intracapsular tonsillotomy has been developed to prevent risks linked to surgery, especially haemorrhages leading to death in extreme cases. Children with apnea, poor quality of life (sleep problems, daytime tiredness), poor academic performance or late growth are candidates for adenotonsillectomy. The management of children with mild SDB is still evolving. Adenotonsillectomy is usually not recommended for adenoidal hypertrophy. Treatment options with mild OSA include watchful waiting, inhaled nasal corticosteroids, and adeno-tonsillectomy. The treatment decision should be made after a discussion between the patient, caregivers and the surgeon regarding the risks and benefits of possible therapies. The surgical procedure is efficient in more than 75% of cases. Close clinical follow-up is necessary, especially in obese children. Primary and secondary haemorrhaging, as well as postoperative pain, are considerably reduced in partial tonsillotomy. Tonsillotomy (intracapsular or subtotal tonsillectomy) is a modern technique because it has been suggested that perioperative pain and postoperative haemorrhage are reduced with the tonsillotomy technique. There is no significant difference in subjective outcome between tonsillotomy and tonsillectomy. These findings may support wider use of tonsillotomy for the treatment of sleep disorders breathing in children. Children with residual disorder may be candidates for surgical procedures such as nasal disobstruction, pharyngoplasty, lingual tonsillectomy or maxillofacial surgery.

Surgical treatment for sleep disorders breathing in children and teenagers

Adenotonsillectomy is the standard surgery for moderate and severe sleep disorders breathing (SDB) in 2 to 6-year-old children, often due to tonsillar and adenoidal hypertrophy. Recently, partial subtotal intracapsular tonsillotomy has been developed to prevent risks linked to surgery, especially haemorrhages leading to death in extreme cases. Children with apnea, poor quality of life (sleep problems, daytime tiredness), poor academic performance or late growth are candidates for adenotonsillectomy. The management of children with mild SDB is still evolving. Adenotonsillectomy is usually not recommended for adenoidal hypertrophy. Treatment options with mild OSA include watchful waiting, inhaled nasal corticosteroids, and adeno-tonsillectomy. The treatment decision should be made after a discussion between the patient, caregivers and the surgeon regarding the risks and benefits of possible therapies. The surgical procedure is efficient in more than 75% of cases. Close clinical follow-up is necessary, especially in obese children. Primary and secondary haemorrhaging, as well as postoperative pain, are considerably reduced in partial tonsillotomy. Tonsillotomy (intracapsular or subtotal tonsillectomy) is a modern technique because it has been suggested that perioperative pain and postoperative haemorrhage are reduced with the tonsillotomy technique. There is no significant difference in subjective outcome between tonsillotomy and tonsillectomy. These findings may support wider use of tonsillotomy for the treatment of sleep disorders breathing in children. Children with residual disorder may be candidates for surgical procedures such as nasal disobstruction, pharyngoplasty, lingual tonsillectomy or maxillofacial surgery.

Patterns and Grade of Velopharyngeal Closure in Candidates for Adenotonsillectomy

The most common type of velopharyngeal valve (VPV) closure is a matter of controversy. The aim of this study was to estimate the most common type of VPV closure, including identification of the type and grade of VPV closure among Egyptian children. This study included patients who were candidates for adenotonsillectomy. In these cases, video-nasoendoscopy and speech assessment were performed prior to surgery in addition to otorhinolaryngology examination and preoperative laboratory tests. By examination of 97 patients, video-nasoendoscopy of the VPV revealed that 49 patients had coronal VPV closure (50.5%), 48 patients had circular VPV closure (49.5%) and no patients had sagittal VPV closure. Coronal and circular closure are the main types of VPV closure in Arabic-speaking children, as neither sagittal closure nor circular closure with Passavant's ridge were detected in this study. Therefore, revision of the methods of repair for persistent velopharyngeal insufficiency (VPI) is required.

