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Can a Surgical Option Treat Childhood Sleep Apnea?

How a familiar childhood procedure is helping kids sleep better

Published on: October 30, 2019

little girl sleeping soundly

Editor's note: This article was sponsored by the Polyclinic. For more than 100 years, The Polyclinic has served the Seattle community with a mission to promote the health of its patients with personalized care. Our team of more than 240 doctors and advanced-practice professionals provides care at 12 locations, offering primary care, nearly every medical and surgical specialty, and a comprehensive range of services, including lab, diagnostic imaging, urgent care, and an outpatient surgery center.

A generation ago, most childhood tonsil-removal surgeries were recommended to treat frequent, painful throat infections. And tonsil-removal surgery, or tonsillectomy, still provides relief from recurrent strep throat, a common childhood ailment. But that’s not what brings most pediatric patients in to consult with Fariha S. Farid, D.O., an ENT physician in practice at The Polyclinic’s Northgate Plaza and Madison clinics.

While today’s parents and grandparents may have had enlarged tonsils removed due to frequent strep infections, most modern pediatric tonsil removals are performed to treat obstructive sleep apnea, or OSA.

“Thirty years ago, 90 percent of tonsillectomies were done for infection,” says Farid. “Today, just 20 percent are done for infection, and 80 percent are for OSA.” She attributes this shift to multiple factors, including rising rates of pediatric OSA and stricter guidelines from the American Academy of Otolaryngology around performing tonsillectomy.

How tonsillectomy relieves pediatric OSA

Pediatric sleep apnea occurs when a child’s airway is obstructed during sleep, resulting in brief interruptions in breathing. Although OSA is commonly associated with adults — generally males in midlife — the disorder is also common in children. According to studies on the general pediatric population, as many as 5.7 percent of children experience OSA.

Most cases of OSA in children are linked to anatomy and genetics; underlying factors include enlarged tonsils, obesity and anatomical or neuromuscular characteristics. Helping children with OSA is important, because untreated OSA is linked to a variety of physical, emotional and behavioral problems, from bed-wetting and sleep terrors to hyperactivity, insomnia and depression. In adults, OSA is linked to mood disorders, cardiovascular disease and diabetes.

For children with enlarged tonsils (which are pillowy mounds of lymphatic tissue at the top of the airway), breathing can be blocked when the muscles of the mouth, face and throat relax during sleep. Tonsillectomy removes this tissue. A 2017 analysis of four studies on tonsillectomy patients with a mean age of 8.3 found that tonsillectomy significantly reduced sleep-disordered breathing and improved blood-oxygen levels.

Nonsurgical treatments for pediatric OSA include medication, oral appliances and continuous positive airway pressure (CPAP) therapy. Noninvasive approaches include myofunctional therapy (MFT), a method of exercising facial muscles to strengthen the mouth and tongue. Tonsillectomy can be combined with other therapies to treat pediatric OSA, says Farid. 

What to expect, from diagnosis to recovery

Children with persistent sleep difficulties or those who snore may be referred for a sleep study, an overnight test that monitors nighttime breathing to diagnose OSA. After a child is diagnosed with OSA, the family may be referred to an ENT physician for a consultation. If a child is a candidate for tonsillectomy, caregivers may have the option of choosing between several different surgical techniques to remove the tonsils.

Electrocautery tonsillectomy uses high heat to destroy tonsil tissue quickly and with less postoperative bleeding than other methods. Other methods include the harmonic scalpel and a newer procedure called coblation, which involves radiofrequency at a low temperature to gently and precisely remove tissue, which may result in a less painful recovery.

No matter which method is used, parents and caregivers can expect to sacrifice some sleep during their child’s recovery. Healing generally takes about two weeks, longer if the tonsils are removed together with the adenoids (the glands located where the nose meets the throat behind the soft palate).    

But there’s good news: Pediatric tonsillectomy patients tend to heal more quickly and handle postoperative pain better than adult patients, says Farid.

“Most pediatric tonsillectomy patients are 15 or younger, and most of my tonsillectomy patients have been under 10,” says Farid. “The younger the patient, the better they tend to handle the surgery and recovery process. Patients 6 and younger usually do great; older children and teenagers may experience more pain or discomfort postoperatively.”

Postoperative bleeding is the biggest health concern during recovery; up to 2.2 percent of patients experience bleeding within 24 hours of tonsillectomy, says Farid. Any sign of bleeding (more than a few drops, or a slight pink tinge after a child gargles with ice water) is a medical emergency warranting a visit to the emergency room.

Making sure children take pain medication on a strict schedule is another caregiver responsibility. “Kids tend to do well after surgery — it’s the caregivers who are on call constantly. Staying ahead of a child’s pain and dosing medications on time is vital, which might mean waking up in the night to give medication, especially in the first week after surgery,” says Farid.

After young patients heal from tonsillectomy, many experience improved sleep and get sick less often, says Farid. And though many parents ask whether tonsil removal will hurt their child’s immune system, there are no studies that show a negative impact on immune function, she notes.

“It’s important to have a good conversation with your ENT about what to expect before, during and after tonsillectomy. It’s normal to be worried before your child has surgery,” says Farid. “But after surgery, most parents say their child did great.”

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