Factors associated with lingual tonsil hypertrophy in Canadian adults

Abstract

BackgroundHypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea. The underlying etiology of lingual tonsil hypertrophy (LTH) in the adult patient is unclear and likely multifactorial. Previous studies have suggested that the lingual tonsils may undergo compensatory hyperplasia post-tonsillectomy in children, although it is unknown if this occurs or persists into adulthood. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults.MethodsAdult patients presenting for consultation to an academic Rhinology/General Otolaryngology practice were eligible for enrollment. Demographic data including age, body mass index (BMI), Reflux Symptom Index (RSI), history of allergy, and history of tonsillectomy was collected via questionnaire. Endoscopic photographs of the base of tongue and larynx were captured. These were graded for LTH and Reflux Finding Scale (RFS) by blinded examiners. Statistical analysis was performed by comparing the mean LTH value to the variables of interest using two-tailed T-test. P < .05 was considered significant.ResultsOne hundred two subjects were enrolled. Age ranged from 18 to 78. 28 patients had previous tonsillectomy. This was not associated with a significant increase in lingual tonsil tissue (r = −0.05, p = 0.61). RFS >7 or RSI >13 was considered positive for laryngopharyngeal reflux. There was no difference in LTH based on RSI positivity (p = 0.44). RFS positivity correlated with increased lingual tonsil tissue (p < 0.05). BMI >30 was associated with increased lingual tonsil hypertrophy (p < 0.05).ConclusionsAn elevated body mass index and positive Reflux Finding Score are associated with lingual tonsil hypertrophy in adults. Reflux symptom index, history of allergy and history of childhood tonsillectomy are not associated with LTH.

Instruments evaluating the clinical findings of laryngopharyngeal reflux: A systematic review

“…We also observed an overreliance on the same laryngeal signs, especially those described in RFS, and a lack of consideration of other laryngeal (i.e., vocal fold erythema, leukoplakia, and keratosis) and extralaryngeal signs (i.e., tongue tonsil hypertrophy, posterior pharyngeal wall and anterior pillars erythema, edema, coated tongue), although they seemed to concern a considerable number of patients according to previous clinical reports. 7,8,39,45,69 The lack of consideration of these signs might significantly affect the development of an instrument and its usefulness as a diagnostic tool (i.e., patient inclusion) or therapeutic outcome.…”

Clinical outcomes of laryngopharyngeal reflux treatment: A systematic review and meta‐analysis

“…It is partly for this subjective aspect that a few authors prefer to assess both frequency and intensity of each symptom with a clear definition of the corresponding rates . With regard to signs assessment, vocal fold erythema, keratosis, and a large number of extralaryngeal signs (i.e., posterior pharyngeal wall inflammation, anterior pillars inflammation, coated tongue) are not evaluated with RFS, although they concern a considerable number of patients . Moreover, some usual signs related to LPR (i.e., leukoplakia, granuloma) consisted of exclusion criteria in other studies .…”

“…60,86 With regard to signs assessment, vocal fold erythema, keratosis, and a large number of extralaryngeal signs (i.e., posterior pharyngeal wall inflammation, anterior pillars inflammation, coated tongue) are not evaluated with RFS, although they concern a considerable number of patients. 45,102,103 Moreover, some usual signs related to LPR (i.e., leukoplakia, granuloma) 102 consisted of exclusion criteria in other studies. 51 In addition, our analysis suggests that only a few authors performed blinded evaluations with regard to the patient complaints.…”

Lingual tonsil lymphatic tissue regrowth in patients undergoing transoral robotic surgery

“…Lingual tonsil hypertrophy (LTH) is a clinical condition often observed in clinical practice during the inspection of the tongue base region . This lymphatic hypertrophy (LH) is implicated in a variety of airway pathologies, ranging from sleep‐related breathing disorders, lingual tonsillitis, and difficult intubation procedures . Additionally, it is frequently a cause of foreign body sensation in the throat and of pharyngodynia in cases of it inflammation …”

“…The etiology regarding the growth of this lymphatic tissue (LT) has not been clearly proved . The few studies about this topic showed that previous adenotonsillectomy, laryngopharyngeal reflux (LPR), and a high body mass index could be correlated to LTH, even if defined data regarding this aspect are not available …”