A 5-year-old child with adenotonsillar hypertrophy is evaluated for OSA. Polysomnography shows an apnea-hypopnea index (AHI) of 12 events/hour. The most appropriate management is:

• A Adenotonsillectomy ✓
• B Observation and reassessment in 6 months
• C Continuous positive airway pressure (CPAP) therapy
• D Intranasal corticosteroids alone

Explanation

Pediatric OSA with AHI >1.5 events/hour in the presence of adenotonsillar hypertrophy warrants adenotonsillectomy as first-line treatment, per the American Academy of Pediatrics guidelines. An AHI of 12 represents moderate-severe pediatric OSA. CPAP is reserved for cases where surgery is contraindicated or as adjunct if residual OSA persists post-surgery. Intranasal steroids may be used for mild disease (AHI 1–5) or as bridge therapy. Observation alone is inappropriate at this severity.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.