Effect of adenotonsillectomy on attention deficit-hyperactivity disorder in children with adenotonsillar hypertrophy: A prospective cohort study

BackgroundThis study was conducted to explore the effect of adenotonsillectomy on the improvement of attention deficit hyperactivity disorder (ADHD) symptoms in children with adenotonsillar hypertrophy. MethodsThis prospective cohort study was conducted on 59 children aged 6–12 years with adenotonsillar hypertrophy and ADHD who were candidates for adenotonsillectomy at Besat Hospital, Hamadan University of Medical Sciences, in 2014. The status of ADHD was evaluated at baseline and one and three months after surgery using Conners' Rating Scales. ResultsOf 59 children with ADHD (35 boys and 24 girls), 41 improved one month after surgery and 51 after three months. Only 8 children had no improvement. The Conners' score decreased significantly from 71.37 at baseline to 61.31 (P = 0.001) and 49.14 (P = 0.001) one and three months after surgery, respectively. The score of attention deficit and hyperactivity decreased from 1.76 and 2.10 at baseline to 1.52 and 1.83 after one month (P = 0.001) and to 1.24 and 1.52 after three months (P = 0.001), respectively. The results were statistically significant for both boys and girls. ConclusionThis study indicated that adenotonsillectomy can significantly improve ADHD in children with adenotonsillar hypertrophy and help them return to normal life.

Vitamin D Levels in Children With Otitis Media With Effusion: A Case-Control Study

Background: Otitis media with effusion (OME) is one of the main sources of hearing impairment in children. One of the possible causes of middle ear infection and OME is immune system disorders. Based on previous studies, vitamin D deficiency plays an important role in the incidence of middle ear infections. Objectives: This study aimed to determine blood levels of vitamin D in children with OME (as an inflammation of the middle ear) in comparison to a control group of patients admitted to Loghman-Hakim hospital in Tehran. Patients and Methods: In this case-control study, one hundred twenty children with OME who were admitted to Loghman-Hakim hospital between April 2013 and March 2014 and who were candidates for adenotonsillectomy were studied. They were divided into two groups based on tympanometry. The first group contained patients with OME and hearing loss of Type B or Type C2, and the second group (control) contained patients without OME and tympanometry of Type A or Type C2. On the day of surgery, blood samples were obtained for measurement and comparing of serum levels of vitamin D in the two groups. Results: In this study, 120 children (40 cases and 80 controls) that were candidates for tonsillectomy were studied. The largest number of cases was males (60%). The mean age of patients with otitis media was 5.7 ± 2.6 years-old and in the control group was 7.2 ± 2.2 years-old. The mean levels of vitamin D in children with OME was 26.1 ± 14.6 ng/mL and in children in the control group was 29.5 ± 17.9 ng/mL (P = 0.27). Conclusions: Although there was not a significant relation shown between vitamin D levels between the two groups in our study, the vitamin D level in OME patients was less than in the control group. Therefore, it seems that measuring the level of vitamin D in these patients is necessary, and a deficiency of vitamin D must be treated. In order to achieve certain results with more detail we suggest more studies with larger sample sizes and covering a longer time period are needed on this topic.

Prognosis for Spontaneous Resolution of OSA in Children

Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment. The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline. After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors. Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT. ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

An Update on the Management of Pediatric Obstructive Sleep Apnea

Obstructive sleep apnea (OSA) is a sleep-related breathing disorder characterized by episodes of upper airway collapse during sleep. The severity of OSA is categorized according to the apnea hypopnea index (AHI) found on polysomnogram. Pediatric OSA is classified as mild (AHI 1–5), moderate (AHI 5–10), or severe (AHI > 10). While the exact pathophysiology of OSA is still being investigated; adenotonsillar hypertrophy is the most common cause of obstruction in children. Thus, adenotonsillectomy is the mainstay of treatment for moderate to severe OSA. Patients at high risk for perioperative respiratory complications, including those less than 3 years of age and those with significant co-morbid medical conditions like Trisomy 21, should be monitored overnight following surgery. The management of patients with mild OSA is still evolving. Treatment options for children with mild OSA include watchful waiting, leukotriene inhibitors and/or inhaled nasal corticosteroids, and adenotonsillectomy. Treatment decisions should be made after a frank discussion of the risk and benefits of therapies between the patient, caregivers, and physician. Children with poor quality of life and school performance are candidates for adenotonsillectomy. Close clinical follow-up is necessary for children managed conservatively since a small number of patients, especially those who are obese, can develop more significant obstruction over time. Obese children and those patients with severe disease are at risk for persistent OSA following primary treatment with adenotonsillectomy. Historically, positive airway pressure (PAP) was the mainstay of treatment for persistent disease after adenotonsillectomy. While PAP can be effective in treating children with OSA, adherence is often poor. The utilization of drug-induced sleep endoscopy (DISE) has allowed for surgeons to identify and target additional sites of obstruction. Based on DISE findings, children with residual OSA may be candidates for surgical procedures such as lingual tonsillectomy, pharyngoplasty, supraglottoplasty, or tongue base reduction.

