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Child Behavior and Quality of Life Before and After Tonsillectomy and Adenoidectomy
Nira A. Goldstein, MD;
Mahnur Fatima, MD;
Thomas F. Campbell, PhD;
Richard M. Rosenfeld, MD, MPH
Arch Otolaryngol Head Neck Surg. 2002;128:770-775.
Objective To determine the relationship between child behavior and quality of
life before and after tonsillectomy and adenoidectomy by means of a standardized
assessment of child behavior, the Child Behavior Checklist (CBCL), and a validated
quality-of-life survey of pediatric obstructive sleep apnea, the OSA-18.
Design Before-after study.
Setting Hospital-based pediatric otolaryngology practice in a metropolitan area.
Participants Sixty-four children (mean [SD] age, 5.8 [3.1] years; 36 boys, 28 girls)
who underwent tonsillectomy and adenoidectomy for treatment of sleep-disordered
breathing or recurrent tonsillitis.
Intervention Parents or caretakers completed the OSA-18 and the CBCL for ages 2 to
3 years or 4 to 18 years before surgery and 3 months postoperatively.
Main Outcome Measures The OSA-18 mean survey scores and change scores, and the CBCL total
problem T scores and change in total problem T scores.
Results The mean (SD) preoperative OSA-18 score was 3.9 (1.5) and change score
was 2.3 (95% confidence interval, 1.9-2.7). The mean total problem score was
7.3 points lower after surgery (95% confidence interval, 4.9-9.7), indicating
a significant decrease (P<.001, matched t test). The preoperative CBCL total problem score was
consistent with abnormal behavior for 16 children (25%), but only 5 children
(8%) scored in the abnormal range postoperatively (P
= .03, log-likelihood ratio test). The OSA-18 preoperative mean survey score
had fair to good correlation with the preoperative CBCL total problem T score
(r = 0.50, P<.001, Pearson
correlation), and the OSA-18 change score had fair to good correlation with
the change in CBCL total problem T score (r = 0.54, P<.001, Pearson correlation).
Conclusions Behavioral and emotional difficulties are found in children with sleep-disordered
breathing before treatment and improve after intervention. Scores on a standardized
measure of assessment of behavior demonstrate significant correlation with
scores on a validated quality-of-life instrument.
From the Division of Pediatric Otolaryngology, State University of
New York Downstate Medical Center and the Long Island College Hospital, Brooklyn,
NY (Drs Goldstein, Fatima, and Rosenfeld); and Department of Communication
Science and Disorders, University of Pittsburgh, and Department of Audiology
and Communication Disorders, Children's Hospital of Pittsburgh, Pittsburgh,
Pa (Dr Campbell).
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