Evaluation of symptoms of preopoperative and postoperative psychosomatic screening in children with adenoidectomy and adenotonsillectomy.

INTRODUCTION: Adenoidectomy and adenotonsillectomy are very common operations in childhood. It is important to clarify their effects on this age group; in this study, we aimed to investigate the effects of the causative agent on children's mental health by using scales that help to screen for indications of mental disorders in children, who have had adenoidectomy or adenotonsillectomy, both before and after surgery. In this way, we aimed to investigate the effects of this factor on children's mental health. MATERIALS AND METHODS: The study included 82 children aged 6-12 years with signs of upper respiratory tract obstruction or recurrent adenotonsilitis. Adenotonsillectomy was performed in 41 patients included in the study and adenoidectomy was performed in 41 patients included in the study. 40 healthy children matched with the patient groups in terms of age and gender were included in the control group. Patients, were divided into three groups, those who underwent adenoidectomy, patients undergoing adenotonsillectomy and those in the control group Preoperative and postoperative questionnaires were used to investigate the effect of tonsillectomy or adenoidectomy on the mental health of children. The Parents' Form for the Strengths and Difficulties Questionnaire, the Parental Form for the Children's Anxiety Screening Scale, the Sleeping Scale for Children and the Quality of Life Scale for Children were used in the screening. RESULTS: In children, who underwent adenoidectomy/adenotonsillectomy due to recurrent infection and adeno/adenotonsillar hypertrophy; it was seen that there was a significant decrease in the scores for the Strengths and Difficulties Questionnaire, the Anxiety Screening Scale in Children, and the Sleep Scale in Children, and a significant increase in Quality of Life Scale for Children scores. OUTCOME: In conclusion, adenoidectomy/adenotonsillectomy in children with sleep apnea due to recurrent episodes of infection and adeno/adenotonsillar hypertrophy was thought to prevent further neurobehavioral problems, likely to become more complex in the future, and to improve quality of life.

Adaptation and validation of the Spanish version of the Tonsil and Adenoid Health Status Instrument.

OBJECTIVES/HYPOTHESIS: The Tonsil and Adenoid Health Status Instrument (TAHSI) is a disease-specific questionnaire, intended for completion by parents, for assessing quality of life related to tonsil and adenoid disease or its treatment in children with throat disorders. The aim of this study was to validate the Spanish adaptation of the TAHSI, thus allowing comparison across studies and international multicenter projects. STUDY DESIGN: Multicenter prospective instrument validation study. METHODS: Guidelines for the cross-cultural adaptation process from the original English-language scale into a Spanish-language version were followed. The psychometric properties (reproducibility, reliability, validity, responsiveness) of the Spanish version of the TAHSI (s-TAHSI) were assessed in 51 consecutive children undergoing adeno/tonsillectomy (both before and 6 months after surgery) and a separate cohort of 50 unaffected children of comparable age range. RESULTS: Test-retest reliability (γ = 0.8) and internal consistency reliability (α = 0.95) were adequate. The s-TAHSI demonstrated satisfactory content validity (r > 0.40). The instrument showed excellent between-groups discrimination (P < .0001) and high responsiveness to change (effect size = 2.09). CONCLUSIONS: Psychometric testing of the s-TAHSI yielded satisfactory results, thus allowing assessment of the subjective severity of throat disorders in children. LEVEL OF EVIDENCE: 2c. Laryngoscope, 128:1469-1475, 2018.

Scoping review of pediatric tonsillectomy quality of life assessment instruments.

