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International Journal of Pediatric... Jan 2022The aim of this systematic review is to summarise the existing literature regarding management of residual obstructive sleep apnoea post adenotonsillectomy in children... (Review)
Review
STUDY OBJECTIVE
The aim of this systematic review is to summarise the existing literature regarding management of residual obstructive sleep apnoea post adenotonsillectomy in children with Down Syndrome.
METHODS
PubMed, EMBASE, Cochrane and Scopus were searched to retrieve all studies published up to May 2020 regarding the management of obstructive sleep apnoea in children with Down Syndrome post adenotonsillectomy.
RESULTS
Eight studies were identified including five retrospective studies, two prospective and one case series. Five articles addressed surgical treatments only, two articles addressed hypoglossal nerve stimulation and one article addressed both surgical and medical treatments. Findings were similar across most studies where the obstructive apnoea hypopnoea index (oAHI) was reduced post intervention however given the heterogeneity in methodology and patient demographics, results were not directly comparable. Limited evidence was found regarding BMI and outcome post-surgery, suggesting that those who were normal weight or overweight had a significant reduction in the oAHI, compared to those who were obese.
CONCLUSION
The most optimal treatment for the management of residual obstructive sleep apnoea remains uncertain. There are various treatment options described in the literature, however, they have not been thoroughly studied, with only eight relevant articles found. Studies comparing outcomes following different treatment interventions and using consistent parameters are required to gain further understanding of the most optimal treatment for residual obstructive sleep apnoea in this population. Understanding if specific phenotypic features, such as weight, influence response to therapy will also be important. This information will help to develop treatment algorithms, which will assist in improving patient care by directing treatment and ensuring a more consistent approach to overall management. The high prevalence of residual obstructive sleep apnoea in children with Down Syndrome following first line treatment makes this a clinically important area to target in this particular cohort of children to avoid long term complications of untreated OSA.
Topics: Adenoidectomy; Child; Down Syndrome; Humans; Prospective Studies; Retrospective Studies; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 34785079
DOI: 10.1016/j.ijporl.2021.110966 -
Journal of Otolaryngology - Head & Neck... 2024Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Adenotonsillectomy is one of the most common surgical procedures worldwide. The current standard for securing the airway in patients undergoing adenotonsillectomy is endotracheal tube (ETT) intubation. Several studies have investigated the use of the laryngeal mask airway (LMA) in this procedure. We conducted a systematic review and meta-analysis to compare the safety and efficacy of the LMA versus ETT in adenotonsillectomy.
METHOD
Databases were searched from inception to 2022 for randomized controlled trials and comparative studies. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. The primary outcome is the rate of perioperative respiratory adverse events (PRAEs). Secondary outcomes included the rate of conversion to ETT, desaturations, nausea/vomiting, and surgical time. A subgroup analysis, risk of bias, publication bias, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) assessments were also performed.
RESULTS
Twelve studies were included in the analysis (4176 patients). The mean overall conversion to ETT was 8.36% [95% confidence interval (CI) = 8.17, 8.54], and for the pediatric group 8.27% (95% CI = 8.08, 8.47). The mean rate of conversion to ETT secondary to complications was 2.89% (95% CI = 2.76, 3.03) while the rest was from poor surgical access. Overall, there was no significant difference in PRAEs [odds ratio (OR) 1.16, 95% CI = 0.60, 2.22], desaturations (OR 0.79, 95% CI = 0.38, 1.64), or minor complications (OR 0.89, 95% CI = 0.50, 1.55). The use of LMA yielded significantly shorter operative time (mean difference -4.38 minutes, 95% CI = -8.28, -0.49) and emergence time (mean difference -4.15 minutes, 95% CI = -5.63, -2.67).
CONCLUSION
For adenotonsillectomy surgery, LMA is a safe alternative to ETT and requires less operative time. Careful patient selection and judgment of the surgeon and anesthesiologist are necessary, especially given the 8% conversion to ETT rate.
