Influence of Tonsillar Size on OSA Improvement in Children Undergoing Adenotonsillectomy

Objective. To determine if pediatric obstructive sleep apnea (OSA) improves after adenotonsillectomy (AT) regardless of tonsil size. Study Design. Case series with chart review. Setting. Pediatric Otolaryngology Department, Johns Hopkins Hospital. Subjects. Seventy children 1 to 18 years of age who underwent polysomnography (PSG) before and after AT. Methods. Tonsil size was evaluated using the Brodsky grading scale. Results. Children were stratified by tonsil size as 2+ (n = 20), 3+ (n = 36), and 4+ (n = 14). There was a significant improvement in obstructive apnea-hypopnea index (oAHI), apnea index (AI), and saturation nadir across all 3 groups after AT. Preoperative oAHI, AI, and hypopnea index (HI) were similar regardless of tonsil size (P >.05). Overall, oAHI improved from a median of 11.8 6 21.7 to 2.0 6 6.1 events/h, with 40% (28/70) of children having complete resolution. The oAHI (P <.0001-0.02), AI (P <.0001-0.017), HI (P <.0001-0.058), and saturation nadir (P < .0001-0.017) significantly improved for the 2+, 3+, and 4+ groups. Only the HI (P = .058) in the 2+ group did not. The median oAHI improvement was 3.4 6 26.4 events/h in the 2+ group, 8.3 6 16.6 events/h in the 3+ group, and 12.3 6 19.5 events/h in the 4+ group, with 25% (5/20), 50% (18/36), and 36% (5/14), respectively, having complete resolution. There was no correlation between OSA severity and tonsil or adenoid size (P >.32). Conclusion. Tonsil size did not correlate with OSA severity. While a larger proportion of patients classified as 3+ and 4+ had complete resolution after surgery, significant improvement was seen in AI and saturation nadir even in those classified as 2+.