Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apn
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LARYNGOLOGY
Postoperative morbidity after adenotonsillectomy versus adenopharyngoplasty in young children with obstructive sleep apnea: an RCT Johan Fehrm1,2 · Anna Borgström2 · Pia Nerfeldt1,2 · Danielle Friberg2,3 Received: 4 March 2020 / Accepted: 5 May 2020 © The Author(s) 2020
Abstract Purpose In our previous randomized controlled trial (RCT), comparing adenotonsillectomy (ATE) with adenopharyngoplasty (APP) in children with severe obstructive sleep apnea (OSA), there were no differences in respiratory sleep parameters or quality of life. The purpose of the present report was to evaluate postoperative morbidity from this RCT. Methods The study was a blinded RCT in 83 children (ATE = 47; APP = 36), 2–4 years of age, with an obstructive apnea– hypopnea index of ≥ 10. Pain was assessed from the first until the tenth day after surgery with a logbook that reported pain by child (FPS-R, Faces Pain Scale-Revised) and caregiver (visual analogue scale), analgesic use, return to normal diet, and weight change. Bleeding, infection, satisfaction with treatment, speech, and swallowing were assessed with a questionnaire and medical records 6 months after surgery. Results Sixty-four children (77%) returned the logbook and 65 (78%) answered the questionnaire. The median (interquartile range) day the children graded themselves as pain free (FPS-R = 0) was 7 (6–10) after ATE, compared with 9 (7 to > 10) after APP (p = 0.018). There were no other significant differences between the groups regarding any other pain-related outcomes, bleeding, infection, satisfaction, swallowing, or speech, but three children (11%) reported impaired speech after APP compared to none after ATE (p = 0.067). Conclusion The results regarding postoperative morbidity were in favor of ATE and the results from our previous report showed no advantages of APP. Therefore, APP should not be recommended in young, otherwise healthy children with OSA. Keywords Obstructive sleep apnea · Adenotonsillectomy · Adenopharyngoplasty · Pharyngoplasty · Tonsillar pillar closure · Tonsillectomy
Introduction Adenotonsillectomy (ATE) is a common procedure and the primary treatment for children with obstructive sleep apnea (OSA) [1, 2]. Previous studies have shown ATE to be an effective treatment to improve quality of life, respiratory * Johan Fehrm [email protected] 1
Department of Otorhinolaryngology, Karolinska University Hospital, Stockholm, Sweden
2
Department of Clinical Science, Intervention and Technology, CLINTEC, Karolinska Institutet, Stockholm, Sweden
3
Division of Otorhinolaryngology, Department of Surgical Science, Uppsala University, Uppsala, Sweden
sleep parameters, and behavior [3]. Even so, persistent OSA has been reported to be 13–75% after ATE [4–8], and alternative surgical treatment methods have been proposed to improve the results. For instance, studies have indicated that ATE with closure of the tonsillar pillars, referred to as adenopharyngoplasty (APP), has been more effective for improving the obstructive apnea–hypopnea in
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