Multidisciplinary Care for Severe Pediatric Obstructive Sleep Apnea
Thirteen-month-old Chidalu Chioma was snoring loudly and waking up gasping for air when she was referred by her pediatrician to pediatric otolaryngologist Zhen “Jane” Huang, MD, MBA, CPO, an assistant professor in the Department of Otorhinolaryngology at McGovern Medical School at UTHealth Houston. “I diagnosed her with middle-ear fluid during that visit and scheduled a sleep study as well as an x-ray of her adenoids, and a follow-up audiogram,” Dr. Huang says.
Chidalu’s sleep study showed an apnea-hypopnea index (AHI) of 146 with a 60% oxygen nadir, indicating very severe obstructive sleep apnea (OSA). During the study, she stopped breathing more than 100 times an hour.
“Due to the severity of her OSA and the size of her tonsils and adenoids, we scheduled a tonsillectomy and adenoidectomy quickly after getting her sleep study results,” Dr. Huang says. “During the surgery, we also placed tympanostomy tubes for persistent otitis media. She came back for her postoperative follow-up in July, and Mrs. Chioma was happy with her progress.”
Like much of the care the department’s physicians provide, management of Chidalu’s OSA was a team effort, in this case involving pulmonologist and sleep medicine specialist Cindy Jon, MD, and her nurse practitioner Katie Ahlstrom, APRN, who fitted her with a CPAP mask. Stephanie Rios, AuD, a member of the Department of Otorhinolaryngology’s audiology team, confirmed middle ear effusion and mild hearing loss. Konstantinos Boukas, MD, associate professor and medical director of pediatric critical care medicine, managed her postoperative care in the Pediatric Intensive Care Unit due to higher risk for pulmonary edema and respiratory failure in OSA patients.
“The experience was really good,” her mother Chidinma Chioma says. “Dr. Huang gave me a thorough explanation of what to expect, which calmed my nerves. She kept me informed before and after the procedure, did a great job, and all in all, the experience was outstanding.”