Synchronous airway lesions in children with obstructive sleep apnea.

Obstructive sleep apnea (OSA) affects many children, particularly those with Down syndrome (DS), with prevalence estimates ranging from 50% to 100%. Although adenotonsillectomy is the traditional first-line treatment, individuals with DS frequently have residual OSA (rOSA) because to their complex airway architecture. Lingual tonsil hypertrophy has been found as a significant risk factor for rOSA; however, the role of lingual tonsillectomy (LT) in this population is uncertain. We conducted a systematic review and meta-analysis according to PRISMA and Cochrane guidelines, registered with PROSPERO (CRD42024552955). We included studies of pediatric patients (≤18 years) with DS and rOSA who underwent LT. Primary outcomes were changes in apnea-hypopnea index (AHI), obstructive AHI (OAHI), and oxygen nadir (O₂). Secondary outcomes included postoperative complications. Three retrospective case series comprising 68 patients met the inclusion criteria. Pooled analysis demonstrated a mean improvement in oxygen nadir of 4.58% (95% CI: 2.73-6.43, I2 = 0%). AHI and OAHI scores were decreased by -2.97 (95% CI: -8.88 to 2.94, I2 = 24%) and -8.20 (95% CI: -13.46 to -2.94, I2 = 0%) respectively. Complication rates were low but inconsistently reported. Lingual tonsillectomy appears effective in improving OSA severity in children with DS. While promising, outcome improvements may be less pronounced than in the general population, likely due to complex anatomical and physiological factors unique to this group. Standardized outcome measures and prospective studies are needed to better guide management in this high-risk group.

Tonsillectomy (TE) is one of the most performed head and neck surgeries. Patients range from children to seniors, and there is a wide range of indications and various complications related to TE. The most feared complication is post-tonsillectomy haemorrhage (PTH). Multicentric retrospective study, conducted between 2014 and 2018, includes data from 8166 patients who underwent TE. Among these patients, 3889 were men (47.62%) and 4277 were women (52.28%), with a mean age of 29.06 years. For this study, we analysed a total of 14,030 unilateral tonsillectomies (resected tonsils), of which 2,302 were performed primarily as unilateral surgeries, while 11,728 were part of bilateral procedures. Late post-tonsillectomy haemorrhage (LPTH) was significantly associated with the type of surgery performed (unilateral versus bilateral procedure; p < 0.0001). In the unilateral group, bleeding occurred in 217 cases (9.43%), while in the bilateral group, it was noted in 1062 cases (18.11%). When analysing the total sample (14030 unilateral tonsillectomies), the incidence of LPTH was found to be 9.12%. The occurrence of bleeding in our sample was influenced by several factors, including hospital choice, age, and gender (p < 0.0001). Additionally, the use of anticoagulants was associated with bleeding (p = 0.0449), as was antiplatelet medication (p = 0.0160). However, factors such as the spectrum of indications, surgical technique, surgeon experience, and the use of electrocoagulation during surgery did not impact LPTH. The severity of bleeding was linked to the use of anticoagulants (p = 0.0002) and antiplatelet medication (p = 0.0404). Our study highlighted the importance of methodology when studying LPTH as the outcome of unilateral and bilateral TE procedures. LPTH occurrence was most influenced by the choice of hospital and the patient's age and gender. The severity of bleeding was affected by the use of anticoagulants and antiplatelet agents. The manner in which LPTH was treated did not affect the likelihood of LPTH recurrence.

