Improved objective outcomes and quality of life after adenotonsillectomy with inferior turbinate reduction in pediatric obstructive sleep apnea with inferior turbinate hypertrophy

摘要

Objectives/Hypothesis: Whether adenotonsillectomy (AT) is sufficient for pediatric obstructive sleep apnea syndrome (OSAS) with persistent severe allergic rhinitis (PSAR) remains unclear. This study attempts to identify the role of inferior turbinate reduction in treating pediatric OSAS with PSAR. Study Design: Case series with planned data collection. Methods: Fifty-one subjects aged 3 to 12 years with OSAS and PSAR were enrolled. Among them, 23 patients underwent AT concurrent with microdebrider-assisted inferior turbinoplasty (MAIT) (group AT-MAIT) and 28 patients underwent AT alone (group AT). Before surgery and at 1 year after surgery, objective outcomes were assessed using overnight polysomnography and acoustic rhinometry. Subjective outcomes were evaluated using the Obstructive Sleep Apnea (OSA)-18 quality-of-life questionnaire (OSA-18). Results: Following surgery, the median apnea-hypopnea index, minimal oxygen saturation, and snoring index were 0.8 (/h), 94 (%), and 104 (/h) in group AT-MAIT, respectively, compared with 3.5 (/h), 93 (%), and 158 (/h) in group AT, respectively (P .05). In group AT-MAIT, the median postoperative minimal cross-sectional area recorded by acoustic rhinometry was 0.31 cm2, significantly larger than 0.16 cm2 in group AT (P .01). Compared with postoperative scores in group AT, those in group AT-MAIT were significantly improved in domains of physical symptoms, emotional symptoms, daytime function, caregiver concerns, and overall OSA-18 scores (P .05). Conclusions: Analytical results suggest that AT with concurrent MAIT achieves favorable subjective and objective outcomes in pediatric OSAS with PSAR. We believe that volume reduction of the inferior turbinate plays an important role in treating pediatric OSAS with inferior turbinate hypertrophy.