Outcome of tonsillotomy in children with obstructive sleep-disordered breathing.

OBJECTIVE/BACKGROUND: Most children treated for obstructive sleep disordered breathing (oSDB) are not systematically assessed by polysomnography (PSG) nor by structuredsymptom quantification before surgical treatment. The main objective of this study wasto investigate the effect of adeno-tonsillotomy (ATO) on symptom burden and PSGparameters. METHODS: Children aged 2-10 years with oSDB were selected for ATO based uponclinical findings according to current standards of care in Denmark. Each childunderwent standardized assessment before and 3 months after surgery, including aPSG, tonsil size assessment, and the Pediatric Sleep Questionnaire -Sleep RelatedBreathing Disorder (PSQ) to quantify symptom burden. Obstructive sleep apnea (OSA)was defined as an obstructive apnea-hypopnea index (oAHI) ≥2/h. Successfultreatment was defined as post-surgery oAHI ≤5/h, and complete cure as oAHI ≤2/h. RESULTS: Fifty-two children were included. Mean age was 5.0 years (SD ± 1.76). Thirteen children were identified with baseline oAHI <2/h. Significant improvement inOSA severity was observed in children with moderate-to-severe OSA, in whom oAHI decreased from 15.7/h to 2.6/h (p < 0.001). Treatment success was obtained in 85% and cure was obtained in 42% of children. PSQ-score significantly improved from 0.52 (CI 0.47-0.56) to 0.26 (CI 0.21-0.32) (p < 0.001). Baseline OSA severity was notcorrelated to baseline symptom burden nor to symptom relief after ATO. There were noserious adverse events. CONCLUSIONS: Adeno-tonsillotomy significantly reduced symptom burden in otherwise healthy children with oSDB symptoms. Significant improvement in oAHI was observedonly in children with moderate-to-severe OSA. We recommend combining clinicalevaluation with PSQ and oAHI.

Feasibility of conducting type III home sleep apnoea test in children.

OBJECTIVES: To test the feasibility of conducting unattended paediatric type III HSAT and to identify issues for improvements to optimize signal quality. MATERIAL AND METHODS: Parents were instructed in setting up the unattended HSAT and reported their experiences. Signal quality and causes of signal failure of recordings were assessed. RESULTS: Forty children were included. Mean age was 5.2 years. Predefined success criteria were met in 53% of recordings. Main causes of signal failure were nasal cannula, pulse-oximetry and battery failure. Sensor fixation techniques were developed and implemented during the study and hence signal quality improved. Seventeen (94%) parents reported HSAT to be either easy or medium hard to use.Conclusions and significance: Unattended paediatric type III HSAT can be conducted at home with acceptable signal quality. Signal quality improved considerably using simple sensor fixation techniques.

Longterm results after tonsillotomy: outcome, residual symptoms and need for revision surgery.

Background: Tonsillotomy (TT) has gradually replaced tonsillectomy for children with upper airway obstruction during sleep in Denmark. The disadvantage is potential tonsil regrowth.Objectives: To present results on outcome of TT in a Danish hospital setting.Material and methods: Observational cohort study with follow up. All patients were invited for a postoperative examination/telephone interview and to fill in a questionnaire.Results: Medical records from 141 consecutive children up to 12 years of age who underwent TT with or without adenoidectomy in 2015 and 2016 were analyzed. Median follow up time was 33 months (18-41 months), 132 (94%) completed the questionnaire, of which 84 underwent clinical examination. 97% would recommend the procedure. At follow up, a significant reduction of all symptoms was found as well as a significant increase in BMI. Tonsil size ≤ 2 was observed in 81% of patients at follow up. One patient had been referred due to postoperative bleeding. Six patients needed revision tonsil surgery.Conclusion and significance: TT is a safe and effective procedure. However, due to the risk of regrowth of tonsils or recurrent tonsillitis, revision surgery may be necessary, and physicians should pay attention to the risk of recurrence of obstructive symptoms.

Diagnostic challenges in otogenic brain abscesses.

INTRODUCTION: Otogenic brain abscess (OBA) is a rare complication to otitis media, but one with a potentially devastating outcome. Early diagnosis of OBA is crucial for successful treatment. The objective of this study was to determine the incidence of OBA in a Danish population and to describe its clinical manifestation, management and outcome. MATERIAL AND METHODS: A total of 93 patients were retrospectively enrolled by diagnosis codes for brain abscess from 1999 to 2010. Records were reviewed to register age, symptoms, clinical findings, co-morbidity, imaging, microbiology and treatment. RESULTS: Seven were found to have had an otogenic focus of infection. The incidence of OBA was 1/million, and the mean age was 43 years, ranging from ten to 81 years. Five patients had acute otitis media and two had infectious cholesteatoma. Four had previously suffered a head trauma. The young patients presented with symptoms indicative of meningitis and the elderly patients with symptoms resembling a stroke. None of the patients were treated with antibiotics before admission to hospital. No mortalities occurred, but three had sequelae in the form of hearing loss and/or neurological impairment. CONCLUSION: The OBAs manifested with symptoms mimicking meningitis in young patients and stroke in elderly patients. Absence of fever does not rule out OBA; and regardless of any present ear symptoms, an ear, nose and throat examination should be performed without delay to locate the focus of infection and to facilitate targeted treatment. FUNDING: not relevant. TRIAL REGISTRATION: not relevant.