To explore the effectiveness of immunosuppressive therapy (IST) and tonsillectomy (TE) in Caucasians with high-risk IgA-nephropathy (IgAN). The prospective non-randomised comparative study enrolled incident Caucasian patients with a definite clinical and histological diagnosis of primary IgAN (n=221, age 34±11 years, 52% male) at high risk of progression. All patients received immunosuppressive therapy (72.3% glucocorticoids monotherapy) without tonsillectomy (IST) (control group, n=136), or with tonsillectomy (TE+IST) (experimental group, n=85). The follow-up period was 33 (15; 69) months. Kaplan-Meyer and Cox regression analyses combined with pseudo-randomisation methods (1:1 matching of comparison groups and inverse probability of treatment weighting (IPTW) were applied to assess the effects of TE+IST on primary outcomes: complete remission (CR), overall (complete or partial) remission (OR), and disease progression (>40% decrease in eGFR or ESKD). The rates of early OR in the IST and TE+IST groups were 72.8% and 94.1%, respectively (p<0.001). In Kaplan-Meyer analyses, the time to remission was 2-fold shorter in TE+IST group (p<0.001). In adjusted Cox models, the probabilities of early OR and CR were significantly higher in the tonsillectomy group compared to IST alone (hazard ratio (HR)=3.364 (2.302-4.917) and HR=6.315 (2.620-15.224), respectively). The disease progression was registered in three cases (3.5%) in those on the combination therapy compared to 39 patients (28.9%) in the IST group (adjusted HR=0.126 (0.037-0.427). Analyses performed in propensity score 1:1 matched groups and IPTW-weighted Cox models have yielded similar results. Tonsillectomy and immunosuppressive therapy may be effective for remission induction and delaying progression in high-risk IgAN patients.

Summary Purpose Cancer of unknown primary (CUP) in the head and neck region accounts for around 5% of malignancies, predominantly presenting as squamous cell carcinoma (SCCUP). Despite improved diagnostic modalities that have resulted in a decreasing incidence, therapeutic management of SCCUP remains challenging due to conflicting retrospective evidence. Materials and methods A comprehensive literature search was performed using the keywords “cancer,” “unknown,” “primary,” “cervical,” “head,” “neck,” “squamous,” “cell,” “carcinoma,” “treatment,” and “diagnosis” across the PubMed database and OpenEvidence platform. Current guidelines, including those from the National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO), were analyzed to summarize state-of-the-art diagnostic and therapeutic strategies. Results A standardized diagnostic workup is essential and comprises medical history, comprehensive ENT examination, ultrasound-guided core needle biopsy, positron-emission tomography (PET/CT) imaging, and panendoscopy with palatine and lingual tonsillectomy. This approach enables identification of the primary tumor in up to 78% of cases. If a primary tumor is detected, treatment follows site-specific protocols. All SCCUP cases should be reviewed in a multidisciplinary tumor board, taking into account factors such as disease burden, immunohistochemistry (IHC), performance status, comorbidities, potential treatment-related toxicities, patient compliance, and expected functional recovery. Treatment strategies are neck dissection (ND) with adjuvant radiotherapy (RT) or chemoradiotherapy (CRT) if necessary or definitive RT or CRT. Due to inconsistent retrospective studies, it is unclear which treatment modality is currently superior. Conclusion Management of SCCUP remains complex and requires individualized multidisciplinary decision-making. Prospective trials are essential to optimize treatment strategies.

ObjectiveThe objective of this study was to describe the postoperative morbidity of adults undergoing lingual tonsillectomy. MethodsThis is a retrospective study performed at an academic medical center. Adults who underwent lingual tonsillectomy were identified using the 2014-2022 American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) database via Current Procedural Terminology (CPT®) code 42870. Data collected included patient demographics, comorbidities, length of stay, readmissions, reoperations, and postoperative complications. Linear regression was used to analyze variable effects on length of stay. ResultsTwo hundred and thirty-two patients were included, 129 (55.6%) females and 103 (44.4%) males, with a mean age of 51.6 years (range 18-87 years). Thirty (12.9%) were diabetic, 48 (20.7%) were smokers, and 76 (32.8%) had hypertension treated with medications. Length of stay ranged from 0 to 19 days, with a median of one day, and diabetes was associated with increased length of stay (p=0.004). Within 30 days post-operation, there was one (0.4%) mortality. Complications included three (1.3%) cases of pneumonia, three (1.3%) cases of urinary tract infections, two (0.9%) reintubations, two (0.9%) cases requiring mechanical ventilation for more than 48 hours, one (0.4%) case of septic shock, and one (0.4%) case requiring cardiopulmonary resuscitation. Three (1.3%) patients returned to the operating room, and three (1.3%) were readmitted for a related reason. There were two cases of postoperative hemorrhage within 30 days. ConclusionThis analysis demonstrated a low risk for morbidity and mortality among lingual tonsillectomy patients.