OBJECTIVES/HYPOTHESIS: Sleep-disordered breathing or recurrent tonsillitis have detrimental effects on the child's physical health and quality of life. Tonsillectomy is commonly performed to treat these common conditions and improve the child's quality of life. This scoping review aims to present a comprehensive and descriptive analysis of quality of life questionnaires as a resource for clinicians and researchers when deciding which tool to use when assessing the quality of life effects after tonsillectomy. STUDY DESIGN: A comprehensive search strategy was undertaken across MEDLINE (PubMed), CINAHL, Embase, and Cochrane CENTRAL. METHODS: Quality of life questionnaires utilized in studies investigating pediatric patients undergoing tonsillectomy for chronic tonsillitis or sleep-disordered breathing were included. Methodological quality and data extraction were conducted as per Joanna Briggs Institute methodology. RESULTS: Ten questionnaires were identified, consisting of six generic and four disease-specific instruments. The Pediatric Quality of Life Inventory was the most commonly utilized generic questionnaire. The Obstructive Sleep Apnea-18 was the most commonly utilized disease-specific questionnaire. CONCLUSIONS: This review identified a range of generic and disease-specific quality of life questionnaires utilized in pediatric patients who have undergone tonsillectomy with or without adenoidectomy for sleep-disordered breathing or chronic tonsillitis. Important aspects of each questionnaire have been summarized to aid researchers and clinicians in choosing the appropriate questionnaire when evaluating the quality of life effects of tonsillectomy. LEVEL OF EVIDENCE: NA Laryngoscope, 127:2399-2406, 2017.

Clinical practice guideline: tonsillitis II. Surgical management.

In 2013, a total of 84,332 patients had undergone extracapsular tonsillectomies (TE) and 11,493 a tonsillotomy (TT) procedure in Germany. While the latter is increasingly performed, the number of the former is continually decreasing. However, a constant number of approximately 12,000 surgical procedures in terms of abscess-tonsillectomies or incision and drainage are annually performed in Germany to treat patients with a peritonsillar abscess. The purpose of this part of the clinical guideline is to provide clinicians in any setting with a clinically focused multi-disciplinary guidance through the surgical treatment options to reduce inappropriate variation in clinical care, improve clinical outcome and reduce harm. Surgical treatment options encompass intracapsular as well as extracapsular tonsil surgery and are related to three distinct entities: recurrent episodes of (1) acute tonsillitis, (2) peritonsillar abscess and (3) infectious mononucleosis. Conservative management of these entities is subject of part I of this guideline. (1) The quality of evidence for TE to resolve recurrent episodes of tonsillitis is moderate for children and low for adults. Conclusions concerning the efficacy of TE on the number of sore throat episodes per year are limited to 12 postoperative months in children and 5-6 months in adults. The impact of TE on the number of sore throat episodes per year in children is modest. Due to the heterogeneity of data, no firm conclusions on the effectiveness of TE in adults can be drawn. There is still an urgent need for further research to reliably estimate the value of TE compared to non-surgical therapy of tonsillitis/tonsillo-pharyngitis. The impact of TE on quality of life is considered as being positive, but further research is mandatory to establish appropriate inventories and standardized evaluation procedures, especially in children. In contrast to TE, TT or comparable procedures are characterized by a substantially lower postoperative morbidity in terms of pain and bleeding. Although tonsillar tissue remains along the capsule, the outcome appears not to differ from TE, at least in the pediatric population and young adults. Age and a history of tonsillitis are not a contraindication, abscess formation in the tonsillar remnants is an extremely rare finding. The volume of the tonsils should be graded according to Brodsky and a grade >1 is considered to be eligible for TT. The number of episodes during 12 months prior to presentation is crucial to indicate either TE or TT. While surgery is not indicated in patients with less than three episodes, a wait-and-see policy for 6 months is justified to include the potential of a spontaneous healing before surgery is considered. Six or more episodes appear to justify tonsil surgery. (2) Needle aspiration, incision and drainage, and abscess tonsillectomy are effective methods to treat patients with peritonsillar abscess. Compliance and ability of the patient to cooperate must be taken into account when choosing the surgical method. Simultaneous antibiotic therapy is recommended but still subject of scientific research. Abscess tonsillectomy should be preferred, if complications have occurred or if alternative therapeutic procedures had failed. Simultaneous TE of the contralateral side should only be performed when criteria for elective TE are matched or in cases of bilateral peritonsillar abscess. Needle aspiration or incision and drainage should be preferred if co-morbidities exist or an increased surgical risk or coagulation disorders are present. Recurrences of peritonsillar abscesses after needle aspiration or incision and drainage are rare. Interval TE should not be performed, the approach is not supported by contemporary clinical studies. (3) In patients with infectious mononucleosis TE should not be performed as a routine procedure for symptom control. TE is indicated in cases with clinically significant upper airway obstruction resulting from inflammatory tonsillar hyperplasia. If signs of a concomitant bacterial infection are not present, antibiotics should not be applied. Steroids may be administered for symptom relief.

