Pulmonary Function after Adenotonsillectomy

Document Type: Original


1 Department of Otorhinolaryngology, Isfahan University of Medical Science, Isfahan. Iran.

2 Poursina Hakim Research Institute, Isfahan university of medical science, Isfahan, Iran.


Adenotonsillar hypertrophy is a common disorder among children which, without proper treatment, may lead to considerable problems. Although the consequences of this disorder have been studied in other articles, we decided to evaluate the changes in pulmonary function tests in these children after adenotonsillectomy, and the correlation between clinical and spirometric parameters.
Materials and Methods:
We conducted a before- and after- clinical trial. Forty children (17 females and 23 males) with a diagnosis of upper airway obstruction due to adenotonsillar hypertrophy were enrolled in this study. Mean age of the participants was 6.9±1.9 years. Eight spirometric parameters were selected for evaluation pre-operatively and 40 days postoperatively. Besides, symptom scores were defined for each patient to assess their disease severity, pre- and postoperatively. Data were analyzed statistically.
Forced vital capacity (FVC) increased from 1.28±0.26% pre-operatively to 1.33±0.24%postoperatively (P=0.05). Peak expiratory flow increased from 2.74±0.65% pre-operatively to 2.84±0.51% postoperatively (P=0.02) and mid expiratory forced expiratory flow (FEF25–75)was 1.81±0.48% pre-operatively, increasing to 1.91±0.50% postoperatively (P=0.02). Maximal expiratory flow at 25% of FVC (MEF25)increased from 1.09±0.36% pre-operatively to 1.21±0.34% postoperatively (P=0.02). There was no correlation among the other spirometric parameters (FEV1, FEV1/FVC, MEF50 and MEF75) pre- and post-operatively (P>0.05). Despite some improvements in pulmonary function indices, there was no correlation between changes in spirometric parameters and severity of the snoring (P>0.05).
Although our findings reveal that adenotonsillectomy had a positive effect on pulmonary function tests, we found no significant correlation between alterations in spirometric parameters and severity of snoring. However, performing a spirometric examination in children with adenotonsillar hypertrophy may be beneficial for assessing the pulmonary status of the affected patient.


Main Subjects

1. Khalifa MS, Kamel RH, Zikry MA, Kandil TM. Effect of enlarged adenoids on arterial blood gases in children. J Laryngol Otol. 1991;105:436–8.

2. Menashe VD, Farrechic C, Miller M. Hypoventilation and corpulmonale due to chronic upper airway obstruction. J Pediatr.1965;66:198–203.

3. Niedzielska G, Kotowski M, Niedzielski A, Assessment of pulmonary function and nasal flow in children with adenoid hypertrophy, Int J Pediatr Otorhinolaryngol. 2008;72:333–5.

4. Arens R. McDonough JM, Corbin AM, et al. Upper airway size analysis by magnetic resonance imaging of children with obstructive sleep apnea syndrome. Am J Respir Crit Care Med. 2003; 167:65–70.

5. Rosen CL, Larkin EK, Kirchner HL, et al. Prevalence and risk factors for sleep-disordered breathing in 8- to 11-year-old children: association with race and prematurity. J Pediatr. 2003; 142:383–9.

6. Tal A, Leiberman A, Margulis G, Sofer S. Ventricular dysfunction in children with obstructive sleep apnea: radionuclide assessment. Pediatr Pulmonol.1988;4:139–43.

7. Marcus CL, Greene MG, Carroll JL. Blood pressure in children with obstructive sleep apnea. Am J Respir Crit Care Med.1998;157:1098–103.

8. Gozal D. Sleep-disordered breathing and school performance in children.Pediatrics.1998;102: 616- 20.

9. O’Brien LM, Gozal D. Behavioral and neurocognitive implications of snoring and obstructive sleep apnea in children: facts and theory.Paediatr Respir Rev.2002;3:3–9.

10. O’Brien LM, Mervis CB, Holbrook CR, Bruner JL, Klaus CJ, Rutherford J, et al. Neurobehavioral implications of habitual snoring in children. Pediatrics. 2004;114:44–9.

11. Kharb S, Yadav SPS, Singh H, Singh GP. Effect of adenotonsillectomy on arterial blood gases and acid-base balance. Int J Pediatr Otorhinolaryngol. 1998;43: 213–15.

12. Pires MG, Di Francesco RC, Grumach AS, Mello JF. Evaluation of inspiratory pressure in children with enlarged tonsils and adenoids. Braz J Otorhinolaryngol. 2005;71(5):598–601.

