Intracapsular coblation tonsillectomy and adenoidectomy for the treatment of pediatric obstructive sleep apnea/hypopnea syndrome

Objective: To report the findings of five years' experience using standardized coblation intracapsular tonsillectomy with adenoidectomy for treatment of pediatric sleep apnea. Study Design: Case series. Methods: A five-year retrospective analysis of coblation tonsillectomy performed by a single department for sleep apnea was completed. Results: A total of 159 tonsillectomy and adenoidectomy (T&A) cases performed with coblation technique were reviewed. The mean preoperative apnea-hypopnea index (AHI) was 17.8 and mean postoperative AHI was 3.3. Polysomnogram (PSG) normalization (AHI < 1), was achieved in 54.7% patients. Normalization of PSG data was achieved in only 42.2% of overweight patients (body mass index [BMI] ≥ 85th percentile). Based on regression analysis, Friedman tongue position (III and IV) and elevated AHI were determined to be independent predictors of poor response to T&A. Conclusions: Contrary to popular belief, a review of 159 cases demonstrates that T&A does not always result in normalization of polysomnographic data. Although complete resolution is not achieved in most cases, T&A offers significant improvements in AHI. Predictive variables such as BMI, FTP, and AHI should be taken into account when designing a treatment plan. It is important to recognize the need for close follow-up and early detection of residual disease in the pediatric population.