Long-Term Outcomes of Medical Treatment of Adenotonsillar Hypertrophy in Children With Obstructive Sleep Disordered Breathing.

Objective: Adenotonsillectomy is widely recognized as first-line treatment for obstructive sleep disordered breathing (oSDB), especially for older children with severe disease. The best course of treatment for children with milder oSDB is less clear. It has been our practice to offer surgical candidates with mild symptoms (snoring with occasional short, infrequent pauses by parental report) the option of medical treatment with an antibiotic and oral steroid. We examine the immediate and long term-effects of this intervention.

Methods: We reviewed the records of children presenting to our academic Pediatric Otolaryngology practice in the years 2000 to 2023. Tonsil size before and after treatment, resolution of snoring, and ultimate need for surgery were recorded. Follow-up phone calls were made to patient families when information was incomplete.

Results: One hundred sixty-nine patients underwent medical treatment for mild oSDB. Among children with acute (≤2 months) symptoms, 38% (20/53) had resolution of snoring and 42% (18/43) did not require surgery. Mean tonsil size (Brodsky grade) decreased from 2.58 to 2.20 after medical treatment in this group. Among children with chronic symptoms, 34% (26/77) had resolution of snoring and 30.0% (18/60) did not require surgery. Their mean tonsil size decreased from 2.58 to 2.13.

Conclusions: These results suggest that treatment of mild oSDB treatment with short-course amoxicillin-clavulanate and 5 days of prednisolone is safe and can result in resolution of snoring in many children. More than one third of children treated this way avoided surgery with follow-up averaging 5 years. These observations argue for a prospective, randomized trial of this medical treatment as an alternative to immediate surgery.

Level of evidence: 3 - retrospective review.