Presentation
Obese child (BMI >99%) with a recent history of tonsillitis presented with about one week of loud snoring and audible breathing on exam.
Patient Data
Moderately severe hypertrophy of the adenoidal soft tissues with moderately severe effacement of the nasopharyngeal airway.
Also noted is moderately severe hypertrophy of palatine tonsillar soft tissues.
The epiglottis is not well delineated on this exam.
The precervical prevertebral soft tissues are normal. Loss of normal cervical lordosis may be due to positioning. The bone density is normal. He is obese.
Case Discussion
Primary indications for adenotonsillectomy in the pediatric population include recurrent infections and obstructive sleep-disordered breathing (oSDB). Obstructive SDB is a spectrum of disorders ranging from primary snoring to obstructive sleep apnea (OSA).
OSA affects anywhere from 1.2-5.7% of the pediatric population; increased incidence correlates with the epidemic of obesity in children and its impact on a child's quality of life is often underestimated. Up to 40% of children with oSDB have associated behavioral problems (anxiety, depression, hyperactivity, secondary enuresis, aggression), which can result in poor school performance.
Obstructive SDB can also lead to growth failure and should be considered on the differential for failure to thrive. The impact of OSA on quality of life can be similar to that of other chronic illnesses, such as rheumatologic diseases.
Prompt ENT referral was recommended for detailed evaluation and possible adenoidectomy, adenotonsillectomy, and tonsillectomy.
This case was submitted with supervision and input from:
Soni C. Chawla, M.D.
Associate Professor
Department of Radiological Sciences
David Geffen School of Medicine at UCLA
Olive View - UCLA Medical Center