الفهرس 
Anatomy and Developmental characteristics of the Upper Airway in ChildhoodOnly 14 pages are availabe for public view
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Abstract
Background: Sleep disordered breathing is a common pediatric condition (4-11%).Enlarged tonsil and adenoid is one of the commonest causes of SDB so adenotonsillectomy (AT) is decidedly advocated as the first line of treatment. However, 20-40% of patients will have persistent signs and symptoms of SDB after AT. Drug-induced sleep endoscopy (DISE) involves assessment of the upper airway using a flexible endoscope while patients are in a pharmacologically-induced sleep-like state. DISE may provide a more individualized surgical plan, predict factors that may cause treatment failure and limit unsuccessful surgeries. The aim of this study was to predict factors of failure that cause persistent sleep disordered breathing in children after adenoidectomy &/or tonsillectomy using DISE variables.
Patients and methods: This is a prospective non randomized case series study included 100 patients, presenting with symptoms of SDB, A pediatric sleep questionnaire (PSQ) asked to be completed by the parents of every child who will undergo adenoidectomy &/or tonsillectomy for SDB before and after operation. Patients 2–12 years of age who underwent DISE-directed adenoidectomy &/or tonsillectomy for SDB between July 2017 & May 2018 were eligible. Children who had previous operation for SDB and syndromic children are excluded. Other variables include history of asthma, BMI, snoring duration, history of allergic rhinitis, tonsil size according to Brodsky score, and adenoid size on x-ray.
Results: 100 children satisfied the inclusion criteria. Based on post-operative modified PSQ, SDB resolved in 81 patients (81%), whereas 19 (19%) had persistent symptoms. Findings observed in failed cases using DISE were; allergic rhinitis (severe form), inferior turbinate hypertrophy, deviated nasal septum (DNS), tongue base collapse, lateral pharyngeal wall collapse, lingual tonsil hypertrophy and retroflexed epiglottis. Also children who are obese and asthmatic showed treatment failure.
Conclusions: Despite the prevalence of AT for treatment of SDB, about 20% of Patients will show treatment failure. DISE is a safe and useful technique for exact localization of sites of upper airway obstruction, improving surgical planning, elimination of unnecessary procedures, and improving surgical outcomes.
Key words: adenoidectomy, tonsillectomy, AT, pediatric sleep disordered breathing (SDB), DISE..