Our objective was to investigate the safety and efficacy of transoral robotic surgery (TORS) lingual tonsillectomy (LT) with and without epiglottopexy and to compare it with non-robotic approaches for children with obstructive sleep apnea (OSA). A multi-institutional retrospective chart review was conducted on 56 patients who underwent TORS LT (32 males, 24 females; mean age 11.7 ± 4.2 years; 29 syndromic) between 2015 and 2024 at 2 tertiary care pediatric hospitals. Preoperative and postoperative polysomnogram data were collected and analyzed, along with clinical and demographic data to analyze predictors of surgical success. Of the patients with pre- and postoperative polysomnogram, 26 patients (60.5%) were considered a surgical success. Significant improvements were seen in apnea hypopnea index (mean reduction of -14.39 ± 5.2; p = 0.0079), apnea hypopnea index during rapid eye movement (mean reduction of -25.89 ± 8.8; p = 0.0057), and O2 nadir (mean improvement of 5.73% ± 1.64%; p = 0.0012). There were no significant differences in the proportion of surgical success based on preoperative OSA severity, presence of a syndrome, or presence of obesity. Eleven patients experienced complications (19.6%), including postoperative hemorrhage requiring operative intervention (8.9%) and oropharyngeal scarring (3.6%). For pediatric patients with OSA and lingual tonsillar hypertrophy, TORS is an effective and safe method of performing LT, with benefits including excellent 3-dimensional visualization and a greater ability to distinguish the lingual tonsil/tongue musculature interface. While this is the largest pediatric TORS LT study to date, further research with larger sample sizes and additional sleep and quality of life metrics would add to the existing literature.

The majority of the current literature assessing OSA utilizes change in AHI as the outcome measure. Clinical effectiveness of therapy is influenced by treatment adherence. Mean disease alleviation (MDA) was designed to determine the effectiveness of treatment as a function of both treatment efficacy and adherence. Our study compares outcomes in OSA patients treated with transoral robotic surgery (TORS) with lingual tonsillectomy and hypoglossal nerve stimulation (HGNS) using MDA. A retrospective study of CPAP-intolerant OSA patients that underwent HGNS or TORS from 2015 to 2022 was conducted. Comparisons of MDA and treatment efficacy were performed using a Wilcoxon sum rank tests after 3:1 matching for race, age, sex, body mass index, and baseline AHI. Statistical significance was defined as P < .05. One hundred fifty-nine patients (127 HGNS and 32 TORS) were included. Mean AHI decreased postoperatively in both TORS and HGNS patients (P < .001). There was no difference in AHI reduction between TORS and HGNS patients (22.95 ± 21.99 vs 23.27 ± 15.28; P = .50). This relationship persisted when examining MDA between TORS and HGNS patients (41.56 ± 58.24 vs 51.46 ± 29.05; P = .40). Mean disease alleviation is a useful metric combining both adherence and efficacy to determine the effectiveness of OSA treatments expanding beyond AHI. Our data suggests that the clinical effectiveness of TORS and HGNS is comparable, and both are promising treatment options for well-selected OSA patient's refractory to CPAP.

Utility of concurrent pharyngoplasty with adenotonsillectomy to treat pediatric obstructive sleep apnea.

Adenotonsillectomy (AT) to improve obstructive sleep disordered breathing (oSDB) is a common paediatric surgical procedure. Children living with obesity have both an increased risk of oSDB and a higher perioperative risk. We aimed to establish whether AT in children with severe obesity improves clinical symptoms, and whether this correlates with quantifiable sleep studies. A secondary outcome was preoperative change in BMI z-score amongst children attending a specialist anaesthetic clinic. A retrospective electronic notes review over a 2-year period identified children 2-16 years living with 'severe' obesity undergoing AT for oSDB. Demographic data, BMI and BMI z-score were collated preoperatively and at surgery. Pre- and postoperative quantifiable sleep study data and clinical episodes were examined. Postoperative AHI < 5/ODI4 < 4/h or clinical symptom resolution was considered 'curative'. A total of 1007 tonsillectomies were performed for oSDB; 55 met inclusion criteria and 30 underwent preoperative sleep studies. Age ranged from 3 to 15 years (mean 8.7, SD 3.3) with a 2:1 ratio of males to females. Nine children (34.6%) underwent both pre- and postoperative studies with ODI4/AHI ranges of 0.5-121.2/h and 0-9.3/h, respectively. Overall 'cure' rate was 42.3%, with postoperative sleep studies confirming clinical findings. Preoperative mean BMI z-score was +3.83 (SD 1.19) with significant reduction at the time of surgery (-0.17, SD 0.29; p = 0.004) following lifestyle intervention (mean 6.0 months; SD 11.7 weeks). Over half of severely obese children undergoing AT had residual postoperative oSDB symptoms. Sleep studies might identify those benefitting from further intervention. Findings support the effectiveness of preoperative lifestyle intervention, but the impact on symptoms and surgical timing should be further delineated.

