Adenotonsillectomy in Children with Persistent OSA
67 Questions
1 Views

Choose a study mode

Play Quiz
Study Flashcards
Spaced Repetition
Chat to lesson

Podcast

Play an AI-generated podcast conversation about this lesson

Questions and Answers

What is a crucial factor in deciding treatment options for children with OSA?

  • Shoe size
  • Severity of nighttime sleep problems and daytime dysfunction (correct)
  • Hair length
  • Eye color

    • When might adenotonsillectomy be considered as a treatment option for children with OSA?

  • Only for children with obesity as the primary cause
  • After all other treatments have been tried and failed
  • If the child refuses all other treatment options
  • If the child has enlarged tonsils (correct)

    • What is a potential consideration when deciding on adenotonsillectomy for children with OSA and underlying medical conditions?

  • Color of the child's hair
  • Number of teeth the child has
  • Weight of the child's backpack
  • Presence of neuromuscular disorders (correct)

    • What does a preoperative polysomnogram provide for children undergoing adenotonsillectomy?

    <p>Baseline data in case OSA persists or recurs after surgery</p> Signup and view all the answers

    Why might adenotonsillectomy be the first choice for children with OSA and enlarged tonsils?

    <p>To address potential airway obstruction</p> Signup and view all the answers

    What is a risk factor for persistent OSA and/or respiratory complications following adenotonsillectomy in children younger than 3 years?

    <p>Down syndrome</p> Signup and view all the answers

    Children with obesity (BMI ≥95th percentile) undergoing adenotonsillectomy are at increased risk for:

    <p>Requiring adjuvant procedures due to multiple sites of obstruction</p> Signup and view all the answers

    What condition requires evaluation for hypothyroidism prior to adenotonsillectomy in children?

    <p>Down syndrome</p> Signup and view all the answers

    What is a common feature of adenoid and tonsil size in children with sickle cell disease?

    <p>Larger than normal volunteers</p> Signup and view all the answers

    What is a characteristic of craniofacial anomalies that affects the outcomes of adenotonsillectomy?

    <p>Presence of multiple sites of airway obstruction</p> Signup and view all the answers

    Which group of children may also have significant hypoventilation in addition to obstructive symptoms post-adenotonsillectomy?

    <p>Children with neuromuscular disorders</p> Signup and view all the answers

    What is a common indication for adenotonsillectomy in children with obstructive sleep apnea?

    <p>AHI greater than 10</p> Signup and view all the answers

    In children with non-severe OSA (AHI 2-10), what are the two management options mentioned?

    <p>Adenotonsillectomy or watchful waiting</p> Signup and view all the answers

    What factor influences the decision between adenotonsillectomy and watchful waiting in children with non-severe OSA?

    <p>Symptom severity and patient preference</p> Signup and view all the answers

    In which group of children may the results of adenotonsillectomy be less dramatic compared to lean children?

    <p>Obese children</p> Signup and view all the answers

    What improvement is typically observed in children with OSA and enlarged tonsils after adenotonsillectomy?

    <p>Improved daytime sleepiness</p> Signup and view all the answers

    Which aspect has not shown a clear benefit following adenotonsillectomy in children aged 2-9 with mild to moderate OSA?

    <p>Improved executive skills</p> Signup and view all the answers

    What is a potential concern when considering supplemental oxygen therapy for children with OSA?

    <p>Risk of alveolar hypoventilation</p> Signup and view all the answers

    What is a primary reason for using nasal CPAP or BiPAP in children with predisposing factors for OSA?

    <p>Aiding breathing in cases where adenotonsillectomy is ineffective</p> Signup and view all the answers

    What is a significant outcome reported by studies on rapid maxillary expansion in children with narrow jaws and adenotonsillar hypertrophy?

    <p>Reduction in AHI, especially in children with small tonsils</p> Signup and view all the answers

    Why is weight loss emphasized in obese children with OSA?

    <p>To reduce the risk of additional obesity-related comorbidities</p> Signup and view all the answers

    In what scenario might rapid maxillary expansion be considered as an alternative to adenotonsillectomy in children with narrow jaws?

