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Table 5. Tonsillectomy and oSDB Caregiver Counseling
Summary
1. Enlarged tonsils is the most common reason that children develop oSDB.
2. oSDB is not solely due to enlarged tonsils; muscle tone also plays a role.
3. Obesity plays a major role in oSDB.
4. PSG is considered the best test to confirm that a child has OSA which would
benefit from surgery. It also provides baseline information in case there are
persistent symptoms after surgery.
5. A PSG is not necessary in all cases and access may be limited by availability of
sleep laboratories and willingness of insurers and third-party payers to cover the
cost of testing. For an otherwise healthy child with a strong history of struggling
to breathe with daytime symptoms and enlarged tonsils, a PSG is typically not
performed unless the parents want to confirm the diagnosis.
6. The success of tonsillectomy is variable. The age, weight, ethnicity, OSA severity,
and associated medical conditions all affect the success. Younger, normal weight,
non-African-American children may have a resolution of oSDB of 80%.
7. For obese children, tonsillectomy produces complete resolution of oSDB <50%
of the time.
8. Caregivers need to be aware that their child may require additional interventions
to cure his/her oSDB which can vary from weight loss, medications, or wearing a
special mask while sleeping that will keep the airway open. Some children may be
candidates for more advanced sleep surgery procedures.
Figure 1. Subjective Tonsil Grading Scale