Children with genetic syndromes, especially Down syndrome (DS), are considered high-risk candidates for adenotonsillectomy (AT) due to anatomical abnormalities and comorbidities. This study aimed to evaluate the safety of AT in patients with DS and other genetic syndromes (OS). This retrospective study included 62 syndromic patients (46 DS, 16 OS) under 18 years of age who underwent tonsillectomy ± adenoidectomy ± ventilation tube (VT) insertion between 2010 and 2025. Demographics, comorbidities, surgical details, complications, and hospital stays were reviewed. Indications included sleep-disordered breathing (51/62, 82.3%) and recurrent tonsillitis (16/62, 25.8%). Procedures performed were AT (51/62, 82.3%) or tonsillectomy alone (11/62, 17.7%) ± VT insertion (16/62, 25.8%). Median hospital stay was 1 day (IQR: 1-1), with 93.5% (58/62) discharged after 1 day. Two-day stays occurred in 18.75% of OS patients (3/16) and 2.2% of DS patients (1/46). Planned intensive care unit admission was required in 2 OS patients (3.2%). No emergency admissions or perioperative mortality occurred. Overall complication rate was 8.1% (5/62)-8.7% in DS and 6.3% in OS (P = 1.00)-including bleeding requiring reoperation (1/62, 1.6%), respiratory event (1/62, 1.6%), and insufficient oral intake (3/62, 4.8%). AT appears to be safe in children with genetic syndromes, with low rates of complications.

Residual obstructive sleep apnea (OSA) following adenotonsillectomy (AT) is common in children with obesity. Drug-induced sleep endoscopy (DISE) identifies upper airway obstruction and guides surgery. A gap remains in evaluating multiple DISE-directed treatments. This study evaluates multiple DISE-directed procedure outcomes, obstruction patterns, and BMI in pediatric patients. This single-institution retrospective cohort study included pediatric patients who underwent DISE-directed interventions from 2009 to 2020. Variables included patient characteristics, DISE timing, obstruction patterns, obstructive apnea-hypopnea index (OAHI), and OSA-18 quality-of-life (QOL). Chi-square tests compared patient demographics and comorbidities between single and multiple DISE groups. Unpaired t-tests compared age, OAHI, and OSA-18 scores between single and multiple DISE groups as well as multiple-DISE outcomes for high versus normal BMI groups. Of 122 children who underwent DISE, 27 (22%) had multiple DISE-directed procedures. Average age at first DISE for single and multiple DISE patients was 7.25 (SD = 3.93) and 4.99 (SD = 3.63) years, respectively (P < .01). Common obstructions at second DISE involved the epiglottis (N = 20, 74%), adenoid (N = 18, 67%), and inferior turbinates (N = 15, 56%). Multilevel obstruction was identified in 96% (N = 26) of second and 80% (N = 4) of third DISEs. Children with high BMI (versus normal BMI) exhibited shorter intervals between DISEs. Patients who underwent single DISE exhibited significant OAHI improvement (mean 8.48 vs 3.91, P < .05), but this was not significant for multiple DISEs. The OSA-18 score improved significantly in patients with single DISE (mean summed score 61.3 vs 44.6, P < .05). Pediatric OSA involves persistent, multilevel obstruction, especially in younger patients with elevated BMI undergoing multiple DISE-directed procedures. These findings support anatomy-guided, patient-specific surgical planning for high-risk groups. While a single DISE-directed intervention can significantly improve OAHI and QOL, repeated procedures may yield diminishing returns, underscoring the need to consider their timing and utility. Early multidisciplinary evaluation and long-term follow-up are essential for managing persistent OSA.

