The link between chronic adenotonsillar hypertrophy (CAH) and behavioural disturbance is well recognised. Several studies have found that CAH has been associated with attention deficit hyperactivity disorder (ADHD) and treatment of CAH may diminish symptoms of ADHD in a subset of children. In addition, enuresis (EN) is also common in children with ADHD. This cross-sectional study involved 75 children between the ages of five and16 who had already been listed for adenotonsillectomy. The validated Turgay DSM-IV Based Child and Adolescent Behavior Disorders Screening and Rating Scale and Nocturnal Enuresis Questionnaire were presented to parents in the preoperative visit and at six months post-treatment. The mean age of participants was 9.2. After adenotonsillectomy, mean inattention scores fell from 5.69 to 4.46, hyperactivity index decreased from 6.5 to 5.9 and total ADHD scores declined from 12.2 to 10.4. Furthermore 26 of the subjects were diagnosed with primary EN before adeno-tonsillectomy and 14 of these enuretic children had total remission six months after surgery. The frequency of EN dropped from 34.7% to 16.0% and this remission rate was found to be statistically significant. The authors discuss that whilst this study has obvious limitations including small sample size, lack of control group and short follow-up period, it does bring into focus the relationship between behavioural disturbance and CAH. They advocate that adeno-tonsillectomy can be beneficial, and emotional and behavioural problems should be identified and discussed at consultations to allow early treatment.
Adenotonsillectomy can improve ADHD and nocturnal enuresis
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