[Topical preparations for therapy of tonsillar pathology].

This paper highlights clinical and diagnostic aspects of tonsillar pathology with special reference to modern methods for the treatment of pharyngeal diseases of different etiology. A detailed characteristic of local symptomatic therapy is presented including the use of NSAIDs (non-steroidal anti-inflammatory drugs). These agents have advantages over other medications for local therapy due to high anti-inflammatory and analgesic activities. Also, they significantly improve the patients' quality of life. The use of a local anti-inflammatory drug is a major component of the treatment of inflammatory pharyngeal pathology. Regardless of the nature of the disease, either bacterial or viral.

Long-Term Results From Tonsillectomy in Adults.

BACKGROUND: Tonsillectomy is performed more than 400 000 times in the European Union each year, making it one of the most common operations. Nonetheless, there have been only a few long-term studies of quality of life after tonsillectomy. METHODS: In 2004, data on the quality of life after tonsillectomy were obtained from adult German-speaking tonsillectomy patients by means of the Glasgow Benefit Inventory and a questionnaire specifically designed for that study. The present study concerns the further followup of these patients, sometimes many years later. 114 patients with recurrent tonsillitis were included in this descriptive study. RESULTS: Of the 114 patients, 97 (85%) provided further data at 14 months, and 71 (62%) at ca. 7 years. The Glasgow Benefit Inventory revealed postoperative improvement of quality of life at 14 months and at 7 years, with median values of 16.67 points (quartile 11.11/25) and 13.89 points (quartile 8.33/25) (p=0.168). The mean number of annual episodes of sore throat fell from 10 preoperatively to 2 postoperatively (p=0.0001). The number of visits to the doctor, the intake of analgesic drugs and antibiotics, and the number of medical absences from work also declined significantly over the period of observation. CONCLUSION: Tonsillectomy was associated with a longlasting improvement of health and quality of life, and with lower utilization of medical resources. The 62% response rate at 7 years leaves the question open whether patients with a favorable postoperative course may have been more likely than others to participate in the study.

Patient-reported outcomes in children suffering with mild to moderate tonsillitis versus those in children with severe tonsillitis.

OBJECTIVE: To quantify the impact that mild to moderate tonsillitis has on quality of life in children and compare it to that of severe tonsillitis. METHODS: In this prospective study, parents of children aged 0-16 years completed the Paediatric Throat Disorders Outcome Test, and quality of life scores in the tonsillitis groups were compared. RESULTS: A hundred children were recruited: 58 had severe tonsillitis and were offered surgery, and 42 had mild to moderate tonsillitis and were managed conservatively. The mean outcome test scores in those children undergoing surgery were 36.7 for tonsillectomy patients and 36.9 for adenotonsillectomy patients, compared with a score of 31.5 for the mild to moderate tonsillitis patients (p = 0.019). CONCLUSION: Children with mild to moderate disease had significantly better quality of life scores than those with severe disease. It is thought that those with mild to moderate disease have short-term improvements in general quality of life after surgery, which disappear in the medium term. This transient improvement needs to be balanced against the morbidity of the surgery and the cost burden to the National Health Service. The results of this study support the national drive towards limiting tonsillectomy to children with severe tonsillitis or obstructive sleep apnoea.