Abstract Background and Aims Considering a paucity of relevant data, the study aimed to evaluate an efficacy of treatment with immunosuppression (IST) combined with tonsillectomy (TE) in Caucasian patients with high-risk primary IgA-nephropathy (IgAN). Methods The study enrolled cases of primary IgAN (n = 221, age 34 ± 11 years, 52% male) with eGFR &amp;gt;20 ml/min/1.73 m2 and at high risk of progression. The latter defined as (i) proteinuria &amp;gt;1 g/day or (ii) the probability of starting dialysis within 5 years &amp;gt;11% with at least one of the following morphological lesions: mesangial proliferation, endocapillary hypercellularity, and cellular crescents. All patients received immunosuppressive therapy (steroid monotherapy −73%, steroids with cyclophosphamide, mycophenolic acid, cyclosporine, or azathioprine −27%). The prospectively followed experimental group received IST combined with TE (IST + TE, n = 85), no earlier than 12 months before and no later than 12 months after the start of IST. In most patients, TE was performed before the start of IST (n = 52; 61.1%), and the median time between the IST start and TE was −0.9 (−3.7; 1.5) months. The historic control group comprised subjects undergone only immunosuppressive therapy without TE (IST, n = 136). The follow-up period was 32 (14; 67) months. Outcomes were overall (complete or partial) remission (OR), and progression as a composite of ESKD or eGFR decrease of &amp;gt;40% from baseline. Kaplan–Meyer curves and Cox regression models combined with pseudo-randomisation methods (1:1 propensity score matching (PSM) of comparison groups and inverse probability of treatment weighting) were applied to compare the efficacy of IST + TE with only IST. Results In 1:1 PSM groups, the cumulative proportions of cases with OR and composite outcome and times to event had significant differences in favour of the IST+TE group (Fig. 1A and B). In Cox regression models, the combination therapy was associated with a significantly increased probability of remissions and the decrease in the probability of composite end-point of the IgA-nephropathy progression by 80–87% (Fig. 2). Conclusion Caucasian patients with high-risk IgAN can benefit from the immunosuppression combined with tonsillectomy to induce disease remission and delay progression.

Tonsil-related procedures are considered fundamental and effective in the surgical treatment of obstructive sleep apnea (OSA). The range of techniques includes intratonsillar approaches, such as tonsillotomy (TT), as well as extracapsular procedures, such as tonsillectomy (TE) and uvulopalatopharyngoplasty (UPPP). Patients undergoing these procedures span all age groups, from children to seniors. This multicentric retrospective study, conducted between 2014 and 2018, analysed data from 3,498 patients who underwent bilateral TT, TE, or UPPP for OSA or ronchopathy. The cohort included 2,221 men (63.49%) and 1,277 women (36.51%). Of these, 2,808 patients (80.27%) underwent TT, 226 (6.46%) underwent TE, and 464 (13.26%) underwent UPPP. Late postoperative haemorrhage (LPOH) occurrence was significantly associated with the type of surgery (p < 0.0001) and the hospital where the procedure was performed (p < 0.0001). The incidence of LPOH in the TT group ranged from 0% to 5.88% across hospitals (p = 0.0068); whereas in the TE and UPPP groups, rates ranged from 0% to 33.33% (p = 0.0413 and p = 0.0409, respectively). The occurrence of repetitive bleeding was not influenced by treatment choice (readmission vs. outpatient care, observation vs. surgical revision, general vs. local anaesthesia). The severity of bleeding in all three groups was not affected by age and gender. The use of anticoagulants negatively impacted LPOH severity (p = 0.0166) in the UPPP group. No deaths occurred in our sample; however, three cases of severe postoperative bleeding (grade "D") were observed. Late postoperative haemorrhage remains a serious complication of tonsil-related surgery with the potential for life-threatening outcomes. The marked variability in bleeding incidence between surgical techniques and departments highlights the need for standardised perioperative protocols. Although no fatalities occurred, the occurrence of severe cases underlines the importance of vigilant postoperative monitoring. In our OSA cohort, tonsillotomy showed favourable safety, and recent evidence suggests it may represent a valuable alternative also in recurrent tonsillitis, warranting further research.

