title: Evaluation and management of pediatric obstructive sleep apnea beyond tonsillectomy and adenoidectomy.
abstract: OBJECTIVE
  There is an increasing percentage of children with persistent obstructive sleep apnea (OSA) after removal of the tonsils and adenoids (T&A). Although sleep apnea has been an active area of research and treatment in the adult population, our awareness of this problem in children is still in its initial stages. In addition, therapies to successfully treat this residual OSA are still not fully established. It is important to develop evaluation and management protocols for these children.
  
  
  RESULTS
  This review will discuss risk factors associated with persistent OSA after T&A and techniques to evaluate the pediatric airway in order to identify the site, or sites, of obstruction. Various medical and surgical options are presented.
  
  
  CONCLUSIONS
  Clinicians need to be aware of the potential for persistent sleep disordered breathing and OSA in children, despite previous T&A. Evaluation protocols and techniques will differ in children, due to limitations in their cooperation during the physical examination. Alternative methods, such as airway endoscopy and cine MRI, are presented. Medical and surgical options are presented. Outcomes data for pediatric populations are rare. Multilevel, single stage surgery has a higher risk for oropharyngeal stenosis in children compared with adults and conservative, multistage approaches may be more appropriate.
authors: Department of Otolaryngology Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, University of Cincinnati, Ohio 45229, USA. Sally.Shott@cchmc.org
authors: Sally R
authors: SR
authors: Shott
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003952:Diagnostic Imaging; D004724:Endoscopy; D006801:Humans; D019186:Mandibular Advancement / Q000295:instrumentation; D009968:Orthodontic Appliances, Removable; D010155:Palatal Expansion Technique / Q000295:instrumentation; D017286:Polysomnography; D012307:Risk Factors; D020181:Sleep Apnea, Obstructive / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery*; D014068:Tonsillectomy / Q000009:adverse effects