Topics: Humans; Tonsillectomy; Adenoidectomy; Laryngeal Masks; Intubation, Intratracheal; Postoperative Complications
PubMed: 38899617
DOI: 10.1177/19160216241263851 -
Cureus Jan 2024Grisel's syndrome is an uncommon cervical spine condition marked by non-traumatic rotational subluxation of the atlantoaxial joint. This systematic review aims to... (Review)
Review
Grisel's syndrome is an uncommon cervical spine condition marked by non-traumatic rotational subluxation of the atlantoaxial joint. This systematic review aims to collect potential evidence from relevant studies that reported symptoms, diagnostic methods, and management options among pediatric cases of Grisel's syndrome post otolaryngology procedures, which can aid and guide the diagnosis and management in clinical practice. We conducted both electronic and manual search strategies within the potential databases and included case reports, case series, and articles; however, review papers and correspondence papers were excluded. The post-otolaryngology procedures included adenoidectomy, tonsillectomy, tympanoplasty, cochlear implantation, double opposing Z plasty and pharyngeal flap, and adenotonsillectomy. In this systematic review, we identified and analyzed 20 studies encompassing a total of 24 pediatric patients with Grisel's syndrome following otolaryngology procedures. The patient demographics revealed a fairly even distribution between females (45.83%) and males (50.00%), with ages ranging from 2.5 to 12 years. The most common otolaryngology procedures associated with Grisel's syndrome were adenoidectomy (29.17%) and adenotonsillectomy (33.33%). Clinical symptoms included neck pain (75.00%), torticollis (50.00%), and limited neck mobility (20.83%), while diagnostic confirmation primarily relied on CT scans (50.00%). Treatment strategies varied, with conservative measures being the most frequent choice, followed by surgical interventions in four cases (16.67%). Complications were reported in 20.83% of cases. Due to the rarity of this condition, our findings are limited to case reports only, which may limit the generalizability of results. Grisel syndrome can be effectively managed through conservative treatment, including antibiotics and anti-inflammatory drugs if diagnosed timely. Early diagnosis and prompt management are essential to avoid neurological and fatal complications. This analysis would contribute to improving clinical knowledge and treatment strategies while providing additional insights into this rare condition.
PubMed: 38187032
DOI: 10.7759/cureus.51739 -
The Laryngoscope Apr 2021Prader-Willi syndrome (PWS) increases the risk of obstructive sleep apnea (OSA) due to obesity, hypotonia, and abnormal ventilatory responses. We evaluated... (Meta-Analysis)
Meta-Analysis
OBJECTIVES
Prader-Willi syndrome (PWS) increases the risk of obstructive sleep apnea (OSA) due to obesity, hypotonia, and abnormal ventilatory responses. We evaluated post-adenotonsillectomy complications, polysomnography changes, and quality of life in children with OSA and PWS.
STUDY DESIGN
Systematic review and meta-analysis.
METHODS
We conducted a systematic review and meta-analysis by searching PubMed, Embase, Cochrane, Web of Science, and Scopus. Two researchers independently reviewed studies about adenotonsillectomy for OSA in patients <21 years with PWS. We extracted study design, patient numbers, age, complications, polysomnography, and quality of life. We pooled postoperative changes in apnea hypopnea index (AHI) for meta-analysis. We applied Methodological Index for Nonrandomized Studies (MINORS) criteria to assess study quality.
RESULTS
The initial search yielded 169 studies. We included 68 patients from eight studies with moderate to high risk of bias. Six studies reported on complications and 12 of 51 patients (24%) had at least one. Velopharyngeal insufficiency was the most commonly reported complication (7/51, 14%). We included seven studies in meta-analysis. Mean postoperative improvement in AHI was 7.7 (95% CI: 4.9-10.5). Postoperatively 20% (95% CI: 3%-43%) had resolution of OSA with AHI < 1.5 while 67% (95% CI: 50%-82%) had improvement from severe/moderate OSA to mild/resolved (AHI < 5). Two studies evaluated quality of life and demonstrated improvement.
CONCLUSIONS
Children with PWS undergoing adenotonsillectomy for OSA have a substantial risk of postoperative complications that may require additional interventions, especially velopharyngeal insufficiency. Despite improvements in polysomnography and quality of life, many patients had residual OSA. This information can be used to counsel families when considering OSA treatment options. Laryngoscope, 131:898-906, 2021.
