NEWS
ARCHIVE
October
14, 1998
TOPIC:
Adenoids, Breastfeeding, Pacifiers, Obstructive Sleep
Apnea, Airway, Functional Jaw Orthopedics
QUESTION: What do
all the above topics have in common?
ANSWER: They all impact
growth & development and health & sickness in
known phenomenal ways, and ways yet to be charted.
CITATION: The effect
of adenotonsillectomy in children with OSA, Int J Pediatr
Otorhinolaryngol 1998 Jun 1;44(1):51-8 Shintani T, Asakura
K, Kataura A Department of Otolaryngology, Sapporo Medical
University, Japan.
Adenotonsillar hypertrophy and abnormal
facial morphology are thought to be important for the
occurrence of obstructive sleep apnea syndrome (OSA).
We evaluated the effects of adenidectomy and/or tonsillectomy
and the relationship between the treatment results and
facial morphology in 134 children with OSA. Significant
improvements in apnea-hypopnea indes (AHI) and lowest
blood oxygen saturtion (SaO2) were noted and 78.5% of
the patients improved after adenoidectomy and/or tonsillectomy.
Additional operations were needed in two out of 13 cases
of the adenoidectomy group and two out of four cases
of the adeno-monotonsillectomy group. In the adenotonsillectomy
group, the unimproved children tended to have smaller
tonsils, narrower epipharyngeal airspace, and more poorly-developed
maxillary and mandibular protrusion than the improved
children. PMID: 9720681, UI: 98385635
DISCUSSION: It is
apparent that growth and development can drastically
affect infant health and for that matter health in life
after infancy. While adenotonsillectomy seems to be
a lost art in revival, Pediatricians for years balked
at removing Tonsils and Adenoids. But with the SUPERBUGS
coming and a generation of hypersensitive children,
mainly due to the blatent over-use of anti-biotics,
other modes of treatment are being revived--even leeches
and maggots. But just as this surgical treatment--T&A--
to open the airway and get rid of bad bugs may be revived,
so may other means of opening the airway. For airway
is a major health issue....and one that is rarely measured
or monitored. We assume all non-sick children have good
airways...but that is not true. There are plenty of
children with subclinical airway diseases including
OSA because no one is concentrating on that area of
diagnosis EXCEPT in the critically evident patients.
FUTURE: Just as height
and weight are monitored from birth through teenage
hood today, new measures of health await us in the future.
New growth charts diffentiating between breastfed and
bottle fed infants need be used; jaw growth; airway
patency; and blood oxygen levels will all be major monitored
areas in the future once norms are re-evaluated and
protocols established. Breastfeeding will be shown to
provide good growth and development of the jaws and
airway, while pacifiers will be shown to be devastatingly
destructive to growth and development of the jaws and
airway. Adenotonsillectomy and the related removal of
pathogens from the upper airway will become a welcome
standard and lead to healthier children overall and
billions in savings of time and money. And Functional
Jaw Orthopedics which today so often targets repair
of damaged jaw growth and development, will enter the
preventive field and be used more soon after birth in
post birth cranial evaluation, manipulation and treatment.
This will give infants a greater chance for normal growth
and development of the orofacial structures which is
so important from the initial latching on to mom...to
the extremely important 1st year of jaw and airway development...and
throughout the next 14-20 years of growth.
THOUGHTS?
Take Care,
Dr. David Page