The use of clinical parameters to predict obstructive sleep apnea syndrome severity in children: the Childhood Adenotonsillectomy (CHAT) study randomized clinical trial.

It is important to distinguish children with different levels of severity of obstructive sleep apnea syndrome (OSAS) preoperatively using clinical parameters. This can identify children who most need polysomnography (PSG) prior to adenotonsillectomy (AT). To assess whether a combination of factors, including demographics, physical examination findings, and caregiver reports from questionnaires, can predict different levels of OSAS severity in children. Baseline data from 453 children from the Childhood Adenotonsillectomy (CHAT) study were analyzed. Children 5.0 to 9.9 years of age with PSG-diagnosed OSAS, who were considered candidates for AT, were included. Polysomnography for diagnosis of OSAS. Linear or logistic regression models were fitted to identify which demographic, clinical, and caregiver reports were significantly associated with the apnea hypopnea index (AHI) and oxygen desaturation index (ODI). Race (African American), obesity (body mass index z score > 2), and the Pediatric Sleep Questionnaire (PSQ) total score were associated with higher levels of AHI and ODI (P = .05). A multivariable model that included the most significant variables explained less than 3% of the variance in OSAS severity as measured by PSG outcomes. Tonsillar size and Friedman palate position were not associated with increased AHI or ODI. Models that tested for potential effect modification by race or obesity showed no evidence of interactions with any clinical measure, AHI, or ODI (P > .20 for all comparisons). This study of more than 450 children with OSAS identifies a number of clinical parameters that are associated with OSAS severity. However, information on demographics, physical findings, and questionnaire responses does not robustly discriminate different levels of OSAS severity. clinicaltrials.gov Identifier: NCT00560859.

The Effect of Intravenous Magnesium Sulfate on Laryngospasm After Elective Adenotonsillectomy Surgery in Children

Background:Laryngospasm is the protective reflex of tracheobronchial tree against secretions and hemorrhage. This reflex is more prevalent in adenotonsillectomy in the presence of light anesthesia, which can lead to obstruction of airway, complications, and mortality. Different methods have been studied for preventing this complication; however, none of them could reliably prevent it.Objectives:The objective was to assess the effect of magnesium sulfate on laryngospasm and coughing after adenotonsillectomy.Patients and Methods:Seventy children with three to 12 years of age and ASA classes I and II, who were candidates for adenotonsillectomy, were recruited in this randomized clinical trial. The study group received 15 mg/kg intravenous magnesium sulfate and the control group received 0.9% normal saline with the same volume, 2 minutes after tracheal intubation via intravenous infusion for 20 minutes. After removing the endotracheal tube in the recovery room, the patients were assessed at minutes zero, 15, and 30in terms of laryngospasm and coughing. The assessment was based on four-point scale of severity of these complications and saturation percentage of arterial oxygen in operating and recovery room. After collecting the data, results were analyzed with the SPSS 16 software anda P value < 0.05 was considered statistically significant.Results:Laryngospasm was not found in the magnesium sulfate group; however, its incidencewas5.7% in the control group. The incidence rates of coughs were 17.1% and 40% in the magnesium sulfate group and in the control group, respectively, which had no statistically significant differences.Conclusions:Intravenous magnesium sulfate with dose of 15 mg/kg could not prevent laryngospasm and coughing after removal of the endotracheal tube in patients undergoing adenotonsillectomy; however, it reduced coughing and laryngospasm in the magnesium sulfate group compared with the control group.

Predictors of Obstructive Sleep Apnea Severity in Adenotonsillectomy Candidates

There is uncertainty over which characteristics increase obstructive sleep apnea syndrome (OSAS) severity in children. In candidates for adenotonsillectomy (AT), we evaluated the relationship of OSAS severity and age, sex, race, body mass index (BMI), environmental tobacco smoke (ETS), prematurity, socioeconomic variables, and comorbidities. Cross-sectional screening and baseline data were analyzed from the Childhood Adenotonsillectomy Trial, a randomized, controlled, multicenter study evaluating AT versus medical management. Regression analysis assessed the relationship between the apnea hypopnea index (AHI) and risk factors obtained by direct measurement or questionnaire. Clinical referral setting. Children, ages 5 to 9.9 y with OSAS. Of the 1,244 children undergoing screening polysomnography, 464 (37%) were eligible (2 ≤ AHI < 30 or 1 ≤ obstructive apnea index [OAI] < 20 and without severe oxygen desaturation) and randomized; 129 (10%) were eligible but were not randomized; 608 (49%) had AHI/OAI levels below entry criteria; and 43 (3%) had levels of OSAS that exceeded entry criteria. Among the randomized children, univariate analyses showed significant associations of AHI with race, BMI z score, environmental tobacco smoke (ETS), family income, and referral source, but not with other variables. After adjusting for potential confounders, African American race (P = 0.003) and ETS (P = 0.026) were each associated with an approximately 20% increase in AHI. After adjusting for these factors, obesity and other factors were not significant. Apnea hypopnea index level was significantly associated with race and environmental tobacco smoke, highlighting the potential effect of environmental factors, and possibly genetic factors, on pediatric obstructive sleep apnea syndrome severity. Efforts to reduce environmental tobacco smoke exposure may help reduce obstructive sleep apnea syndrome severity. Clinicaltrials.gov (#NCT00560859).