Application of the Paediatric Throat Disorders Outcome Test (T-14) for tonsillectomy and adenotonsillectomy.

INTRODUCTION: The T-14 questionnaire is a validated patient reported outcome measure (PROM) used to assess the value of paediatric tonsillectomy from the patient's perspective. Tonsillectomy is a procedure under threat. As such, this study aimed to provide further evidence supporting the role of tonsillectomy in the management of recurrent tonsillitis and obstructive sleep apnoea. METHODS: A prospective uncontrolled observational study was undertaken examining 54 paediatric patients undergoing tonsillectomy at our institution. Parents of children having surgery were invited to complete a T-14 questionnaire preoperatively as well as at three and six months postoperatively. RESULTS: The questionnaire was completed for 52 of the 54 patients preoperatively as well as at 3 and 6 months postoperatively (96% response rate). The mean difference between the preoperative and six-month T-14 score was 31.8 (p<0.0001). T-14 scores at three months were also significantly improved compared with those taken preoperatively (mean difference: 29.9, p<0.0001). CONCLUSIONS: This is the first study in the literature to assess T-14 questionnaires at three and six months following paediatric tonsillectomy, providing evidence of the early benefit on PROMs. Tonsillectomy is the most common surgical procedure performed in the UK, and it is regarded highly by patients and otolaryngologists alike. This study provides significant evidence that tonsillectomy improves PROMs, thereby demonstrating its ongoing clinical value as a funded National Health Service procedure.

Does tonsillectomy improve quality of life in adults? A systematic literature review.

AIM: To determine whether tonsillectomy improves quality of life in adults suffering from chronic or recurrent tonsillitis. METHOD: A systematic literature search of the Medline and Pubmed databases was conducted in order to identify all relevant studies measuring quality of life directly. RESULTS AND CONCLUSION: Eight studies were identified. The Glasgow Benefit Inventory and the Short Form questionnaire were the main tools used to assess quality of life changes. Tonsillectomy is likely to improve the overall quality of life as it particularly improves patients' physical and general health. The social benefits of tonsillectomy appear to be non-significant. The effects are likely to be long-lasting and have a greater impact on younger patients. The presence of coexisting chronic conditions and the severity of infective symptoms due to tonsillitis are also influencing factors.

Impact of information leaflets on behavior of patients with gastroenteritis or tonsillitis: a cluster randomized trial in French primary care.

OBJECTIVE: To assess the impact of four patient information leaflets on patients' behavior in primary care. DESIGN: Cluster randomized multicenter controlled trial between November 2009 and January 2011. PARTICIPANTS: French adults and children consulting a participating primary care physician and diagnosed with gastroenteritis or tonsillitis. Patients were randomized to receive patient information leaflets or not, according to the cluster randomization of their primary care physician. INTERVENTION: Adult patients or adults accompanying a child diagnosed with gastroenteritis or tonsillitis were informed of the study. Physicians in the intervention group gave patients an information leaflet about their condition. Two weeks after the consultation patients (or their accompanying adult) answered a telephone questionnaire on their behavior and knowledge about the condition. MAIN MEASURES: The main and secondary outcomes, mean behavior and knowledge scores respectively, were calculated from the replies to this questionnaire. RESULTS: Twenty-four physicians included 400 patients. Twelve patients were lost to follow-up (3 %). In the group that received the patient information leaflet, patient behavior was closer to that recommended by the guidelines than in the control group (mean behavior score 4.9 versus 4.2, p < 0.01). Knowledge was better for adults receiving the leaflet than in the control group (mean knowledge score 4.2 versus 3.6, p < 0.01). There were fewer visits for the same symptoms by household members of patients given leaflets (23.4 % vs. 56.2 %, p < 0.01). CONCLUSION: Patient information leaflets given by the physician during the consultation significantly modify the patient's behavior and knowledge of the disease, compared with patients not receiving the leaflets, for the conditions studied.

