Are there alternatives to a tonsillectomy for pediatric OSA?

For many pediatricians, a tonsillectomy and adenectomy are the first line of treatment for a child with obstructive sleep apnea. But are they always necessary? 

A recent study published in the journal Pediatrics compared a group of Australian children who received a T&A for a diagnosis of mild OSA with a group of children who remained on the waiting list for the procedure. While the children who received a T&A were reported to have better sleep and behavior than the control group, there was no difference in cognitive function between the two groups.

For parents who are nervous about surgery in young children, this study might be good news, since it may be possible to delay surgery (and anesthesia) until the child is older and bigger without impacting their cognitive development. Additionally, in cases where the OSA is a function of smaller passages, it may lessen with growth, especially in cases like these, where the original impact was mild.

However, delaying surgery doesn’t mean that OSA has to go untreated. A study by the University of Sao Paolo in Brazil looked at orofacial muscle tone in children with tonsillar hypertrophy and OSA and found that, compared to children who snored but did not have OSA, the OSA children had poorer muscle tone.

Some therapies can provide a non-invasive intervention for poor orofacial muscle tone, and there is evidence that these therapies can reduce the effect of OSA in children. Especially in the case of children with only a mild case of OSA, parents may want to look into orofacial myofunctional therapy (OMT) as an alternative, especially in smaller children for whom anesthesia and surgery can be more dangerous.

How your practice can help

Dental practices that serve pediatric patients should consider having a team member train in OMT as part of their sleep apnea services. Since OMT can also help children develop better chewing,  swallowing, and tongue positioning habits, it can benefit the oral health of many young patients, and many communities do not currently have an OMT who works with children.

If you’d like to know more about pediatric OSA and its treatments, Dr. Dassani’s book Healthy Sleep, Happy Kids is available on Amazon.  

Dr. Meghna Dassani has practiced dentistry for over two decades and is passionate about the role dentists play in whole-body health. You can learn more at her website: MeghnaDassani.com.