The Effect of Adenotonsillectomy on Children's Quality of life

Document Type: Original

Authors

1 Department of otorhinolaryngology, Mashhad branch ,Islamic Azad University, Mashhad, Iran.

2 Department of Pediatrics, Mashhad Branch, Islamic Azad University, Mashhad, Iran.

3 General Practitioner, faculty of medicine, Mashhad branch, Islamic Azad University, Mashhad, Iran.

4 Medical Student, faculty of medicine, Mashhad branch, Islamic Azad University, Mashhad, Iran.

Abstract

Introduction:
Adenoid hypertrophy is the most common cause of chronic airway obstruction in children. The aim of this study was to evaluate the effect of adenotonsillectomy on sleep and behavioral disorders in children with adenotonsillar hypertrophy.
 
Materials and Methods:
In a prospective observational study, all children with an indication of adenotonsillectomy based on American Academy of Otolaryngology – Head and Neck Surgery criteria and sleep disorders referred to our otolaryngology clinic were enrolled and examined. Rutter Children’s Behavior (RCBQ) and Child Sleep Habit Questionnaires (CSHQ) were completed by the children’s parents both before and 3 months after the operation.
 
Results:
A total of 44 children (25 boys and 19 girls) with a mean (standard deviation [SD]) age of 7.86± 2.26 years and mean (SD) body mass index (BMI) of 16.37±1.35 kg/m2 were studied. Mean scores of RCBQ and CSHQ decreased significantly 3 months after adenotonsillectomy, and sleep habits and behavior improved significantly (P<0.05). Although there was no significant relationship between improvement of behavior and the gender, age or BMI of the children, there was a significant relationship between improvement of sleep habits and age as well as BMI (P<0.05).
 
Conclusion: 
As adenotonsillectomy causes significant improvements in children`s quality of life (including sleep and behavior), it is recommended in children with adenotonsillar hypertrophy.

Keywords

Main Subjects


1. Basha S, Bialowas C, Ende K. Adenotonsilar hypertrophy. In: Cummings CW, Flint PW, Harker LA, et al, eds. Otolaryngology head and neck surgery. 4th ed. Sanfrancisco: Mosby; 2005: 4146-9.

2. Seden A, Tami T. Fundamentals of the ear, nose and throat. 12th ed. Philadelphia: Lippincott &Wilkins; 2002: 457-66.

3. Probst R, Grevers G, Iro H. Basic otorhinolaryngology: a step by step learning guide 2nd ed. Stuttgart : Thieme: 2006: 108.

4. Kliegman RM, Behrman RE, Jenson HB, Stanton BF. Nelson textbook of pediatrics. 18th ed. Philadelphia, Saunders; 2007: 95.

5. Paparella MM. Otolaryngology. 3rd ed. Philadelphia: Saunders; 1991: 2129 – 45.

6. Amin RS, Carroll JL, Jeffries JL, Grone C, Bean JA, Chini B, et al. Twenty-four hour ambulatory blood pressure in children with sleep-disordered breathing. Am J Respir Crit Care Med 2004; 169(8): 950-6.

7. Amin RS, Kimball TR, Bean JA, Jeffries JL, Willging JP, Cotton RT et al. Left ventricular hypertrophy and abnormal ventricular geometry in children and adolescents with obstructive sleep apnea. Am J Respir Crit Care Med. 2002; 165 (10): 1395-9.

8. Chervin RD, Dillon JE, Bassetti C, Ganoczy DA, Pituch KJ. Symptoms of sleep disorders, inattention, and hyperactivity in children. Sleep 1997; 20(12): 1185-92.

9. Gozal D. Sleep-disordered breathing and school performance in children. Pediatrics 1998;102(3): 616-20.

10. Nieminen P, Lopponen T, Tolonen U, Lanning P, Knip M, Lopponen H. Growth and biomedical markers of growth in children with snoring and obstructive sleep apnea. Pediatrics 2002; 109(4):1-6.

11. Baugh RF1, Archer SM, Mitchell RB, Rosenfeld RM, Amin R, Burns JJ, et al. Clinical Practice Guideline: Tonsillectomy in Children. Otolaryngol Head Neck Surg. 2011; 144: S1-30.

12. Rutter M. A Children’s Behavior Questionnaire for compilation by teachers: preliminary Findings. J Child Psychol Psychiatr 1967; 8(1): 1-11.