Children's quality of life after adenotonsillectomy.

OBJECTIVE: Although adenotonsillectomy is one of the most frequently performed surgical procedures in the pediatric population, its impact on health-related quality of life (HRQL) has not been well established. The objective of this study was to determine the impact of adenotonsillectomy on children's HRQL. METHODS: Parents of the children who underwent adenotonsillectomy were invited to our clinic approximately one year after the surgery for a face-to-face survey to evaluate their child's HRQL. In total, 119 parents of children who underwent adenotonsillectomy for different reasons were interviewed. To quantify the benefit of the operation, the Glasgow Children's Benefit Inventory (GCBI) was used. RESULTS: The mean GCBI score was 58 +/- 17.5 (minimum -22.9, maximum 79.2), indicating an increase in overall HRQL. Gender had no influence on the GCBI scores (p > 0.05). Satisfaction scores of the children aged 2-6 years were significantly higher than those of other age groups. CONCLUSION: Surgical treatment of chronic adenotonsillar disease has a positive impact on children's HRQL. Although surgery is highly effective in all age groups, in terms of children's quality of life, better results can be obtained if the operation is done in the earliest years of life.

Recurrent tonsillitis in adults: quality of life after tonsillectomy.

BACKGROUND: The aim of this study was to assess the effect of tonsillectomy in adults with recurrent tonsillitis on their quality of life and on their use of medical resources. METHOD: 114 patients who had had at least three episodes of acute tonsillitis in the 12 months preceding tonsillectomy were evaluated pre- and postoperatively with a questionnaire developed by the authors, and with the Glasgow Benefit Inventory. RESULTS: 97 patients (85%) filled out the questionnaires completely. The Glasgow Benefit Inventory revealed an improvement in the overall score (+19) and in the partial scores for general well-being (+18) and physical health (+39). The degree of support from friends and family was unchanged (±0). Significant decreases were observed in visits to a physician, analgesic and antibiotic consumption, days off from work, and episodes of sore throat. The number of visits to a physician because of sore throat decreased from an average of five preoperatively to one postoperatively; the number of episodes of sore throat, from seven to two; and the number of days taken off from work, from twelve to one per year. 65% of the patients surveyed took analgesics for sore throat preoperatively, 7% postoperatively. 95% took antibiotics for sore throat preoperatively, 22% postoperatively. CONCLUSION: Although this study had a number of limitations (small size, retrospective design, short follow-up), it was able to show that tonsillectomy for adults with recurrent tonsillitis improves health and quality of life and reduces the need to consume medical resources.

'I've just taken you to see the man with the CD on his head': the experience and management of recurrent sore throat in children.

Tonsillectomies for children with recurrent sore throat are common. There is a perception amongst medical professionals that parents are eager for surgical intervention but the parent/child perspective is overlooked in the literature. This study aimed to identify parent/child experience of recurrent sore throat. The study was qualitative, using grounded theory approach to data collection/analysis. Semi-structured, in-depth, interviews were conducted with 12 dyads of children (aged 4-16) and their parents, attending two Ear, Nose and Throat outpatient clinics held at a hospital in North East England, referred by their General Practitioner for recurrent sore throats. Analysis revealed recurrent sore throats significantly affected the families' quality of life. Families felt the need for antibiotics and tonsillectomies although parent and child were not always in agreement over their choice of treatment. Families felt empowered when the health care system showed some flexibility, such as allowing self re-referral, giving families greater choice in the way they managed the condition. Policy makers need to be aware of the consequences of recurrent sore throats in children and the needs of families in managing this chronic condition. More flexible approaches to health care, such as self re-referral and use of waiting list to review symptoms, may be needed if the number of tonsillectomies is to be reduced.

Factors affecting quality-of-life impact of adult tonsillectomy.

