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Background: Adenotonsillectomy (AT) is commonly performed for childhood OSA syndrome (OSAS), but little is known about prognosis without treatment., Methods: The Childhood Adenotonsillectomy Trial (CHAT) randomized 50% of eligible children with OSAS to a control arm (watchful waiting), with 7-month follow-up symptom inventories, physical examinations, and polysomnography. Polysomnographic and symptomatic resolution were defined respectively by an apnea/hypopnea index (AHI) <2 and obstructive apnea index (OAI) <1 and by an OSAS symptom score (Pediatric Sleep Questionnaire [PSQ]) < 0.33 with ≥ 25% improvement from baseline., Results: After 194 children aged 5 to 9 years underwent 7 months of watchful waiting, 82 (42%) no longer met polysomnographic criteria for OSAS. Baseline predictors of resolution included lower AHI, better oxygen saturation, smaller waist circumference or percentile, higher-positioned soft palate, smaller neck circumference, and non-black race (each P < .05). Among these, the independent predictors were lower AHI and waist circumference percentile < 90%. Among 167 children with baseline PSQ scores ≥ 0.33, only 25 (15%) experienced symptomatic resolution. Baseline predictors were low PSQ and PSQ snoring subscale scores; absence of habitual snoring, loud snoring, observed apneas, or a household smoker; higher quality of life; fewer attention-deficit/hyperactivity disorder symptoms; and female sex. Only lower PSQ and snoring scores were independent predictors., Conclusions: Many candidates for AT no longer have OSAS on polysomnography after 7 months of watchful waiting, whereas meaningful improvement in symptoms is not common. In practice, a baseline low AHI and normal waist circumference, or low PSQ and snoring score, may help identify an opportunity to avoid AT., Trial Registry: ClinicalTrials.gov; No.: NCT00560859; URL: www.clinicaltrials.gov.

Objective: To highlight the incidence of subglottic stenosis (SGS) as a complication of surgery for congenital heart disease and the role of single-stage laryngotracheoplasty in treating this complication., Design: Retrospective case series., Setting: University-based referral center specializing in surgery for congenital heart disease and complex airway problem management., Intervention: Laryngotracheal reconstruction (LTR)., Main Outcome Measure: Successful airway expansion., Results: At last follow-up, 87.5% (7 of 8) of patients remain free of obstructive airway symptoms., Conclusion: SGS can complicate surgery for congenital heart disease in children. Single-stage LTR is an effective treatment modality for this problem.

Correlative data were obtained on RNA levels of cerebrocortical neurons, adrenal fasciculate cell RNA content and serum corticosterone levels in 10, 40 and 100 week old male C57BL/6J mice immediately following a 30 interval of continuous noise stimulation (100 dB re 2 x 10(-5) N/m2, 0.35-20 kHz) and at 1 hr and 4 hr recovery intervals. Quantification of cellular RNA levels entailed use of scanning-integrating microdensitometry of azure B stained tissue sections. Hormonal analyses were done by radioimmunoassay. Noise stimulation induced a mild to moderate adrenocortical activation and a moderate elevation of serum corticosterone levels in all age groups. Noise exposure also resulted in an increase in the RNA content of cerebrocortical neurons. However, maximal neuronal RNA levels proved to be considerably lower (32-36%) in 100 week old mice as compared to both 10 and 40 week old mice during the post-exposure intervals. The overall data support the existence of a lower neuronal capacity for sensory induced RNA synthesis in 100 week old mice. The data also suggest that age dependent differences in neuronal responsiveness are not directly related to the extent of adrenal RNA activation or to a lower availability of circulating glucocorticoids.