Swallowing dysfunction and quality of life in children with tonsillar hypertrophy and sleep-disordered breathing: A prospective cohort study.

BACKGROUND

Tonsillar hypertrophy is a common cause of sleep-disordered breathing (SDB) in children and may contribute to swallowing dysfunction through upper airway obstruction. However, its impact on swallowing-related quality of life has not been well characterized.

OBJECTIVE

To evaluate swallowing-related quality of life in children with tonsillar hypertrophy and SDB, assess the effect of surgical treatment, and validate an Arabic version of the Pediatric SWAL-QOL questionnaire.

METHODS

In this prospective cohort study, 50 children with SDB and Brodsky grade ≥2 tonsillar hypertrophy were compared with 53 healthy controls. Swallowing-related quality of life was assessed using the Pediatric SWAL-QOL questionnaire. Surgical patients completed the questionnaire before and three months after surgery; controls completed it once. Forty-six children completed postoperative follow-up. The Arabic questionnaire underwent forward-backward translation and psychometric validation.

RESULTS

Children with tonsillar hypertrophy and SDB demonstrated significantly worse preoperative SWAL-QOL scores than controls (31.74 ± 25.05 vs. 2.47 ± 4.00; p < 0.001). Following surgical treatment, scores improved significantly to 0.98 ± 1.69 (p < 0.001) and were no longer different from controls (p = 0.211). Significant improvement was observed across all SWAL-QOL domains. Dysphagia severity was not associated with Brodsky tonsil grade or recurrent tonsillitis. The Arabic SWAL-QOL demonstrated excellent test-retest reliability (ICC = 0.996) and high internal consistency (Cronbach's α > 0.80).

CONCLUSIONS

Children with tonsillar hypertrophy and SDB experience significant swallowing dysfunction that improves substantially following surgical treatment. Dysphagia severity appears to be more closely related to functional upper airway obstruction than tonsil size alone. The Arabic Pediatric SWAL-QOL is a reliable tool for assessing swallowing dysfunction in Arabic-speaking pediatric populations.