title: Tonsillotomy in the treatment of obstructive sleep apnea syndrome in children: polysomnographic results.
abstract: BACKGROUND
  The therapy of choice in the treatment of pediatric obstructive sleep apnea syndrome (OSAS) consists of tonsillectomy or tonsillotomy combined with adenoidectomy. While tonsillectomy unfortunately has a notable risk of secondary hemorrhage and postoperative pain, tonsillotomy is safer and less painful for children. The effect of both surgical methods on symptoms of OSAS seems to be equal, but up to now postoperative polysomnographic data for children treated by tonsillotomy are missing.
  
  
  METHODS
  Twenty children aged 2-9 years (mean age: 4.1+/-2.0 years) with OSAS diagnosed by full-night polysomnography were included in the study. OSAS was defined as an apnea-hypopnea index (AHI) of 5 or more with minimum oxygen saturation (SaO(2) min) of less than 90%. Exclusion criteria were obesity, craniofacial abnormalities or other pulmonary, cardiac or metabolic diseases as well as a history of recurrent tonsillitis. All children were treated by CO(2) laser tonsillotomy and adenoidectomy. Three to 12 months (mean: 7.7 months) after the procedure a control-polysomnography was performed in all children.
  
  
  RESULTS
  No statistically significant changes were seen in the pre- and postoperative distribution of sleep stages, sleep efficacy and total sleep time. The AHI decreased from 14.9+/-8.7 to 1.1+/-1.6 (p<0.001), SaO(2) min increased from 71.1+/-11.1% to 91.2+/-3.5% (p<0.001). Thus, all children were cured by the operation.
  
  
  CONCLUSIONS
  These polysomnographic data show that CO(2) laser tonsillotomy in combination with adenoidectomy is highly effective in the treatment of pediatric OSAS and should be preferred over tonsillectomy because of less postoperative pain and a lower risk of postoperative bleeding.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, Ludwig-Maximilians-University Munich, University Hospital Grosshadern, Germany. rdelachaux@gmx.de
authors.forename: Richard
authors.initials: R
authors.lastname: de la Chaux
authors.forename: Christine
authors.initials: C
authors.lastname: Klemens
authors.forename: Martin
authors.initials: M
authors.lastname: Patscheider
authors.forename: Oliver
authors.initials: O
authors.lastname: Reichel
authors.forename: Alfred
authors.initials: A
authors.lastname: Dreher
mesh_terms: D000233:Adenoidectomy; D002245:Carbon Dioxide; D002648:Child; D002675:Child, Preschool; D004564:Electrocoagulation; D005260:Female; D006801:Humans; D008297:Male; D017286:Polysomnography; D020181:Sleep Apnea, Obstructive / Q000503:physiopathology* / Q000601:surgery*; D014068:Tonsillectomy / Q000379:methods; D016896:Treatment Outcome
chemical_list: D002245:Carbon Dioxide