PubMed · 14899022
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1951-11-15. [Tonsillectomy].. https://pubmed.ncbi.nlm.nih.gov/14899022/
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Involution of lymphoid tissues in relation to age has not been defined for bottlenose dolphins (Tursiops truncatus). Twenty-five bottlenose dolphins from the coast of Texas and western Louisiana were examined and complete necropsies were performed with histological samples taken of nearly all tissues. Ages ranged from several days to 27 years. The histology of four lymphoid organs-thymus, pharyngeal tonsil, mucosa-associated lymphoid tissue (MALT) of the colon, and anal tonsil-was assessed. Numerical scores were assigned to specific morphological features, thus creating an involution score. Definable and scorable features of each organ were selected for evaluation and determination of loss of lymphoid elements. Neonatal dolphins were recorded as the reference standard for no involution. The highest score for each organ represented the greatest amount of retention of tissue elements. Thus, the lower the score, the greater degree of involution. Comparing involution scores to tooth age permitted an assessment of involution over time. The greatest degree of involution was found in the MALT of the colon. The MALT of the colon declined dramatically so that after age 10 it was absent from 4 of 14 animals and minimally present in 8 others. Thymic tissue also suffered a precipitous drop in volume after about age 5, but was found in animals up to 24 years of age. Involution was moderate and variable in both pharyngeal and anal tonsils. In some animals, these tissues were reduced in volume early, and prominent in others well into adult life (over 20 years).
Adenotonsillectomy (T&A) has established effectiveness for the treatment of obstructive sleep apnea (OSA). However, more than 20% of children with OSA have respiratory compromise requiring medical intervention in the postoperative period. The reasons for this complication are not well-defined. We aimed to compare the nature and severity of sleep-disordered breathing in children with mild and severe OSA on the first night following adenotonsillectomy. Ten children were classified into groups of mild and severe OSA, based on preoperative testing. On the first night after T&A, they underwent polysomnography, including electroencephalograph, submental electromyography, bilateral electro-oculograms, monitoring of respiratory movements, heart rate, ECG, and oxygen saturation. Sleep-disordered breathing was assessed by the apnea-hypopnea index, the SaO(2) nadir, and the desaturation index, including dips in saturation below 90% (DI(90)). Sleep quality was assessed by sleep efficiency, time spent in each sleep state, and respiratory arousal index. Obstructive events occurred postoperatively in all children, but were more frequent in those with severe OSA preoperatively: the median (interquartile range) mixed/obstructive apnea/hypopnea indicies were 6.9 (2.2-9.8) events/hr and 21.5 (15.1-112.1) events/hr for the mild OSA group and the severe OSA group, respectively (P = 0.009). Obstructive events were the major cause of desaturation during sleep postoperatively. Sleep quality was severely disrupted in both groups, with reductions in both slow-wave sleep and rapid eye movement sleep. In conclusion, despite removal of obstructing lymphoid tissue, upper airway obstruction occurred on the first postoperative night in children with OSA. This study is the first to demonstrate the mechanism of respiratory compromise after adenotonsillectomy, a common postoperative complication in children with severe OSA.
OBJECTIVES: To correlate polysomnographic findings with clinical history of apnea, the degree of obstruction caused by tonsillar hypertrophy, and to age group. STUDY DESIGN AND SETTING: 267 children with a clinical diagnosis of obstructive sleep apnea (OSAS) were evaluated. Patients were divided into preschool- and school-age categories, and subdivided in 3 additional groups, according to tonsillar hypertrophy. Polysomnographic findings were compared within groups. RESULTS: 34% of children had history of OSAS and normal polysomnographic findings. Tonsillar hypertrophy was correlated to more severe apnea among preschool-age children, but not among school-age children. Among children with tonsillar hypertrophy, more severe apnea was observed in preschool-age children than in school-age children. CONCLUSIONS: There is little correlation between polysomnographic and clinical findings in children with OSAS. SIGNIFICANCE: Adenotonsillar hypertrophy leads to more severe polysomnographic patterns in preschool-age children. More severe apnea is observed in younger children with adenotonsillar hypertrophy than in older ones.