The effects of tonsillectomy and adenoidectomy on pulmonary arterial pressure in children B Mustafa Deniz YVlmaz, MD a, * , Ersel Onrat, MD b , Ali AltuntaY, MD a , DayVmi Kaya, MD b , Orhan Kemal Kahveci, MD a , Oktay O ¨ zel, MD a , Sefa Derekfy, MD a , Atac ¸C ¸ elik, MD b a Deparment of Otolaryngology–Head and Neck Surgery, Afyon Kocatepe University, Afyon, Turkey b Department of Cardiology, Afyon Kocatepe University, Afyon, Turkey Received 30 April 2004 Abstract Purpose: It is well known that hypertrophic tonsils and adenoids may cause upper-airway obstruction. The aim of this study is to determine the mean pulmonary arterial pressure (mPAP) in children with hypertrophic tonsils and adenoids and to clarify whether tonsillectomy and adenoidectomy (T&A) has any effect on mean pulmonary arterial pressure of these children. Materials and methods: Fifty-two randomly selected children (36 male, 16 female) aged between 4 and 11 (mean 7.7 F 2.5) a with a diagnosis of upper-airway obstruction resulting from hypertrophied tonsils and adenoids were included in our study. Thirty-three children were assigned as controls with similar age and sex distrubution with the study groups. Mean pulmonary arterial pressure was measured by using Doppler echocardiography preoperatively and mean 5.4 F 2.9 months postoperatively in all subjects. Results: When the mean pulmonary arterial pressure values of study and control group compared preoperatively, the mean pulmonary arterial pressure levels of the children in the study group were significantly higher than the mean pulmonary arterial pressure levels of the children in the control group ( P b .05) (study group mean PAP = 23.13 F 7.68, control group mean PAP = 16.11 F 7.24) (LeveneTs test, P b .05). When the preoperative and postoperative results were compared, it was found that there was a statistically significant decrease in mean pulmonary arterial pressures in these 52 children (preoperative mean PAP = 23.13 F 7.68, postoperative mean PAP = 17.00 F 6.99) (paired sample t test, P b .05). Twenty-seven of the 52 subjects in the study group were pulmonary hypertensive preoperatively. mPAPs of 18 of these children decreased to normal range yielding 9 subjects, and this was also found ststistically significant (McNemar test, P b .001). Conclusion: This study showed that obstructive adenoid and tonsillar hypertrophy causes higher mPAP values in children and revealed that T&A is an effective therapeutic measure in such patients. D 2005 Elsevier Inc. All rights reserved. It has been previosly reported in the literature that increased upper-airway resistance resulting from hypertro- phied tonsils and adenoids can cause intermittant airway obstruction, chronic alveolar hypoventilation, and even lead to severe cardiopulmonary complications like cor pulmo- nale. But most of the reports mentioning these effects are anectodal case reports [1-6]. Although cardiopulmonary sequela of pulmonary hypertension, including cor pulmo- nale and ultimately death, may develop in only a small number of children, these children appear to be part of a much larger group affected by partial upper airway obstruction, most commonly resulting from adenotonsillar hyperplasia [7]. The cardiopulmonary changes in this larger group, which have milder signs and symptoms, have not been investigated in detail. 0196-0709/$ – see front matter D 2005 Elsevier Inc. All rights reserved. doi:10.1016/j.amjoto.2004.06.008 B Presented at the 27th meeting of Turkish Society of Otolaryngology Head and Neck Surgery, October 4-9, 2003, Antalya, Turkey. * Corresponding author. AKU ¨ ANS AraYtVrma Hastanesi (Pembe Hastane), KBB AnabilimdalV, 03200 Afyon, Turkey. Tel.: +90 272 216 7901; fax: +90 272 217 2029. E-mail address: denizy@aku.edu.tr (M.D. YVlmaz). American Journal of Otolaryngology–Head and Neck Medicine and Surgery 26 (2005) 18 – 21