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Nira A. Goldstein, MD; J. Christopher Post, MD; Richard M. Rosenfeld, MD, MPH; Thomas F. Campbell, PhD

Arch Otolaryngol Head Neck Surg. 2000;126:494-498.

Objective  To measure the impact of tonsillectomy and adenoidectomy (T&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&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&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&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&A for chronic upper airway obstruction. Scores on a standardized measure of behavior improve following T&A, but larger studies with increased statistical power are needed to clarify the degree of improvement and its clinical importance.

From the Division of Pediatric Otolaryngology, State University of New York Health Science Center at Brooklyn (Drs Goldstein and Rosenfeld); Department of Pediatric Otolaryngology, Allegheny General Hospital, Pittsburgh, Pa (Dr Post); and Department of Communication Science and Disorders, University of Pittsburgh, and Department of Audiology and Communication Disorders, Children's Hospital of Pittsburgh (Dr Campbell).

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