Tonsil and adenoid removal is 15% of every pediatric surgery performed in the United States, about 530,000 kids a year. And the research says 60 to 70% of those children still have obstructive sleep apnea after the surgery. Dr. Kevin Goles and I go through why that happens, and why upper and lower expansion shrinks tonsils and adenoids without a child going under anesthesia.

Dr. Kevin Goles is the other half of awAIR Unfiltered and my co-instructor on 3 Days to Airway.

CHAPTERS

0:00 Why tonsil and adenoid removal is 15% of all pediatric surgery in the US

3:26 The research: 60 to 70% of kids still have sleep apnea after the tonsils come out

6:30 Nitric oxide and the three lines of immune defense a mouth breather skips

9:37 Dr. Audrey Yoon's Stanford study: 51% adenoid and 75% tonsil reduction from palatal expansion

13:44 Why an upper-only expander is the equivalent of not doing an expander

17:02 530,000 tonsillectomies a year, and how many of those kids get a sleep study first

21:47 CBCT before and afters: adenoid and tonsil shrinkage after six months of expansion

29:42 How a high vaulted palate creates a deviated septum, and why MARPE is wrong for a growing child

38:01 ToothPillow appliances vs fixed expanders: how to choose for a child

43:16 Bedwetting, teeth grinding, and an airway from 1.8 cc to 10.9 cc

STUDIES MENTIONED

Dr. Audrey Yoon and Dr. Clete Kushida, Stanford Sleep Medicine

The adult expansion case shown at 35:29 is published in the book Beautiful Faces.

Dr. HILARY FRITSCH

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Dr. KEVIN GOLES

Instagram: https://www.instagram.com/airway_goles/

TRAIN WITH ME

3 Days to Airway — the hands-on course Dr. Kevin Goles and I teach for doctors adding airway to their practice: https://www.3dayairway.com/

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ABOUT THE SHOW

awAIR Unfiltered is a podcast and YouTube channel hosted by Dr. Hilary Fritsch and Dr. Kevin Goles, two airway dentists on the front lines of nonsurgical sleep and breathing solutions.

Tune in for research breakdowns, in-office insights, honest takes on CPAP and sleep studies, interviews with others in the space, and the kind of clinical candor you rarely hear anywhere else.

This channel is clinical discussion between practitioners. It isn't medical advice, and nothing here is a reason to delay treatment your child's doctor has recommended.