    <p>When the child has not responded to orthodontic treatment alone</p> Signup and view all the answers

    What is the primary cause of hyponatremia after tonsillectomy?

    <p>Inappropriate administration of hypertonic solutions</p> Signup and view all the answers

    What is the most common severe complication of tonsillectomy?

    <p>Postoperative hemorrhage</p> Signup and view all the answers

    When does primary bleeding typically occur after tonsillectomy?

    <p>Within the first 24 hours</p> Signup and view all the answers

    Which technique for tonsillectomy is associated with higher rates of secondary postoperative bleeding?

    <p>Coblation</p> Signup and view all the answers

    What is the recommended management for children with sickle cell disease undergoing adenotonsillectomy?

    <p>Preoperative transfusions to decrease hemoglobin level</p> Signup and view all the answers

    Why are preoperative coagulation studies not routinely performed before adenotonsillectomy?

    <p>Limited predictive value</p> Signup and view all the answers

    What is the significance of a clot in the tonsillar fossa post-tonsillectomy?

    <p>Confirms complete hemostasis</p> Signup and view all the answers

    How should children with significant postoperative bleeding after adenotonsillectomy be managed?

    <p>Admitted and observed</p> Signup and view all the answers

    What can repeated postoperative bleeding after adenotonsillectomy indicate?

    <p>Injury to a large vessel with pseudoaneurysm formation</p> Signup and view all the answers

    Why do children with type 1 von Willebrand disease undergo preoperative administration of desmopressin acetate before adenotonsillectomy?

    <p>To prevent hemorrhage</p> Signup and view all the answers

    What is the purpose of drug-induced sleep endoscopy?

    <p>To determine the site of obstruction during natural sleep</p> Signup and view all the answers

    Which technique allows assessment of airway collapsibility during sleep?

    <p>Drug-induced sleep endoscopy</p> Signup and view all the answers

    What is a key difference between flexible fiberoptic laryngoscopy and drug-induced sleep endoscopy?

    <p>The site of obstruction determination</p> Signup and view all the answers

    Why is PSG considered mandatory for children with comorbidities?

    <p>To document the severity of SDB</p> Signup and view all the answers

    What is the primary focus of office physical examination using flexible fiberoptic laryngoscopy?

    <p>Identifying the site of obstruction during sleep</p> Signup and view all the answers

    What is a common method used to assess surgical outcomes after DISE-directed surgery in children with OSA?

    <p>Cine MRI</p> Signup and view all the answers

    Why is surgery in children often staged rather than addressing multiple sites at once?

    <p>Due to a higher risk of oropharyngeal scarring and stenosis</p> Signup and view all the answers

    Which condition can typically be diagnosed by DISE and was treated with carbondioxide laser supraglottoplasty in children with residual OSA post adenotonsillectomy?

    <p>Laryngomalacia</p> Signup and view all the answers

    What technique was performed for the treatment of laryngomalacia in children with OSA, resulting in a decrease in AHI for 92% of patients?

    <p>Carbondioxide laser supraglottoplasty</p> Signup and view all the answers

    What is a common cause of persistent obstruction post-adenotonsillectomy, leading to residual OSA in children?

    <p>Occult laryngomalacia</p> Signup and view all the answers

    Describe the earliest description of pediatric OSA mentioned in the text.

    <p>Obese, red-faced, hypersomnolent boy named Joe in an 1837 novel by Charles Dickens, The Posthumous Papers of the Pickwick Club.</p> Signup and view all the answers

    Who accurately described pediatric OSA in 1892?

    <p>William Osler</p> Signup and view all the answers

    What term did Osler coin to describe morbidly obese, hypersomnolent patients?

    <p>pickwickian</p> Signup and view all the answers

    Who were the first to describe the clinical features of pediatric OSA in 1976?

    <p>Guilleminault and colleagues</p> Signup and view all the answers

    In what year did Spector and Bautista associate pediatric respiratory distress with tonsillitis and adenoiditis?

    <p>1956</p> Signup and view all the answers

    What are the potential morbidities associated with childhood obstructive sleep apnea?

    <p>Neurocognitive abnormalities</p> Signup and view all the answers

    What is the condition characterized by elevated upper airway resistance without classic apnea or hypopnea?