Adenotonsillectomy (ATE) is the standard procedure to treat children with obstructive sleep apnea (OSA). To investigate whether ATE is more effective than WW for treating otherwise healthy children with mild to moderate OSA. This randomized clinical trial (RCT) of young children investigated the benefit of ATE compared with watchful waiting (WW) after 3 years. The Karolinska Adenotonsillectomy (KATE) RCT was conducted between 2014 and 2020 with a 3-year follow-up and included children aged between 2 to 4 years with an Obstructive Apnea-Hypopnea Index (OAHI) score of 2 or greater and less than 10 at the otorhinolaryngology department of the Karolinska University Hospital in Stockholm, Sweden. All children were randomized to ATE (n = 29) or WW (n = 31). ATE in children with OSA. Data were collected and analyzed in 2023. Results from polysomnography (PSG) and OSA-18 questionnaire were compared between the groups with the difference between changes in OAHI as the primary outcome. Children in the WW group underwent surgical treatment (crossovers) if remaining signs of OSA; OAHI score greater than 1 and/or severe symptoms, and were offered follow-ups but excluded from the per protocol analysis. A total of 48 of 60 children (80%) (ATE n = 23, WW n = 16, crossovers n = 9) completed the study. Thirty-nine of 60 children (65%) were analyzed per protocol, 23 (59%) from the ATE group, 16 (41%) from the WW group. No group difference was seen in changes of OAHI (Cohen d, 0.05; 95% CI, -0.7 to 0.6), but a difference of medium effect size (Cohen d, 0.54; 95% CI, -1.3 to 0.1) when comparing changes in total OSA-18 score, in favor of ATE. Thirteen of 31 children (42%) in the WW group crossed over to surgery, follow-up PSG in 9 showed normalized OAHI after ATE. The crossover group had at baseline more of moderate OSA (Cohen d, 0.8; 95% CI, -1.5 to -0.5), higher total OSA-18 score (Cohen d, 0.8; 95% CI, -1.5 to 0.0), and larger tonsils (Cohen d, 1.3; 95% CI, -2.1 to -0.5) compared with nonoperated. This small long-term RCT suggests that ATE was not more effective than WW. However, almost half of the children in the WW group had remaining signs of OSA and underwent surgery. Altogether, the results indicate that children with mild signs of OSA and small tonsils could be recommended WW. ClinicalTrials.gov Identifier: NCT02315911.

Pain management after pediatric adenotonsillectomy: Do opioids influence healthcare utilization?

ObjectiveThis study aims to evaluate the effects of dentofacial orthopedic treatment (DOT) and adenotonsillectomy (AT) in Obstructive Sleep Apnea (OSA) children with skeletal Class II malocclusion and adenotonsillar hypertrophy (ATH), focusing on changes in sleep respiratory function, anatomic and aerodynamic characteristics of upper airway (UA).MethodsIn this retrospective study, 38 OSA children (mean age: 8.42 years, 15 females and 23 males) were included consecutively. Patients were categorized into two groups: DOT group (n = 20) and AT group (n = 18). Baseline (T0) and follow-up (T1) assessments involved polysomnography and radiological examinations to evaluate improvements in sleep quality as well as changes in craniofacial morphology and UA variables. Aerodynamic parameters such as airflow velocity, airway resistance, and wall shear stress were quantified using computational fluid dynamics.ResultsIn the comparative analysis of sleep respiratory functions, there were no significant differences in apnea-hypopnea index changes between the treatment groups (DOT group: -3.72/h, AT group: -3.32/h, P = 0.600). In the DOT group, UA’s volume average enlargements were observed in the nasopharynx, palatopharynx, glossopharynx, and hypopharynx by 54.5%, 41.6%, 34.0%, and 22.5%, respectively. In comparison, the AT group showed enlargements of 66.0%, 20.1%, 62.9%, and − 1.0%, respectively. In terms of UA aerodynamic characteristics, there were no significant differences between two groups.ConclusionsIn OSA children with skeletal Class II malocclusion and ATH, DOT as a non-invasive approach, has shown improvements in respiratory function comparable to AT, as evidenced by changes in the UA’s anatomical and aerodynamic characteristics.

