A hidden risk factor for residual mouth breathing in children after adenotonsillectomy: airborne allergen sensitization.

Authors

Zhilong Zeng, Ru Gao, Yu Chen, Shasha Huang, Jian Zhang, Zikang Xiao, Wei Li, Clifford Wang, Fang Wang, Tiansheng Wang

Published in

Sleep & breathing = Schlaf & Atmung. Volume 30. Issue 5. Aug 29, 2026. Epub Aug 29, 2026.

Abstract

Mouth breathing (MB), a common manifestation of sleep-disordered breathing in children may induce craniofacial developmental abnormalities leading to adenoid facies. Although adenoidectomy and/or tonsillectomy (A&T) represents the primary therapeutic intervention, a substantial proportion of pediatric patients exhibit residual mouth breathing postoperatively. Why a substantial subset of children exhibit residual MB remains a critical clinical question. Among the overlooked explanations for this incomplete recovery may be sensitization to airborne allergens-a hidden determinant of postoperative outcomes. This study sought to define the role of this under-investigated risk factor in the failure to resolve MB following A&T.
A retrospective analysis was conducted on a cohort of children who underwent A&T at our hospital from June 2023 to June 2024. Incomplete lip seal during sleep was used as the diagnostic criterion for mouth breathing. Allergic rhinitis and rhinosinusitis symptoms were quantified using the Total Nasal Symptom Score (TNSS). Preoperative serum allergen screening was performed in all cases. Multivariate analyses were employed to assess associations between postoperative mouth breathing resolution and age, gender, BMI, allergen sensitization and TNSS.
The study included 502 children. Residual mouth breathing was observed in 39.44% of cases. Atopy to airborne allergens was significantly correlated with surgical outcomes (P = 0.028), with house dust mites (HDM) sensitization exerting particularly strong effects (P = 0.002). Elevated TNSS scores for both allergic rhinitis (correlation coefficient R = 0.249) and rhinosinusitis (correlation coefficient R = 0.290) predicted diminished therapeutic response.
Sensitization to airborne allergens, particularly HDM, is significantly associated with adverse mouth breathing resolution following A&T, suggesting it as a hidden associated factor for residual mouth breathing.

PMID:
42667328
Bibliographic data and abstract were imported from PubMed on 30 Aug 2026.

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