    <p>Upper airway resistance syndrome (UARS)</p> Signup and view all the answers

    What is the primary etiology of pediatric obstructive sleep apnea?

    <p>Fixed and/or dynamic narrowing of the airway</p> Signup and view all the answers

    What are the proposed mechanisms underlying the neurocognitive and behavioral deficits in pediatric sleep-disordered breathing?

    <p>Sleep disruption, hypoxia, hypercapnia, brain inflammation, and hormonal changes</p> Signup and view all the answers

    What consequences can pediatric sleep-disordered breathing lead to, beyond neurocognitive deficits?

    <p>Cardiac dysfunction, blood pressure dysregulation, growth impairment</p> Signup and view all the answers

    What are some potential effects of hypoxemia and sleep fragmentation on children with sleep-disordered breathing?

    <p>Altered brain neurochemistry, growth hormone secretion</p> Signup and view all the answers

    What is the peak incidence age range for pediatric obstructive sleep apnea (OSA)?

    <p>2-6 years</p> Signup and view all the answers

    What genetic factor is more common in nonobese children with OSA, especially those with neurocognitive dysfunction?

    <p>Apolipoprotein E ε-4 allele</p> Signup and view all the answers

    Which gender is affected at higher rates by pediatric OSA, with a 50-100% higher prevalence?

    <p>Boys</p> Signup and view all the answers

    What is the estimated prevalence range of sleep-disordered breathing (SDB) in children based on parental reports and diagnostic testing?

    <p>0.1% to 13.0%</p> Signup and view all the answers

    What do the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) guidelines recommend regarding PSG prior to tonsillectomy?

    <p>PSG is recommended only for selected children with specific premorbid conditions or when there is uncertainty in the need for surgery.</p> Signup and view all the answers

    What are the indications for PSG after adenotonsillectomy in children?

    <p>PSG is indicated for symptomatic children post-surgery and as a prerequisite for nasal CPAP or BiPAP in high-risk children or surgical failures.</p> Signup and view all the answers

    What is known about the natural history of untreated sleep-disordered breathing in children?

    <p>Little is known due to most children with OSA and significant SDB undergoing treatment, limiting studies on long-term effects or resolution.</p> Signup and view all the answers

    What percentage of children in the watchful waiting group normalized their sleep studies in the Childhood Adenotonsillectomy Trial (CHAT)?

    <p>46% of the watchful waiting group normalized their sleep studies.</p> Signup and view all the answers

    What are the primary differences in PSG recommendations between the American Thoracic Society Consensus Committee and the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS)?

    <p>While the American Thoracic Society recommends PSG prior to adenotonsillectomy for snoring children, the AAO-HNS guidelines suggest PSG only for specific cases with premorbid conditions or uncertain need for surgery.</p> Signup and view all the answers

    In the context of adenotonsillectomy, why might PSG be necessary for some children post-surgery?

    <p>PSG may be needed post-surgery for symptomatic children or as a prerequisite for treatment with nasal CPAP or BiPAP in high-risk cases or surgical failures.</p> Signup and view all the answers

    What is the significance of the Childhood Adenotonsillectomy Trial (CHAT) in understanding pediatric OSA treatment?

    <p>It is the only randomized, controlled clinical trial comparing adenotonsillectomy to watchful waiting for pediatric OSA.</p> Signup and view all the answers

    What do the 1996 American Thoracic Society Consensus Committee and the 2012 American Academy of Pediatrics Clinical Practice Guidelines recommend regarding PSG before adenotonsillectomy?

    <p>They recommend obtaining PSG to differentiate primary snoring from OSA.</p> Signup and view all the answers

    Why is there limited knowledge about the natural history of untreated sleep-disordered breathing in children?

    <p>Most children diagnosed with OSA or significant SDB undergo treatment, leaving few untreated cases for long-term study.</p> Signup and view all the answers

    What did the Childhood Adenotonsillectomy Trial (CHAT) find regarding the normalization of sleep studies in the watchful waiting group?

    <p>46% of the watchful waiting group showed normalization in their sleep studies.</p> Signup and view all the answers

    Use Quizgecko on...
    Browser
    Open
    Browser
    Browser