Adenotonsillar Hypertrophy and Upper Airway Obstruction in Evolutionary Perspective

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Abstract
Primary care physicians have become increasingly reluctant to refer children for tonsillectomy and adenoidectomy (T and A) during the past years while antimicrobial therapy for pharyngotonsillitis and otitis media has become more common. Consequently, more children retain tonsils and adenoids throughout the childhood years. Airway compromise from adenotonsillar hypertrophy is reported in 11 cases — 8 with insidious onset, 3 with acute onset. Typical symptoms occurring during sleep include snoring, snorting, enuresis and obstructive apnea. Daytime symptoms include hyponasal speech, oral respiration and morning cephalgia. Methods of assessing children with adenotonsillar hypertrophy and airway compromise included polysomnography and acoustic analysis of respiratory sounds. It appears that airway compromise from adenotonsillar hypertrophy is more common now that fewer children are undergoing T and A, is being more commonly recognized because of improved methods of assessment, or both.

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