Evaluation of nasal obstruction after adenotonsillectomy in children with obstructive sleep apnea: a prospective cohort study

Nasal obstruction in children is often caused by adenoid hypertrophy and allergic rhinitis (AR), both of which contribute to obstructive sleep apnea (OSA). Adenotonsillectomy (AT) is commonly performed to treat OSA, but its effect on nasal obstruction, especially in children with AR, remains unclear.

We conducted a prospective cohort study at Nanjing BenQ Medical Center between October 2024 and March 2025. Eligible participants were children aged 3–12 years with OSA confirmed by level II polysomnography. AR was diagnosed using fiberoptic nasopharyngoscopy and inhalant allergen-specific IgE testing. Patients were assigned to AR and non-AR groups. Nasal symptoms were assessed at baseline and 3-month post-AT using the Nasal Obstruction Symptom Evaluation (NOSE) scale and a Visual Analog Scale (VAS).

A total of 58 children were included (29 AR, 29 non-AR). At baseline, the AR group exhibited higher NOSE scores and VAS ratings for obstruction, itching, rhinorrhea, and sneezing. Three months after AT, NOSE scores decreased significantly in both groups (AR: 18.28, 95% CI 13.24–23.32; non-AR: 27.93, 95% CI 23.34–32.52), though the AR group showed smaller improvements (between-group difference -9.66, 95% CI − 16.32 to − 2.99). In AR patients, VAS scores for all four nasal symptoms improved significantly.

In this study, AT significantly reduced nasal obstruction symptoms in both AR and non-AR children, although the degree of improvement was less pronounced in the AR group. Moreover, AT alleviated other AR-related nasal symptoms beyond obstruction.

ChiCTR2500095586. Registration Date: January 9, 2025.