Home > Journals > Otorinolaringologia > Past Issues > Otorinolaringologia 2015 September;65(3) > Otorinolaringologia 2015 September;65(3):77-83



Cite this article as


A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery

Indexed/Abstracted in: EMBASE, Scopus




Otorinolaringologia 2015 September;65(3):77-83


language: English

Modification of attention parameters in children with obstructive sleep apnea syndrome after adenotonsillectomy

Cassano M. 1, Russo G. 1, Granieri C. 1, Ciavarella D. 2, Cassano P. 1

1 Department of Otorhinolaryngology, University of Foggia, Foggia, Italy; 2 Department of Dentistry, University of Foggia, Foggia, Italy


AIM: This study was aimed to evaluate the effects of sleep apnea on attention parameters in children and the potential reversibility after adenotonsillectomy.
METHODS: Twenty-eight children aged between 4 and 9 years with chronic adenoid and tonsils hypertrophy and a diagnosis of severe sleep apnoea were prospectively enrolled in the study. They were submitted to the “modified bells test” for the assessment of attention. The administration of the test requires the child seeking to tick the bells on a sheet in the shortest time possible, providing a score of accuracy, and a speed. The results are expressed in terms of percentiles compared to the average of the peers of equal months of age.
RESULTS: The modified bells test evidenced in all children attention values lower than the normal for both areas assessed (speed: median 15th percentile; accuracy: median 12th percentile). The correlation between high levels of AHI and attention deficit was statistically significant, concerning both the rapidity (P=-0.524, P=0.01) and the accuracy (P=-0.583, P=0.01). At 3-month follow-up, the bells test values were significantly better reaching the 40th percentile for the parameter “speed” and the 42nd with respect to the “accuracy” (P<0.01).
CONCLUSION: The child suffering from sleep apnea shows a severe attention deficit with regard both to the parameters of speed and to those of accuracy. This deficit, however, can be easily restored with surgical therapy with almost immediate attainment of normal levels.

top of page

Publication History

Cite this article as

Cassano M, Russo G, Granieri C, Ciavarella D, Cassano P. Modification of attention parameters in children with obstructive sleep apnea syndrome after adenotonsillectomy. Otorinolaringol 2015 September;65(3):77-83. 

Corresponding author e-mail