Is Fasting Duration Time Important in Post Adenotonsillectomy Feeding Time?

Background:Adenotonsillectomy is a common otolaryngology surgery. Nausea and vomiting are the most common complications of this procedure with a prevalence ranging from 49% to 73 %.Objectives:Our aim was to evaluate the effects of short time fasting protocol on decreasing postoperative pain, nausea and vomiting, and initiation of oral feeding after adenotonsillectomy.Patients and Methods:120 children aged 4 to 14 years candidates for adenotonsillectomy were randomly divided into intervention and control groups (n = 120, 60 in each group). Each patient of the intervention group was given oral dextrose 10% as much volume as he could consume at 3 and 6 hours prior to the operation. All the data including pain severity, nausea and vomiting of the patients, the time of oral feeding initiation etc. were gathered in checklists after the operation. Statistical analyses were then performed using Statistical Package for the Social Sciences (SPSS) software version 16. Descriptive statistical methods and mean difference test for independent groups and chi square test or Fisher exact test, and if regression needed model test were applied. A P value of 0.05 or less was considered statistically significant.Results:The amount of Acetaminophen administered for the intervention group was significantly lower than the control group, and also the time of oral feeding initiation was significantly shorter in the intervention group than the control group (P < 0.005). Pain severity at all occasions following surgery was significantly lower in the intervention group than the control group (P < 0.001). Although frequency of nausea at recovery time was significantly lower in the intervention group than the control group (P < 0.002), there were no significant differences in frequency of nausea between the two groups at other postoperative occasions. Postoperative vomiting frequency was not significant between the two groups at any occasions.Conclusions:The findings of this survey showed that shortening the duration of pre-adenotonsillectomy fasting period and hydration of patients several hours prior to the operation might be effective in decreasing postoperative pain and facilitating postoperative oral feeding initiation. Nevertheless this method does not seem to prevent postoperative nausea and vomiting.

Adenotonsillectomy in children with von Willebrand's disease: how and when. A case report with review of the literature

The presence of coagulation pathology in children who are candidates for adenotonsillectomy (AT) is a challenge to the otolaryngologist. von Willebrand's disease (vWD) is the most common hereditary coagulopathy and is due to a quantitative and/or qualitative deficiency of von Willebrand's factor (vWF). In recent years, the administration of 1-deamino-8- d-arginine vasopressin (DDAVP) has been recommended as coadjuvant therapy for surgical procedure. This synthetic hormone promotes the release of vWF and factor VIII from endothelial cells. In this report, the authors describe the history of a child with vWD undergoing successful AT after administration of DDAVP. Furthermore, a review of the literature with particular emphasis on the use of DDAVP is made.

Pediatric Obstructive Sleep Disorders

At the recent annual meeting of the Society for Ear, Nose, and Throat Advances in Children in Washington, DC, Alan Seid, MD, San Diego, Calif, reviewed the subject of pediatric obstructive sleep apnea. According to Dr Seid, the terms sleep apnea syndrome and obstructive sleep apnea are misnomers. He submits that the term obstructive sleep disorder more accurately describes this entity; in his experience, only 60% of children who are candidates for adenotonsillectomy on this basis exhibit apnea. Dr Seid outlined the signs and symptoms of obstructive sleep disorders in children as follows: snoring, 100%; stops breathing, 60%; mouth breathing, 25%; awake frequently at night, 20%; hypersomnolence, 15%; obesity, 10%; respiratory failure, 5%; poor school performance, 5%; somnambulism, 5%; nightmares, 5%; and enuresis, 5%. Examination of the child with the obstructive sleep disorder begins with a detailed history and physical examination. A lateral roentgenogram of the nasopharynx is often useful