Introduction: Residual obstructive sleep apnea (OSA) is defined as persistence of the AHI at ≥1 respiratory event per hour of sleep after otorhinolaryngology intervention in pediatric population. In terms of OSA phenotypes in children, we recognize the common, adult, and congenital phenotypes. Material and Methods: We studied 34 pediatric patients with OSA diagnosed by standard overnight polysomnography (PSG). Based on the results, all 34 patients were indicated for adenotonsillectomy (ATE). After 3 months, patients were invited to the sleep laboratory for second control PSG. These OSA patients were divided according to clinical phenotype into two groups: common phenotype and adult phenotype. Results: Residual OSA was diagnosed in 24 patients with a mean AHI 6.67 ± 9.17 after ATE procedure. Incidence of severe residual OSA was 17.6%; moderate residual OSA was 20.6%; mild residual OSA was 32.4%. Residual OSA in classic phenotype was present in eight patients (57.1%). In total, 16 patients with the adult phenotype of OSA (80.0%) were diagnosed with residual OSA. Prevalence was significantly higher in children with the adult phenotype (p < 0.001). Conclusions: We concluded that there is a higher risk of residual OSA in children with the adult phenotype. Phenotyping of children with OSA appears to be an important tool for further management and also in predicting the severity of residual OSA.

To investigate whether adenotonsillectomy (AT) surgery improves swallowing functions and has a positive effect on weight gain and development in paediatric patients. Between January and August 2023, the Pediatric Eating Assessment Tool-10 (PEDI-EAT-10) was administered preoperatively, at the first postoperative month, and at the sixth postoperative month to pediatric patients aged 2-14 years who presented to our clinic for adenotonsillectomy (AT). Additionally, patient' age, sex, physical examination findings, and height and weight percentiles were recorded. The same measurements were performed on children aged 2-14 years who presented to our clinic for otoplasty. Statistical analysis of the study data was conducted using SPSS 26.0. In our study, the preoperative PEDI-EAT-10 scores of the AT group were significantly higher than those of the control group (p < 0.001). During the 6 month follow up, changes in height and weight percentiles and PEDI-EAT-10 scores were found to be statistically significantly different between the case and control groups (p < 0.001). There was a statistically significant correlation between improvements in PEDI-EAT-10 scores over six months and concurrent increases in both height and weight percentiles (p < 0.001, p < 0.001). Furthermore, in the case group, no correlation was found between tonsil grade and the 6-month change in PEDI-EAT-10 scores (p = 0.313). Our study demonstrates that children undergoing AT due to various indications experience an improvement in dysphagia scores and a significant increase in height and weight percentiles postoperatively. Dysphagia may be a contributing factor influencing the growth and development of children who are candidates for AT.

Diagnostic test properties for PET-CT in the setting of carcinoma of unknown primary (CUP) of the head and neck have been previously reported in the setting of limited pathologic correlation resulting in biased reporting. With the advent of transoral robotic techniques such as lingual tonsillectomy, the ability to identify small volume primaries has improved. This study aims to investigate the diagnostic test properties of PET-CT for carcinomas of unknown primary (CUP) of the head and neck. A correlative analysis from our previously published prospective FIND trial between 08/2017 and 12/2019 was performed. Patients with p16 positive cervical nodes and no primary (CUP) on clinical examination or axial imaging were included. PET-CT images were prospectively reported prior to diagnostic surgery. Diagnostic test properties, based on pathologic correlation, were calculated. A total of 22 patients were included (N1: 10 [45.5%]; N2: 10 [45.5%]; N3: 2 [9%]). Nineteen (86.3%) patients were male, with a mean age of 59.1 years (range 47-68). Seventeen patients (77.2%) had a confirmation of an oropharyngeal primary after diagnostic transoral surgery: 5 (22.6%) in the ipsilateral palatine tonsil, 9 (41%) in the ipsilateral base of tongue, 2 (9%) with bilateral palatine tonsils, and 1 (4.5%) with ipsilateral palatine tonsil and contralateral base of tongue primary. Focal FDG uptake was reported in 13 patients (59%): 3 (13.6%) were reported positive, 8 (36.4%) were suspicious, and 2 (9%) were asymmetric uptake. Of the PET-CT positive, suspicious lesions, and asymmetric, 3 (100%), 0 (%), 6 (75%) were true positive, respectively. When all FDG uptake (positive, suspicious, and asymmetric) was classified as positive, the sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), and false negative rate (FNR) were 53%, 20%, 11%, 69%, and 47%, respectively. PET-CT has an important role in the diagnostic evaluation of carcinoma of unknown primary diagnosis. However, sensitivity and specificity rates may be lower than previously suggested. Treatment planning should be based on pathologic confirmation where possible and not solely on PET-CT findings.