Snoring

Snoring in children, in and of itself, does not warrant absolute treatment but may indicate the presence of obstructive sleep apnea (OSA). The most common cause of obstruction is adenoid and tonsillar hypertrophy. Adenotonsillectomy eliminates obstruction in 85–95% of otherwise normal children with OSA.

Differential Diagnosis

• Congenital/anatomic
  –Midface hypoplasia
  –Retrognathia
  –Macroglossia
  –Base of tongue collapse
  –Nasal septal deviation
  –Severe laryngomalacia
  –Craniofacial syndromes
  –Pierre Robin sequence
       –Treacher Collins
       –Goldenhar
       –Nager
       –Apert
       –Klippel-Feil
  –Choanal atresia

• Infectious/inflammatory
  –Adenotonsillar hypertrophy
  –Viral and bacterial rhinosinusitis
  –Allergies
  –Nasal polyposis
  –Gastroesophageal reflux disease
• Tumors
  –Encephalocele
  –Dermoids
  –Gliomas
  –Juvenile nasopharyngeal angiofibroma
  –Chordoma
  –Craniopharyngioma
  –Thyroid tumors
• Neurologic
  –Cerebral palsy: Hypotonia may lead to collapsing pharyngeal soft tissue
  –Myopathies
  –Anoxic encephalopathy
• Systemic
  –Mucopolysaccharide storage disease
  –Cystic fibrosis
• Iatrogenic
  –Prior cleft palate repair
  –Nasopharyngeal stenosis
  –Pharyngeal flap
• Obesity (either as an isolated problem or a contributor to one of the above pathologies)

Workup and Diagnosis

• History
  –Loud snoring, mouth breathing, apneic episodes, gasping or snorting, daytime fatigue or restlessness, nocturnal enuresis, failure to thrive, dysphagia
  –Medical history: Cardiovascular anomalies, craniofacial syndromes, prior surgery in the mouth

• Physical exam
  –Midfacial hypoplasia, retrognathia or micrognathia
  –Tonsillar hypertrophy, nasal mass, adenoid facies
  –Obesity
  –Hyponasal speech

• Studies
  –Lateral skull film evaluates adenoid size
  –Flexible fiberoptic nasopharyngoscopy evaluates nasal cavity, adenoid size, base of tongue, larynx
  –CT of face: Consider for craniofacial anomalies
  –Audio- and videotape of sleep from home
  –Polysomnogram is the gold standard to evaluate for sleep apnea and associated sleep disorders; not necessary in all cases; consider in those with complex medical problems, age <2, or severe history out of proportion to normal exam
  –ECG and chest X-ray if cardiopulmonary disease suspected

Treatment

• Snoring requires treatment only when associated with obstructive sleep apnea
• Medical options
  –Weight loss, if obese
  –Treatment of nasal obstruction
  –30 days of amoxicillin plus clavulanate may be considered in those with mild symptoms to reduce adenotonsillar size
  –CPAP or BiPAP if surgery is contraindicated
• Adenotonsillectomy: First-line surgical treatment
• Uvulopalatopharyngoplasty: Not commonly performed in children
• Midface or mandibular advancement if craniofacial anomalies contributing to OSA
• Tracheotomy: Definitive procedure, because obstruction is bypassed; performed only in extreme cases
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Book Source Details

• Book Title: In A Page: Pediatric Signs and Symptoms
• Author(s): Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan
• Year of Publication: 2007
• Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2007 Lippincott Williams & Wilkins.

Other Book Chapters Related to Snoring

Read excerpts from these other book chapters related to Snoring:

Copyright Details: In A Page: Pediatric Signs and Symptoms, Copyright © 2008 Williams & Wilkins.

More About Causes of Snoring

• Back to symptom: Snoring: Introduction (review 35 causes)
• Next Book Extract About Snoring: STRIDOR AND SNORING (Differential Diagnosis in Primary Care)
• All Book Extracts: All Online Book Extracts for Snoring

More About This Book: Title: In A Page: Pediatric Signs and Symptoms Authors: Jonathan E. Teitelbaum, Kathleen O. Deantonis, Scott Kahan Publisher: Lippincott Williams & Wilkins Copyright: 2007 ISBN: 1-4051-0427-9

 » Next page: STRIDOR AND SNORING (Differential Diagnosis in Primary Care)

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