Influence of upper airway obstruction by enlarged tonsils and adenoids upon recurrent infection of the lower airway in childhood.

The influence of hypertrophied tonsils and adenoids upon ventilation during sleep was evaluated by polygraphic recording before and after adenotonsillectomy. In all 19 cases, esophageal pressure during sleep was elevated as high as 4-6 times normal. This was caused by nasal obstruction due to adenoid hypertrophy and obstruction of the "oral airway" by hypertrophied tonsil and collapse of the tongue due to muscular relaxation during sleep. When minimal amount of contrast media was instilled slowly into the nasopharynx aspiration of the contrast media into the lung was found significnatly more frequently in subjects with upper airway obstruction. Active aspiration of the secretion by marked inspiratory negative pressure during sleep may play a major role in causing recurrent infection of the lower airway frequently seen in these children.