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. 2023 Jun 1;19(6):1027-1033.
doi: 10.5664/jcsm.10468.

Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective

Egambaram Senthilvel  1 , Quang L Nguyen  2 , Bakeerathan Gunaratnam  3 , Yana B Feygin  1 , Rajaneeshankar Palani  1 , Karim El-Kersh  4
Affiliations

Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective

Egambaram Senthilvel et al. J Clin Sleep Med. .

Abstract

Study objectives: Recurrent/residual adenoid hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the role of soft tissue neck X-ray (STN-XR) in evaluating recurrent/residual adenoid tissue hypertrophy.

Methods: This was a single-center retrospective study that included children with sleep study-confirmed OSA and a known history of adenotonsillectomy who underwent STN-XR to evaluate for recurrent/residual adenoid tissue hypertrophy. STN-XR nasopharyngeal obliteration and baseline polysomnographic data were analyzed. Multiple linear regression was used to assess the independent relationship between the results of STN-XR and the total apnea-hypopnea index, while controlling for relevant characteristics.

Results: The study included 160 participants with a median age of 10 years (quartile [Q] 1 = 7, Q3 = 12.25). More than half of the children were male (59.4%) and the median body mass index z-score was 2.11 (Q1 = 1.23, Q3 = 2.54). STN-XR was normal in 39.4%, and it showed mild, moderate, and complete nasopharyngeal obliteration in 20.6%, 32.5%, and 7.5% of the participants, respectively. Multiple regression analysis showed that moderate and complete nasopharyngeal obliteration was associated with an increase in the mean total apnea-hypopnea index by 109% (P = .0002) and 185% (P = .001), respectively, when compared with children without nasopharyngeal obliteration. However, mild nasopharyngeal obliteration, body mass index z-score, age, sex, and race were not significantly associated with an increase in the total apnea-hypopnea index.

Conclusions: STN-XR was useful in assessing recurrent/residual adenoid tissue hypertrophy in children with OSA and a history of adenotonsillectomy. Moderate and complete nasopharyngeal obliteration were associated with significantly increased apnea-hypopnea index. Pediatric sleep physicians may consider STN-XR in the evaluation of children with OSA and previous history of adenotonsillectomy.

Citation: Senthilvel E, Nguyen QL, Gunaratnam B, Feygin YB, Palani R, El-Kersh K. Role of neck radiography in assessing recurrent/residual adenoid hypertrophy in children with OSA and history of adenotonsillectomy: a sleep physician perspective. J Clin Sleep Med. 2023;19(6):1027-1033.

Keywords: OSA; neck radiography; recurrence of adenoid; revision adenoidectomy.

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Conflict of interest statement

All authors contributed toward data analysis, drafting and revising the paper, and agree to be accountable for all aspects of the work. All authors approved the manuscript. Work for this study was performed at the University of Louisville, Norton Healthcare. The authors report no conflicts of interest.

Figures

Figure 1
Figure 1. Examples of neck radiography findings.
(A) Normal. (B) Mild nasopharyngeal obliteration. (C) Moderate nasopharyngeal obliteration. (D) Complete nasopharyngeal obliteration.
See this image and copyright information in PMC

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