Department of Otolaryngology, Faculty of Medicine, Cairo University, Cairo, Egypt.
Department of Otolaryngology, Aswan University, Aswan, Egypt.
Eur Arch Otorhinolaryngol. 2019 Dec;276(12):3413-3417. doi: 10.1007/s00405-019-05633-z. Epub 2019 Sep 13.
Pharyngeal flap surgery used for treatment of velopharyngeal insufficiency (VPI) may be followed by obstructive sleep apnea (OSA) especially if the patient has developed adenoid hypertrophy. However, adenoidectomy may adversely affect speech in these patients. The aim of this study was to assess the effectiveness of transnasal endoscopic power-assisted adenoidectomy in relieving OSA in patients with adenoid hypertrophy who underwent pharyngeal flap surgery, and the impact of the procedure on their speech.
Transnasal endoscopic power-assisted adenoidectomy for nine children presenting with adenoid hypertrophy was performed. The patients had previously undergone pharyngeal flap surgery for treatment of VPI. Flexible nasopharyngoscopy was used in the diagnosis of adenoid hypertrophy. Pre- and postoperative polysomnography with measurement of apnea-hypopnea index (AHI) was done. Additionally, auditory perceptual assessment of speech (APA) and nasalance scores was measured pre- and postoperatively.
All patients were shown to have OSA by polysomnography, and a larger adenoid size was significantly associated with a higher AHI. We achieved a significant improvement in AHI after adenoidectomy. However, six patients still demonstrated OSA, albeit with a reduced severity. Speech was not adversely affected postoperatively as the APA and nasalance scores showed non-significant changes.
Adenoid hypertrophy may be encountered in children who undergo pharyngeal flap surgery, which may cause OSA. Transnasal endoscopic power-assisted adenoidectomy is a safe and effective method for treatment of OSA in those patients without prejudicing the pharyngeal flap, and it has no adverse effect on speech.
用于治疗腭咽闭合不全（VPI）的悬雍垂腭咽成形术（PURPOSE: Pharyngeal flap surgery used for treatment of velopharyngeal insufficiency (VPI) may be followed by obstructive sleep apnea (OSA) especially if the patient has developed adenoid hypertrophy.）后，患者可能会出现阻塞性睡眠呼吸暂停（OSA），尤其是在患者已经出现腺样体肥大的情况下。然而，腺样体切除术可能会对这些患者的语音产生不利影响。本研究旨在评估经鼻内镜电动辅助腺样体切除术对接受悬雍垂腭咽成形术治疗的伴有腺样体肥大的患者缓解 OSA 的效果，以及该手术对其语音的影响。
对 9 例腺样体肥大的患儿进行经鼻内镜电动辅助腺样体切除术。这些患者先前因 VPI 而行悬雍垂腭咽成形术。采用纤维鼻咽喉镜诊断腺样体肥大。对所有患者行术前和术后多导睡眠监测（PSG），并测量呼吸暂停低通气指数（apnea-hypopnea index，AHI）。此外，还在术前和术后对所有患者进行语音感知评估（auditory perceptual assessment of speech，APA）和鼻音化率（nasalance scores）的测量。
所有患者均通过多导睡眠监测证实存在 OSA，且更大的腺样体大小与更高的 AHI 显著相关。我们在腺样体切除术后 AHI 显著改善。然而，6 例患者仍存在 OSA，但其严重程度降低。术后语音未受到不利影响，因为 APA 和鼻音化率的测量结果无显著变化。
在接受悬雍垂腭咽成形术的儿童中可能会遇到腺样体肥大，这可能导致 OSA。经鼻内镜电动辅助腺样体切除术是治疗这些患者 OSA 的一种安全有效的方法，不会对悬雍垂腭咽成形术造成损害，也不会对语音产生不利影响。