Topics: Adenoidectomy; Child; Humans; Polysomnography; Postoperative Complications; Prader-Willi Syndrome; Quality of Life; Sleep Apnea, Obstructive; Tonsillectomy
PubMed: 33026674
DOI: 10.1002/lary.28922 -
The Laryngoscope Jul 2024To assess whether adenotonsillectomy improves levels of inflammatory and cardiometabolic markers in children with polysomnographically diagnosed obstructive sleep apnea... (Meta-Analysis)
Meta-Analysis Review
OBJECTIVE
To assess whether adenotonsillectomy improves levels of inflammatory and cardiometabolic markers in children with polysomnographically diagnosed obstructive sleep apnea (OSA).
DATA SOURCES
Two authors independently searched PubMed, Embase, and Cochrane databases up to August 16, 2022, for studies relating to pre- and post-operative levels of serum markers in pediatric patients undergoing adenotonsillectomy.
REVIEW METHODS
Data were extracted from included articles into a structured proforma. Meta-analyses of the standardized mean difference (SMD) were conducted in random-effects models. We calculated the probability of benefit (POB) and number needed to treat (NNT) for outcomes that demonstrated a statistically significant effect after adenotonsillectomy. The primary outcomes were changes in serum markers including C-reactive protein (CRP), high-sensitivity CRP (hs-CRP), Insulin-like growth factor 1 (IGF-1), interleukin-10 (IL-10), interleukin-6 (IL-6), tumor necrosis factor-alpha (TNF-α), Brain natriuretic peptide (BNP), insulin, glucose, total cholesterol, triglyceride, low-density lipoprotein (LDL), high-density lipoprotein (HDL).
RESULTS
We screened 1616 studies and included 26 studies with 1331 participants. Meta-analysis was performed on 20 of the included studies. Adenotonsillectomy was associated with a significant decrease in insulin levels (SMD = -0.322, 95% Confidence Interval (CI) = -0.583 to -0.061), CRP (SMD = -0.946, 95% CI = -1.578 to -0.314), and BNP (SMD = -1.416, 95% CI = -2.355 to -0.477) and significant increase in levels of IGF-1 (SMD = 0.691, 95% CI = 0.207 to 1.176). There were no significant changes in levels of triglyceride, total cholesterol, TNF-α, LDL, HDL, glucose, IL-10, and IL-6.
CONCLUSION
In children with polysomnographically diagnosed OSA, adenotonsillectomy was associated with improvements in serum biomarkers, comprising lower CRP, insulin, and BNP, and higher IGF-1. Laryngoscope, 134:3030-3037, 2024.
Topics: Humans; Sleep Apnea, Obstructive; Tonsillectomy; Adenoidectomy; Biomarkers; Child; C-Reactive Protein; Interleukin-10; Interleukin-6; Insulin-Like Growth Factor I; Tumor Necrosis Factor-alpha; Natriuretic Peptide, Brain; Child, Preschool
PubMed: 38380991
DOI: 10.1002/lary.31249 -
BMC Pediatrics May 2020Pediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Pediatric sleep-disordered breathing (SDB) correlated with respiratory conditions of snoring and hypopnea. Mean platelet volume (MPV) was an inflammatory marker, related to increased inflammatory condition of pediatric patients. Increase of MPV level may cause failure to thrive or increased upper airway infection rate. The aim of this study was to perform systematic review and meta-analysis to investigate the difference on MPV values for pediatric SDB, and compare the change on MPV after surgery in patients with pediatric SDB.
METHODS
A systemic review of the studies from PubMed, EMBASE, and Cochrane Library databases was conducted in March 2020, supported by reviewing of published articles for studies comparing MPV in pediatric SDB. Meta-analysis was used to compare the change of MPV in pediatric SDB, and sub-group analysis was also used to compare the MPV decrease after surgeries of adenoidectomy or adenotonsillectomy.
