title: Impact of allergic rhinitis on quality of life after adenotonsillectomy for pediatric sleep-disordered breathing.
abstract: BACKGROUND
  Adenotonsillar hypertrophy is an undisputed major contributor to the development of pediatric sleep-disordered breathing (SDB). However, some children with SDB have experienced a worsening of quality of life (QOL) after adenotonsillectomy. The purpose of this study was to identify the factors of deteriorating QOL after adenotonsillectomy.
  
  
  METHODS
  This was an observational cohort study at a single institute and consisted of 70 children with SDB who underwent adenotonsillectomy. The QOL was evaluated using the 18-item quality-of-life survey for obstructive sleep apnea (OSA-18) prior to surgery (S1), and at 1 month (S2), 6 months (S3), and 12 months (S4) postoperatively. Deterioration of QOL was defined as an increase in total scores of S3 and/or S4 by more than 25% of those on S2. Patients were categorized into rhinitis/nonrhinitis and atopy/non-atopy using the nasal symptom questionnaire and skin-prick test, respectively.
  
  
  RESULTS
  The mean total scores of S2 and S4 were significantly lower than those of S1 (p < 0.001); however, some patients (n = 27, 38.6%) experienced an increase in scores. Patients with worsened QOL showed higher total immunoglobulin E (IgE) levels (p = 0.034) and complained of a rhinitis symptom more frequently (p = 0.039). Children with atopy were more likely to experience deterioration of QOL than those without (p = 0.004). In addition, multivariate logistic regression analysis showed that allergic rhinitis (AR) was a predictor for deterioration of QOL.
  
  
  CONCLUSIONS
  This study suggests that AR may be a risk factor for deterioration of long-term QOL after adenotonsillectomy. Therefore, preoperative evaluation and proper management of AR might be considered in pediatric SDB.
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.
authors.forename: Dong-Kyu
authors.initials: DK
authors.lastname: Kim
authors.affiliation: Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Doo Hee
authors.initials: DH
authors.lastname: Han
mesh_terms: D000233:Adenoidectomy; D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000209:etiology*; D011300:Preoperative Care; D011788:Quality of Life; D065631:Rhinitis, Allergic / Q000150:complications*; D020181:Sleep Apnea, Obstructive / Q000150:complications / Q000601:surgery*; D014068:Tonsillectomy
keywords: adenoidectomy; allergic rhinitis; child; quality of life; sleep-disordered breathing; tonsillectomy