Child Sleeping
April 18, 2020 | by The Polyclinic

By: Malia Jacobson, ParentMap

This article was published in the November edition of ParentMap as sponsored content from The Polyclinic

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 campuses.

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.