RESULTS
There were seven studies included in the review. Six of them including 963 subjects showed that a significant increase of MPV was noted in pediatric SDB compared to those in pediatric non-SDB (P < 0.05). Total standardized mean difference (SMD) in MPV between pediatric SDB and non-SDB was 0.51 (95% CI =0.30-0.72, P < 0.05). A significant decrease of MPV was found in pediatric SDB patients who underwent surgery (total SMD = - 0.36; 95% CI = - 0.70- -0.02, P < 0.05). Decreases of MPV after adenoidectomy and adenotonsillectomy were observed, but only the effect of adenotonsillectomy had a statistical significance (total SMD = - 0.72; 95% CI = - 1.18 - -0.26, P < 0.05).
CONCLUSION
The MPV was significantly higher in patients with pediatric SDB, indicating the presence of increased platelet activity in pediatric SDB patients. The level of MPV could be reduced by the two surgeries, especially adenotonsillectomy.
Topics: Adenoidectomy; Child; Humans; Mean Platelet Volume; Sleep Apnea Syndromes; Snoring; Tonsillectomy
PubMed: 32393268
DOI: 10.1186/s12887-020-02099-5 -
Sleep Medicine Reviews Apr 2022Spontaneous resolution of pediatric obstructive sleep apnea (OSA) may stand behind the observed benefit of rapid maxillary expansion (RME), mainly supported by... (Review)
Review
Spontaneous resolution of pediatric obstructive sleep apnea (OSA) may stand behind the observed benefit of rapid maxillary expansion (RME), mainly supported by uncontrolled case series. We aimed to review the controlled, ideally randomized, evidence on the effectiveness of RME as compared to watchful waiting or alternative treatment of pediatric OSA. We only found one randomized clinical trial comparing RME with watchful waiting. The other four studies compared RME with the gold-standard treatment adenotonsillectomy, three of them in a non-randomized fashion. The results of the RCT showed no statistically significant differences in the enhancement of main (apnea hypopnea index, AHI) and secondary outcomes between RME and watchful waiting. Furthermore, reproducibility of the published studies was limited by insufficient description of their patients' inclusion criteria. We could not find convincing evidence of the benefit of RME over watchful waiting in patients with pediatric OSA. RCTs with reproducible inclusion criteria comparing RME with watchful waiting are still critically needed to support this intervention for the treatment of pediatric OSA. In the absence of solid evidence with RCT, RME should not be recommended for the treatment of pediatric OSA. PROSPERO REGISTRATION NUMBER: CRD42021249261. RUNNING SUMMARY: This systematic review explores the benefits of rapid maxillary expansion compared to spontaneous resolution of pediatric obstructive sleep apnea.
Topics: Adenoidectomy; Child; Humans; Palatal Expansion Technique; Randomized Controlled Trials as Topic; Reproducibility of Results; Sleep Apnea, Obstructive; Watchful Waiting
PubMed: 35286895
DOI: 10.1016/j.smrv.2022.101609 -
Sleep Medicine Apr 2024To study the role of adenotonsillectomy (ADT) for obstructive sleep apnea (OSA) in children with mucopolysaccharidosis (MPS). (Review)
Review
OBJECTIVE
To study the role of adenotonsillectomy (ADT) for obstructive sleep apnea (OSA) in children with mucopolysaccharidosis (MPS).
METHODS
A systematic review were performed following the PRISMA guideline. PubMed and Embase were searched for studies regarding adenotonsillectomy for OSA in children with MPS. The MINOR Score were applied for quality assessment of the included studies.
RESULTS
Nineteen studies were eligible for inclusion: fifteen were retrospective and four prospective. A total of 1406 subjects were included. The samples size varied from 2 to 336, the male to female ratio is 1.2 and mean age varied from 2.4 to 11 years. Overall, 56.2 % (IC 95%: 53.6-58.8) of the included subjects underwent ADT. MPS I and II are the two most operated types. Three studies, including 50 children, reported improvement in polysomnographic parameters after surgery. Two authors described the duration of follow-up: 8.4 and 9.8 years, respectively.
CONCLUSIONS
More than half of children with MPS underwent ADT for the treatment of OSA, although few evidence demonstrated improvement in term of polysomnographic parameters. The two types of MPS most involved are type I and II. Considering the disease progression and anesthetic risks, multidisciplinary management may help identify the subgroup of children with MPS who benefit from ADT for the treatment of OSA.
