Incidence of Cardiopulmonary Manifestations in Patients with Adenotonsillar Hypertrophy

Abstract

Background

Adenotonsillar hypertrophy (ATH) is a common clinical problem in the pediatric age group. The treatment is primarily through oral medications and precautionary measures. In case of persistent and refracting cases causing significant airway obstruction, adenotonsillectomy is advised. In severe ATH and longstanding obstruction of airway, patient is prone to develop apneic spells and cardiopulmonary compromise. It then becomes essential to perform cardiac evaluation in such cases for effective management of the disease.

Objective

To evaluate the incidence of cardiopulmonary complications in children with longstanding adenotonsillar hypertrophy and significant airway obstruction.

Study Design

This is a tertiary hospital based observational prospective study at the Otorhinolaryngology, Department of Children Hospital and Institute of Child Health, Lahore, from October 2021- November 2022.

Results

Total 110 patients were enrolled in this study with male to female ratio of 1.6:1. According to Brodsky classification, 82 (75%) had grade 3+ whereas 28 (25%) had grade 4+ tonsillar hypertrophy. All the patients had symptoms of moderate or severe snoring and apnea. ECG and Echocardiography of all the 110 patients showed cardiac manifestations which was completely resolved in 107 patients after 6 months of adenotonsillectomy, 2 patients were having remitting features and only one patient had persistent cardiac anomaly which was referred to cardiology dept. for further investigation.

Conclusion

Cardiac complications are found common in children suffering from severe adenotonsillar hypertrophy with OSAS for a prolonged period. In patients with significant (>60%) airway obstruction, pre-op cardiac evaluation and post operative cardiac monitoring is essential.

Keywords

Obstructive sleep apnea syndrome (OSAS), adenotonsillar hypertrophy, electrocardiography, ECG changes, adenotonsillectomy.