A 5-year-old boy presents with chronic mouth breathing, snoring, and observed apneas. Polysomnography shows an Apnea-Hypopnea Index (AHI) of 8 events/hour. The recommended first-line surgical treatment is:

• A Tonsillectomy alone
• B Adenotonsillectomy (AT) ✓
• C Adenoidectomy alone
• D CPAP therapy as first-line; surgery only if CPAP fails

Explanation

Adenotonsillectomy (combined adenoidectomy and tonsillectomy) is the first-line surgical treatment for pediatric obstructive sleep apnea, achieving cure in approximately 70–80% of otherwise healthy children. Tonsillectomy alone leaves adenoid hypertrophy uncorrected. CPAP is reserved for children with OSA who are not surgical candidates or who have failed surgery. AHI >5 in children is considered moderate OSA requiring intervention.

Reference: Dhingra Diseases of Ear, Nose and Throat, 7th ed.

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Written and medically reviewed by the StethoPrep medical team.