How effective is adenoidectomy alone for treatment of obstructive sleep apnoea in a child who presents with adenoid hypertrophy?

摘要

A girl aged 20 months presents with parental concern about loud snoring and increased work of breathing when sleeping. On examination, she has adenoid facies (a long, narrow face with mouth open and small Grade 1/4 tonsils (using the Brodsky Grading System).A lateral neck X-ray shows enlarged adenoids obstructing the nasal airway. The child has a history of two ear infections, both of which occurred in the 12 months prior to presentation, and both are resolved after a single course of oral antibiotics. There is no family or personal history of atopy, and skin prick testing was negative for common allergens. Nasal steroid spray had been previously prescribed, but after her parents found this, which led to little improvement, they stopped the treatment. An overnight sleep study showed mild obstructive sleep apnoea (OSA) with an index of obstructive/ mixed respiratory events of 9.2 events/h, a minimum oxygen saturation of 87% and no carbon dioxide retention. Our ear, nose and throat (ENT) surgeon reviewed the 20-month girl and suggested that the most appropriate surgery would be adenoidectomy without tonsillectomy.