OBJECTIVE: To assess the quality of life of adult patients with recurrent tonsillitis after tonsillectomy, and to determine predictive factors for patient satisfaction. METHODS: In a prospective cohort study, a Glasgow benefit inventory questionnaire was posted to 70 adult patients six months after tonsillectomy for recurrent tonsillitis. Data were obtained on patient characteristics, risk factors, tonsillitis history, and clinical and operative findings. The patients were also assessed using self-completed diary data collection regarding acute symptoms (i.e. fever, throat pain, cough and rhinitis), tonsillitis episodes and visits to a doctor, either three to six months before tonsillectomy or six months after tonsillectomy. Predictive factors were sought for inclusion in the worst 30th percentile of patients (i.e. Glasgow benefit inventory score under 18), regarding post-operative change in quality of life. RESULTS: Sixty-two patients (40 females, 22 males; age range 15-46 years) returned the questionnaire (response rate 89 per cent). The mean total Glasgow benefit inventory score after tonsillectomy was +26 (standard deviation 14). The mean scores for Glasgow benefit inventory subscales were: general health +25 (standard deviation 18), social functioning +5 (standard deviation 14) and physical functioning +55 (standard deviation 23). The only factors associated with low patient satisfaction were a small number of tonsillitis episodes (diary-based data) and days with fever before tonsillectomy. CONCLUSIONS: Adult patients with recurrent tonsillitis seemed to be generally pleased with their tonsillectomy. The more symptoms they had prior to surgery, the greater was their improvement in quality of life. No other patient- or disease-related factors were associated with patient satisfaction.

Tonsillectomy may cause altered tongue sensation in adult patients.

OBJECTIVES: To determine the frequency of altered tongue sensation following tonsillectomy, and its relationship to different surgical techniques. DESIGN: Case-control study. SETTING: District general hospital. PARTICIPANTS: One hundred and four consecutive adults undergoing tonsillectomy, and 43 control patients. MAIN OUTCOME MEASURES: Altered tongue sensation. RESULTS: Twenty-eight of 100 patients described altered tongue sensation post-tonsillectomy. No patients in the control group experienced altered tongue sensation. There was a difference in rates of altered sensation between tonsillectomy patient groups undergoing bipolar diathermy and 'cold steel' techniques (p < 0.019). Three months after surgery, 22/23 contactable patients reported complete recovery of tongue sensation. One patient experienced tongue paraesthesia persisting until one year post-tonsillectomy. CONCLUSION: Tonsillectomy resulted in altered tongue sensation in 28 per cent of our study group. Bipolar diathermy dissection was significantly more likely to cause altered sensation than cold steel dissection. Ninety-six per cent of these disturbances resolved by three months, all by one year. Possible alteration of tongue sensation should be discussed whilst obtaining consent for tonsillectomy.

Quality of life after tonsillectomy in children with recurrent tonsillitis.

OBJECTIVE: To describe changes in disease-specific and global quality of life (QOL) for children with recurrent or chronic tonsillitis at 6 months and 1 year after tonsillectomy using two validated instruments, the Tonsil and Adenoid Health Status Instrument (TAHSI) and the Child Health Questionaire-PF28 (CHQ-PF28). STUDY DESIGN AND SETTING: A multicenter, prospective observational outcomes study. RESULTS: Ninety-two children, mean age (SD) 10.6 (3.4) years, enrolled with follow-up available for 58 children at 6 months and 38 children at 1 year. The children showed significant improvements in all subscales of the TAHSI including airway and breathing, infection, health care utilization, cost of care, eating and swallowing (all P < 0.001), and behavior (P = 0.01). Significant improvements were also found on several subscales of the CHQ-PF28, such as general health perceptions, physical functioning, parental impact, and family activities (all P < 0.001). CONCLUSION/SIGNIFICANCE: This uncontrolled study provides prospective evidence of improved disease-specific and global QOL in children after tonsillectomy.

