Effect of Adenotonsillectomy on Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillar hypertrophy is the leading cause for obstructive sleep apnea (OSA) in children. However, clinical improvement after adenotonsillectomy has not been confirmed objectively in Korean children. We evaluated the effects of adenotonsillectomy on polysomnography (PSG) in children with OSA. SUBJECTS AND METHOD: Fifteen children (age range 3 to 13) who had macroscopic adenotonsillar hypertrophy and a respiratory disturbance index (RDI) greater than 1 on preoperative PSG were enrolled in this study and underwent adenotonsillectomy. All children underwent preoperative and postoperative PSG at 10 weeks after adenotonsillectomy. In addition, the care-givers of each child were asked to check the deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and 8 weeks after surgery. Scores from the preoperative and postoperative PSG and ADHD RS-IV were compared using the paired samples t-test. RESULTS: The improvements in RDI, apneahypoapnea index, apnea index, arousal index, lowest O2 saturation and snoring time on postoperative PSG were significant (p<0.05). About 67% (10 of 15) patients were successfully treated with surgery, but 33% (5 of 15) children had RDI greater than 1 after surgery. ADHD RS-IV score showed significant improvement (p<0.05). CONCLUSION: This study suggests that adenotonsillectomy is effective in the treatment of childhood OSA, but dose not have perfect results. The presence of residual OSA after surgery in a large number of patients is a significant probability that deserves more studies and intervention.

A Case of Angiomyolipoma Originated in Larynx / 대한이비인후과학회지

Angiomyolipoma is a benign tumor that is composed of adipose tissue, blood vessels and smooth muscle. The kidney is the most commonly affected organ. In the general population, the incidence of angiomyolipoma is about 0.3%. It is sometimes associated with tuberous sclerosis. However, extrarenal angiomyolipoma is uncommon, although it has been observed in other organs such as liver, heart, mediastinum, spermatic cord, vaginal wall, oral cavity, etc. In the larynx, angiomyolipoma has been rarely reported in the literature. We present a case of angiomyolipoma in the larynx, which was completely removed by laryngomicrosurgery. Thus, we report this case with a review of the literature.

Long Term Follow-Up Results of Adenotonsillectomy on Pediatric Obstructive Sleep Apnea / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Adenotonsillecotmy is the most commonly recommended for pediatiric obstructive sleep apnea (OSA). The clinical improvement after surgery had been suggested on previous studies, which looked at only very short time follow-up. We aimed to study long-term changes in polysomnography (PSG) after adenotonsillectomy for OSA in children. SUBJECTS AND METHOD: Nine children (age range 3 to 13) who had macroscopic adenotonsillar hypertrophy and a respiratory disturbance index (RDI) greater than 1 on preoperative PSG were enrolled in this study and underwent adenotonsillectomy. All children underwent preoperative and postoperative PSG at 3 months and 12 months after surgery. In addition, the caregivers for each child were asked to check attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before, 3 months and 12 months after surgery. Scores from preoperative and postoperative PSG and ADHD RS-IV were compared using the paired sample t-test. RESULTS: Mean of RDI and apnea index improved significantly in postoperative 3 months and 12 months (p<0.05). About 67% (6 of 9) patients had RDI lesser than 1 in postoperative 3 months. However, 12 months later, 44% (4 of 9) children had RDI lesser than 1. ADHD RS-IV score showed significant improvement in postoperative 3 months and 12 months (p<0.05). CONCLUSION: This study suggests that adenotonsillectomy is effective in the treatment of childhood OSA. And the effects of adenotonsillecotmy on pediatric OSA are maintained at least 12 months.

Effect of Adenotonsillectomy on Inattention and Hyperactivity in Children with Sleep Disordered Breathing / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Sleep disordered breathing (SDB) is a common problem in the otolaryngology clinic and adenotonsillar hypertrophy is thought to be one of the most common etiologic factors. SDB possibly exhibits problems of behavioral regulation, such as inattention, hyperactivity and impulsive behavior. The goal of this study was to assess the effect of adenotonsillectomy on inattention and hyperactivity in children. SUBJECTS AND METHOD: We selected 54 pediatric patients with sleep disordered breathing. Adenotonsillectomy was performed for all patients. Adenotonsillar hypertrophy and the degree of SDB were evaluated preoperatively. The degree of inattention and hyperactivity was evaluated by attention deficit hyperactivity disorder rating scale-IV (ADHD RS-IV) before and after surgery. RESULTS: ADHD RS-IV score showed significant improvement after the operation in most children with SDB. But the improvement of ADHD RS-IV was not associated with the degree of adenotonsillar hypertrophy. However, much improvement in postoperative ADHD RS-IV was observed with children having higher preoperative ADHD RS-IV and/or SDB scale. CONCLUSION: Adenotonsillectomy seems to improve inattention and hyperactivity in most children with SDB. Improvement is more apparent in children with severe sleep disturbance and severe attention deficit and hyperactivity.

Efficacy of Benzodiazepines to Laryngopharyngeal Reflux: A Double-Blind, Randomized Controlled Study / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Anti-anxiety drugs such as benzodiazepines are often given to globus patients in practice, based on the notion that globus is a kind of somatization disorder. However, many of globus are caused by laryngopharyngeal reflux (LPR) and the effects of anti-anxiety drugs to LPR are unknown. The study goal was to assess the efficacy of benzodiazepines to LPR. SUBJECTS AND METHOD: We selected 51 LPR patients, who were confirmed by 24-hour double-probe ambulatory pH monitoring. Patients were allocated into case and control groups at random and entered into a double-blind trial. Patients in the control group received proton pump inhibitors and prokinetics. Diazepam was added to patients in the case group. Assessments were made after 4 weeks of treatment using reflux symptom index (RSI) and reflux finding score (RFS). RESULTS: In both groups, RSI and RFS were improved significantly at the end of the study. However, there was no significant difference between the two groups. CONCLUSION: Diazepam seems to have little efficacy in the treatment of LPR.