{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T19:09:06Z","timestamp":1761419346622,"version":"3.40.5"},"reference-count":29,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2019,12,9]],"date-time":"2019-12-09T00:00:00Z","timestamp":1575849600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Otolaryngology"],"published-print":{"date-parts":[[2020,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Obstructive sleep\u2010disordered breathing (OSDB) is very common in children. Adenotonsillectomy is usually curative, but there is emerging evidence that topical nasal steroids can also be effective for some children and may avoid the need for surgery. The number of children referred for assessment of OSDB is increasing and in some departments, waiting times are long. We established a paediatrician\u2010led clinic for assessment and initial medical management of OSDB and in this study we report the proportion of children who avoided the need for surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>Referral letters to the otolaryngology department were screened and those with suspected OSDB and no significant co\u2010morbidities were diverted to the paediatrician\u2010led clinic. We recorded data for a consecutive series of children seen in this clinic with suspected OSDB over a 3\u2010month period. Parents completed a 5\u2010item subset of questions from the OSA\u201011 questionnaire before and after treatment with 6\u00a0weeks of topical nasal steroids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the 3\u2010month study period, 103 children were seen, with a mean age of 6 (range 1\u201016). Six (5.8%) had improved spontaneously before clinic attendance. Of the 97 children who were still symptomatic, 17 (17.5%) were referred directly for surgery on the basis of the severity of their symptoms, or because of other coexisting conditions that required surgical treatment (such as recurrent tonsillitis or otitis media). Three declined intranasal steroids. Seventy\u2010seven had a trial of intranasal steroids, of whom 34 (35%) reported enough improvement to avoid surgery, and 29 (28%) failed to improve and were referred for surgery. Fourteen (14%) failed to attend after the trial of steroids: of these, 5 (5%) were contactable by phone and confirmed improvement after topical steroids. OSA\u20105 scores were significantly improved following intranasal steroids.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>A paediatrician\u2010led clinic can be an effective way to ease the workload of an over\u2010stretched otolaryngology service, and judicious use of topical nasal steroids can help around 40% of children with OSDB avoid surgery.<\/jats:p><\/jats:sec>","DOI":"10.1111\/coa.13479","type":"journal-article","created":{"date-parts":[[2019,11,22]],"date-time":"2019-11-22T11:54:30Z","timestamp":1574423670000},"page":"190-196","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Our experience of a paediatrician\u2010led clinic for the medical management of children with obstructive sleep\u2010disordered breathing"],"prefix":"10.1111","volume":"45","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3245-5117","authenticated-orcid":false,"given":"Haytham","family":"Kubba","sequence":"first","affiliation":[{"name":"Department of Otolaryngology Royal Children's Hospital Parkville Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katherine","family":"Rowe","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gideon","family":"Pinczower","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Robert","family":"Sloane","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics Royal Children's Hospital Parkville Vic. Australia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michelle","family":"Waterham","sequence":"additional","affiliation":[{"name":"Department of General Paediatrics Royal Children's Hospital Parkville Vic. 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