Child behavior and quality of life before and after tonsillectomy and adenoidectomy

Objective: To determine the relationship between child behavior and quality of life before and after tonsillectomy and adenoidectomy by means of a standardized assessment of child behavior, the Child Behavior Checklist (CBCL), and a validated quality-of-life survey of pediatric obstructive sleep apnea, the OSA-18. Design: Before-after study. Setting: Hospital-based pediatric otolaryngology practice in a metropolitan area. Participants: Sixty-four children (mean [SD] age, 5.8 [3.1] years; 36 boys, 28 girls) who underwent tonsillectomy and adenoidectomy for treatment of sleep-disordered breathing or recurrent tonsillitis. Intervention: Parents or caretakers completed the OSA-18 and the CBCL for ages 2 to 3 years or 4 to 18 years before surgery and 3 months postoperatively. Main Outcome Measures: The OSA-18 mean survey scores and change scores, and the CBCL total problem T scores and change in total problem T scores. Results: The mean (SD) preoperative OSA-18 score was 3.9 (1.5) and change score was 2.3 (95% confidence interval, 1.9-2.7). The mean total problem score was 7.3 points lower after surgery (95% confidence interval, 4.9-9.7), indicating a significant decrease (P<.001, matched t test). The preoperative CBCL total problem score was consistent with abnormal behavior for 16 children (25%), but only 5 children (8%) scored in the abnormal range postoperatively (P=.03, log-likelihood ratio test). The OSA-18 preoperative mean survey score had fair to good correlation with the preoperative CBCL total problem T score (r=0.50, P<.001, Pearson correlation), and the OSA-18 change score had fair to good correlation with the change in CBCL total problem T score (r=0.54, P<.001, Pearson correlation). Conclusions: Behavioral and emotional difficulties are found in children with sleep-disordered breathing before treatment and improve after intervention. Scores on a standardized measure of assessment of behavior demonstrate significant correlation with scores on a validated quality-of-life instrument.