Topics: Child; Male; Humans; Female; Child, Preschool; Retrospective Studies; Prospective Studies; Polysomnography; Adenoidectomy; Tonsillectomy; Sleep Apnea, Obstructive; Mucopolysaccharidoses
PubMed: 38402648
DOI: 10.1016/j.sleep.2024.02.030 -
The Laryngoscope Mar 2022Assess the risks and benefits of adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in children with cerebral palsy (CP).
OBJECTIVES/HYPOTHESIS
Assess the risks and benefits of adenotonsillectomy (AT) for obstructive sleep apnea (OSA) in children with cerebral palsy (CP).
STUDY DESIGN
Systematic review.
METHODS
We conducted a systematic review of Medline, Embase, and Cochrane Central Registry from 1946 to 2021. Broad search concepts included cerebral palsy, pediatric, tonsillectomy/adenoidectomy, and sleep. Additional articles were identified by searching reference lists. Studies on the safety and efficacy of AT for OSA management in children with CP were included.
RESULTS
Fifteen articles met inclusion criteria. Articles were classified into one or more of four themes: intraoperative risk (n = 1), postoperative risk (n = 3), postoperative care requirements (n = 6), and surgical outcomes (n = 7). No intraoperative anesthetic complications were reported. Postoperatively, respiratory complications including pneumonia were common and necessitated additional airway management. Following AT, children with CP required close postoperative observation, experienced increased lengths of stay, and had increased odds of unplanned intensive care unit (ICU) admission. Benefits following AT were improvement in OSA as measured by a reduction in obstructive apnea-hypopnea index (OAHI) as well as improved quality of life in some; however, many patients went on to require tracheostomy due to persistent OSA.
CONCLUSIONS
Children with CP who undergo AT have a significant risk of developing a postoperative respiratory complication. Realistic counseling of families around increased perioperative risks in this population is imperative and close postoperative monitoring is critical. Many children will obtain a reduction in OAHI, but additional surgical management is often required, including tracheostomy. Further research is needed to determine the best management strategy for OSA in children with CP. Laryngoscope, 132:687-694, 2022.
Topics: Adenoidectomy; Cerebral Palsy; Child; Humans; Risk Assessment; Sleep Apnea, Obstructive; Tonsillectomy; Treatment Outcome
PubMed: 34032299
DOI: 10.1002/lary.29625 -
International Journal of Pediatric... Oct 2020To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures.
OBJECTIVE
To increase awareness and the index of suspicion regarding Grisel's syndrome among otolaryngologists after otolaryngology procedures.
METHOD
We conducted a search of MEDLINE/PubMed for articles published through January 2020 utilizing the following terms: Grisel's syndrome, Grisel syndrome, and atlantoaxial subluxation alone and in combination with other terms like ENT, otolaryngology, head & neck, tonsillectomy, adenoidectomy, adenotonsillectomy, mastoidectomy, tympanoplasty, and tympanomastoidectomy. We included English-language cases that occurred after surgical procedures and contained the following data: age, onset, common presenting symptoms, diagnostic approach, management options, and the presence of complications.
RESULT
We found 39 papers that met our criteria. Most cases occurred after adenotonsillectomy with or without ventilation tube insertion (55.6%). The majority of the affected population was the pediatric age group, and the main presenting symptom was torticollis that presents as early-onset. In regard to management, most of the cases were treated with medical therapy with or without adjunctive measures (e.g., a cervical collar). No neurological complications were recorded except in one case that was treated with no long term sequel.
CONCLUSION
Grisel's syndrome is a rare complication that occurs after otolaryngology procedures and can result in serious neurological complications and death. A high index of suspicion is an important factor for early diagnosis and management to prevent such complications. In most cases, conservative management is successful with a good prognosis.
Topics: Atlanto-Axial Joint; Humans; Joint Dislocations; Otorhinolaryngologic Surgical Procedures; Postoperative Complications; Syndrome; Torticollis; Treatment Outcome
PubMed: 32658805
DOI: 10.1016/j.ijporl.2020.110225