13. Owens JA, Spirito A, McGuinn M. The Children’s Sleep Habits Questionnaire (CSHQ): Psychometric Properties of A Survey Instrument for School-Aged Children. Sleep 2000; 23(8): 1-9.

14. Rutter M, Tizard J, Whitmore K. Education, Health and Behaviour. London: Longmans; 1970.

15. Ziaeddini SH, Mirkafi A, Nakhaee N. Prevalence of behavior disorder among primary school student of Kerman, educational year 2003-2004. Medical Journal of Hormozgan 2007; 11(2): 221-8. (Persian)

16. Khodam H, Modanlou M, Ziaee T, Keshtkar AA. Behavioral disorders and related factors in school age children of Gorgan. Journal of Research in Nursing 2009; 4(14): 29-37. (Persian)

17. Amiri Majd M. [Relation between behavioral aspects of children with mild mental retardation, Down Syndrome, autism and normal children with maternal mental health]. Psychological Science 2007; 6(24): 410-28 (Persian).

18. Shoghi M, Khanjari S, Farmani F, Hosseini F. [Parasomnias in school-age children]. Iran Journal of Nursing 2005; 18(41,42): 153-9. (Persian)

19. Li HY, Huang YS, Chen NH, Fang TJ, Lee LA. Impact of adenotonsillectomy on behavior in children with sleep-disordered breathing. Laryngoscope 2006; 116(7):1142-7.

20. Broekman BF, Olff M, Tan FM, Schreuder BJ, Fokkens W, Boer F. The psychological impact of an adenoidectomy and adenotonsillectomy on young children. Int J Pediatr Otorhinolaryngol 2010; 74(1): 37-42.

21. Kohler MJ, Lushington K, van den Heuvel CJ, Martin J, Pamula Y, Kennedy D. Adenotonsillectomy
and neurocognitive deficits in children with Sleep Disordered Breathing. PLOS One 2009; 4(10):e7343.

22. Hasukić B, Brkić F, Kapidzić A, Skokić F. Quality of life in children with obstructive sleep apnea after adenotonsillectomy. Med Arh 2008; 62(1): 30-3.

23. Wei JL, Mayo MS, Smith HJ, Reese M, Weatherly RA. Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing. Arch Otolaryngol Head Neck Surg 2007; 133(10): 974-9.

24. Beraldin BS, Rayes TR, Villela PH, Ranieri DM. Assessing the impact adenotonsilectomy has on the lives of children with hypertrophy of palatine and pharyngeal tonsils. Braz J Otorhinolaryngol 2009; 75(1): 64-9.

25. Powell SM, Tremlett M, Bosman DA. Quality of life of children with sleep-disordered breathing treated with adenotonsillectomy. J Laryngol Otol 2011; 125(2): 193-8.

26.Wei JL, Bond J, Mayo MS, Smith HJ, Reese M, Weatherly RA. Improved behavior and sleep after adenotonsillectomy in children with sleep-disordered breathing: long-term follow-up. Arch Otolaryngol Head Neck Surg 2009;135(7):642-6.

27. Mitchell RB, Kelly J. Quality of life after adenotonsillectomy for SDB in children. Otolaryngol Head Neck Surg 2005;133(4): 569-72.

28. Mitchell RB, Kelly J. Behavior changes in children with mild sleep-disordered breathing or obstructive sleep apnea after adenotonsillectomy. Laryngoscope 2007;117(9):1685-8.

29. Goldstein NA, Stefanov DG, Graw-Panzer KD, Fahmy SA, Fishkin S, Jackson A, et al. Validation of a clinical assessment score for pediatric sleep-disordered breathing. Laryngoscope 2012;122(9): 2096-104.

30. Wood JM, Harris PK, Woods CM, McLean SC, Esterman A, Carney AS. Qualities of life following surgery for sleep disordered breathing: subtotal reduction adenotonsillectomy versus adenoton- sillectomy in Australian children. ANZ J Surg 2011; 81(5): 340-4.

31. Tauman R, Gulliver TE, Krishna J, Montgomery-Downs HE, Brien LO, Ivaneko A, et al. Persistence of obstructive sleep apnea syndrome in children after adenotonsillectomy. J Pediatr 2006; 149(6): 803-8.

32. Marcus CL, Moore RH, Rosen CL, Giordani B, Garetz SL, Taylor HG, et al. A Randomized Trial of Adenotonsillectomy for Childhood Sleep Apnea. N Engl J Med 2013; 368(25): 2366-76.