I have come across children with snoring and sleep apnea due to tonsil adenoid hypertrophy are given CPAP. What a punishment, it is absurd and cruel to be given a CPAP machine for a child to wear this gizmo, where as a simple tonsil adenoid operation completely cure the snoring and sleep apnea.
The parents are unaware whom to approach for the snoring problems of their kids. They go to pediatrician or pulmonologist, they do sleep study and prescribe CPAP.This is not the proper way. An ENT surgeon should examine the child and he will be in a better position to do surgery and correct the sleep apnea. This is applicable in adults snoring too. OSA-obstructive sleep apnea- must be treated by removing obstruction in the upper airway, not by CPAP, unless inoperable. CPAP has its place and selecting patients for CPAP is important, otherwise most patients don\’t use it and gives a bad reputation for this wonderful machine.
About CPAP and Surgical Options in Snoring and Sleep Apnea
The Snorers and Sleep apnea sufferers have no other choice but to use either CPAP or undergo surgery. There are nearly 200 Snore cure remedies available in the market, claiming “Snoring cure” but not very effective in severe cases.
CPAP Therapy is commonly prescribed and it is widely accepted all over the world. It has many advantages over other forms of treatment for snoring and sleep apnea. Patients take few days to get used to use this wonderful machine.
What is CPAP (Continuous Positive Airway Pressure)
A CPAP unit blows air into your nose using a small air compressor. A facemask or a set of nasal plugs is used to deliver air through your nose. The pressure of the air is adjusted to give adequate airflow to the nose to allow you to breathe vital oxygen supply and air into your lungs. There are manual and automatic machines, with or without humidifiers.
Disadvantages of CPAP
CPAP is commonly used for sleep apnea patients but some patients find it impossible to use. They find the mask uncomfortable and unnatural. Turning over in bed, and having ones movements restricted by the hose make it worse. CPAP users suffer countless problems when using the machine like headache, dry mouth, sinusitis, nasal congestion and claustrophobia. Most
CPAP has no battery back up and in power outage; they wake up in the middle of night. Carrying the mask and machine where ever you go is another hassle, also not able to use it while traveling in train or flight make it difficult for business travelers.
Obstructive sleep apnea can only be cured by removing the obstruction. That is the main objective for which complex surgical procedures are selected. There is no tailor made “one “surgical procedure that can cure the OSA. Please understand CPAP is not the answer for everyone, there is alternative treatment and cure.
Surgery has its limitations, not any one particular surgery can cure the complex issue of OSA. Different surgical techniques are available.
Of course the “pain factor” is one that frightens the patient and also the morbidity of surgery of its magnitude and carries high risk. Upper airway surgery is a challenge to anesthetist, if general anesthesia is opted. I would say “without pain, no gain”.
3.Snoring OSA in Children Treatment
Tonsillectomy and Adenoidectomy
Snoring and Sleep Apnea (Obstructive sleep apnea) affects up to 10-20% of children. Symptoms of OSA in children may consist of restless sleep, sweating during sleep, snoring, night terror, sleepwalking, bed wetting, daytime fatigue, hyperactive behavior and poor school performance due to an inability to concentrate. Some children only exhibit attention deficit and hyperactive behaviors. In addition, since OSA is a familial problem, it is commonly seen in siblings.
The cause of OSA in children is usually due to enlarged adenoid and Tonsils. However, nasal obstruction due to enlarged turbinates and jaw deformity can also be major contributors to developing OSA.
An X-ray Lateral Neck or a CT image of the Nasopharynx will show enlarged adenoid. A flexible nasal Endoscopy also helps to make the diagnosis. A sleep study if it can be done is of great use.
Treatment by Surgery
The primary treatment for OSA in children is adenoidectomy and tonsillectomy, gives one hundred percent cure. Occasionally, turbinate reduction by radiofrequency may be performed in conjunction with this primary treatment form.
Tonsil adenoid Operation
The duration of adenoidectomy and tonsillectomy is approximately 60 minutes and is performed under general anesthesia. The postoperative course consists of pain and swelling of the throat as well as reduction of food intake for a few days. Laser Tonsillectomy and Coblator tonsillectomy are routinely performed along with traditional dissection method. Microdebrider dissection of adenoid is also done recently.