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

14. Mitchell RB, Kelly J. Outcomes and quality of life following adenotonsillectomy for sleep-disordered breathing in children. ORL J Otorhinolaryngol Relat Spec. 2007;69(6):345–8.

15. Maurizi M, Paludetti G, Todisco T, Dottorini M, Grassi V. Pulmonary function studies in adenoid hypertrophy. Int J Pediatr Otorhinolaryngol. 1980; 2(3):243–50.

16. Di Martino E, Mlynski G, Mlynski B. Effect of adenoid hyperplasia on nasal airflow. Laryngorhino- otology. 1998;77:272–4.

17. Banzatto MG, Grumach AS, Mello JF Jr, Di Francesco RC. Adenotonsillectomy improves the strength of respiratory muscles in children with upper airway obstruction. Int J Pediatr Otorhinolaryngol. 2010;74(8):860–3.

18. Kavukcu S, Coskun S, Cevik N, Kuscu B, Akkoclu A. The importance of pulmonary function tests in adenotonsillectomy indications. Indian J Pediatr. 1993;60:249–255.

19. Brodsky L. Tonsillitis, tonsillectomy and adenoidectomy. In: B.J. Bailey. Head and Neck Surgery–Otolaryngology. Philadelphia:Lippincott; 1993:833–47.

20. Fujioka M, Young LW, Girdany BR. Radiographic evaluation of adenoidal size in children: adenoidal-/nasopharyngeal ratio. Am J Roentgenol. 1979;133:401–10.

21. Yernault JC, Englert M, Sergysels R, Decoster A. Upper airway stenosis: a physiologic study. Am Rev Respir Dis.1973;108: 996–1000.

22. Yadav SP, Dodeja OP, Gupta KB, Chanda R. Pulmonary function tests in children with adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. 2003;67:121–5.

23. Hira HS, Singh H. Assessment of upper airway obstruction by pulmonary function testing. J Assoc Physicians India.1994; 42:531–4.

24. Corren J. Allergic rhinitis and asthma, how important is the link? J Allergy Clin Immunol. 1997;99: S781–S6.

25. Geller M. Vias aéreas unidas, a atopia como processo sistêmico e ontinuo. Rev Bras Alerg Imunopatol. 2002; 25:74–80.

26. Behlfelt K, Linderson-Aronson S, MacWilliam J, Neander P, Laage-Hellman J. Cranio-facial morphology in children with and without enlarged tonsils. Eur J Orthod.1990;12(3):233–43.

27. Woodson GE, Robbins KT. Nasal obstruction and pulmonary function: The role of humidification. Otolaryngol Head Neck Surg.1985;93:505–11.

28. Kendall FP, McCreary EK, Provance PG. Muscles, Testing and Function with Posture and Pain, 4th ed. Baltimore:Lippincott Williams & Wilkins; 2005.

29. Blum DJ, Neel HB. Current thinking on tonsillectomy and adenoidectomy. Comp Ther. 1983; 9: 48–56.

30. Doğruer ZN, Ünal M, Eskandari G, Pata YS, Akbaş Y, Cevik T, Cimen MY Malondialdehyde and antioxidant enzymes in children with obstructive adenotonsillar hypertrophy. Clin Biochem. 2004; 37:718–21.

31. Ünal M, Öztürk C, Görür K. Effect of tonsillectomy on serum concentrations of interleukins and TNF-a in patients with chronic tonsillitis, ORL J Otorhinolaryngol Relat Spec 2002;64:254–6.

32. Boyd JH, Petrof BJ, Hamid Q, Fraser R, Kimoff RJ. Upper airway muscle inflammation and denervation changes in obstructive sleep apnea. Am J Respir Crit Care Med 2004;170:541–6.

33. Tauman R, Ivanenko A, O’Brien LM, Gozal D. Plasma C-reactive protein levels among children with sleep-disordered breathing. Pediatrics2004;113:564-9.

34. Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res. 2005;57:232–6.

35. Goldbart AD, Goldman GL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea and recurrent infection. Chest. 2004;126:13–18.

36. Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep-disordered breathing in children.Am J Respir Crit Care Med.2005;172:364–70.

37. Kheirandish L, Goldbart AD, Gozal D. Intranasal Steroids and Oral Leukotriene Modifier Therapy in Residual Sleep-Disordered Breathing After Tonsillectomy and Adenoidectomy in ChildrenPediatrics2006;117:e61–e6.