Impact of tonsillectomy and adenoidectomy on child behavior

Abstract

Objective: To measure the impact of tonsillectomy and adenoidectomy (T and A) on children's behavioral and emotional problems using a standardized assessment. Design: Prospective study. Setting: Tertiary care children's hospital. Patients: Thirty-six children, aged 2 through 18 years, with symptoms of nighttime snoring, observed apneas, and daytime mouth breathing and physical examination results demonstrating 3+ or 4+ tonsils scheduled for T and A. Intervention: Parents completed a standard survey of their children's symptoms of sleep apnea and a standardized measure of children's competencies and problems, the Child Behavior Checklist for ages 2 through 3 years or 4 through 18 years, before T and A and 3 months postoperatively. Main Outcome Measure: The Child Behavior Checklist total problem score. Results: The preoperative Child Behavior Checklist total problem score was consistent with abnormal behavior for 10 children (28%). After T and A (n = 15), only 2 scores were abnormal, but the change was not statistically significant. In contrast, the mean total problem score was 7.5 points lower after surgery (95% confidence interval, 5.1-9.7), indicating a significant decrease (P < .001, matched t test). Conclusions: This pilot study demonstrates a high prevalence (28%) of abnormal behavior in children undergoing T and A for chronic upper airway obstruction. Scores on a standardized measure of behavior improve following T and A, but larger studies with increased statistical power are needed to clarify the degree of improvement and its clinical importance.