The impact of adenotonsillectomy on children's quality of life.

OBJECTIVES: Although adenotonsillectomy is one of the most frequently performed surgical procedures in the pediatric population, there is little known about its impact on Health-related Quality of Life (HRQL). The aim of this study was to measure children's HRQL-benefit after adenotonsillectomy. DESIGN AND SETTING: The study was carried out as a retrospective postal survey utilising a proxy rating. PARTICIPANTS: In total, 447 parents of children who underwent adenotonsillectomy for the indication of chronic tonsillitis were included. 43% (n = 191) of the parents returned completed surveys. MAIN OUTCOME MEASURES: To quantify the benefit after pediatric adenotonsillectomy the Glasgow Children's Benefit Inventory (GCBI) was used. RESULTS: Mean GCBI-total score was 21 +/- 19 (-8 to 77), showing an improvement in all GCBI subscales. CONCLUSIONS: Adenotonsillectomy is a highly effective approach to treat children with tonsil disease. It has a positive impact on children's HRQL and other areas not directly associated with their tonsil disease. Moreover, this improvement in HRQL is durable and not temporary.

Impact of tonsillectomy on quality of life in adults with chronic tonsillitis.

OBJECTIVES: Tonsillectomy is one of the most frequently performed surgical procedures. Nevertheless there is less known about the impact of this procedure on Health-Related Quality of life (HRQOL). The two different most common used surgical techniques are "cold" (CT) and "hot" (HT) tonsillectomy. The aim of this study was to measure patients' HRQOL-benefit after adult tonsillectomy with the indication of chronic tonsillitis and to compare HT and CT. METHODS: The Glasgow Benefit Inventory (GBI) was used to quantify the health benefit of CT and HT retrospectively in 600 patients aged 16 years and older. RESULTS: 227 of the patients returned the completed surveys. Mean total GBI score was 15.8 (18 SD, 13.2-18.4 CI) for CT and 11.6 (15 SD, 7-16.3 CI) for HT (p = 0.214). Patients reported an improvement in HRQOL in all GBI subscales. We could not find a significant difference in reported HRQOL benefit between HT and CT. CONCLUSION: Adult tonsillectomy, HT as well as CT, for the indication of chronic tonsillitis provides an improvement in HRQOL. This positive impact of tonsillectomy in patients with chronic tonsillitis should be considered in the clinical decision-making process for tonsillectomy.

Changes in behavior and attentional capacity after adenotonsillectomy.

The objective of this study was to quantify behavioral and attention capacity changes in children aged 4-11 y before and 3 mo after adenotonsillectomy (A/T). Overnight cardiorespiratory recordings were performed in 61 "behaviorally normal" children 1 wk before A/T. Tests of sustained attention using visual and auditory continuous performance tests (CPT) were completed by children 1 wk before and 3 mo after A/T. Behavioral Assessment Scales for Children (BASC) and a sleep questionnaire were completed by the parent/s at these same times. Results from overnight cardiorespiratory recordings showed that the children had mild sleep-related breathing disorders (SRBD) preoperatively with a mean apnea/hypopnea index of 3.0/h and a movement awakening index of 2.5/h. The majority had parent-perceived sleep and breathing difficulties that significantly improved post-A/T. BASC T scores for externalizing and internalizing behaviors improved post-A/T, e.g., behavioral symptom index mean pre-A/T was 56.2 (95% confidence interval, 52.8-59.6) compared with 50.9 (48.5-53.5) post-A/T. Some measures indicative of impulsivity and attentiveness obtained from the visual CPT before surgery, improved post-A/T, but no change was observed in any auditory CPT measures. Our data confirm improvements in subjective measures of sleep problems in children treated for SRBD and strengthen the notion of treating the disorder, not only related to the obvious clinical condition but also to the underlying sleep problems and adverse effects on daytime behavior and attention.