Concurrent tonsillectomy or turbinoplasty vs. adenoidectomy alone in pediatric obstructive sleep apnea: outcomes, complications, and operative time.

OBJECTIVE: To evaluate the added benefit of concurrent tonsillectomy or turbinoplasty when performed alongside adenoidectomy in pediatric patients with obstructive sleep apnea (OSA). METHODS: This is a prospective cohort study including a total of 146 children who underwent adenoidectomy alone (AD), adenotonsillectomy (ADTS), or turbinoplasty with adenoidectomy with or without tonsillectomy (T + AD±TS). The study was performed in King Abdulaziz University Hospital, Riyadh, Saudi Arabia between April 2021 and August 2024. Adults and patients with neurological disease or upper airway and craniofacial anomalies were excluded. Postoperative outcomes were assessed via the Pediatric Sleep Questionnaire-Sleep Related Breathing Disorder (PSQ-SRBD), revision surgery rates, complications, and parental satisfaction. Logistic regression analyses were used to identify independent predictors of residual OSA and other clinical outcomes. RESULTS: Compared to AD alone, both ADTS (adjusted odds ratio [aOR] = 0.187, 95% CI: 0.052-0.667, p = 0.010) and T + AD±TS (aOR = 0.053, 95% CI: 0.005-0.541, p = 0.013) significantly reduced the odds of postoperative residual OSA. ADTS was also associated with lower revision rate (OR = 0.214, 95% CI: 0.063-0.730, p = 0.014). Complication rate and parental satisfaction did not differ between the groups (p > 0.05). CONCLUSION: Concurrent tonsillectomy or turbinoplasty enhances the effectiveness of adenoidectomy in managing pediatric OSA without increasing complications. Despite longer operative times, combined procedures improve symptom resolution and reduce the need for revision surgery. Individualized surgical planning based on anatomical and clinical features is recommended.