The Effect of Tonsillectomy Alone in Adult Obstructive Sleep Apnea

Abstract

Adult tonsillectomy alone has beneficial effect in OSA management, particularly in young overweight men with large tonsils, moderate OSA, and low Friedman stage.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…Fourth, there was statistically significant heterogeneity and inconsistency between studies. The study by Senchak et al was a prospective case‐control study with mostly young subjects (mean age 28 years) with mild or moderate OSA. Chen et al and Miyazaki et al had patients with a lower BMI (mean < 25 kg/m 2 ), whereas the patients in the studies by Houghton et al and Martinho et al had a higher overall BMI (33.3 kg/m 2 and 36.6 kg/m 2 , respectively).…”

“…Therefore, because none of the studies evaluated patients with small, nonhypertrophied, or grade 1 tonsils, the findings cannot be generalized to all adult patients. Only two studies reported outcomes for patients with grade 2 tonsils: Nakata et al (3 of 7 patients were successfully treated) and Senchak et al, in which two of two patients were cured, as demonstrated by their pre‐ and posttonsillectomy AHI of 17 and 1.7 events per hour (first patient) and 6.3 and 0.6 events per hour (second patient). Because some adults have grade 1 tonsils, which are endophytic and extend deep to the tonsillar pillars, in some cases the removed tonsils may be the same weight as those of another adult with grades 3 or 4 tonsils.…”

“…Chen et al and Miyazaki et al had patients with a lower BMI (mean < 25 kg/m 2 ), whereas the patients in the studies by Houghton et al and Martinho et al had a higher overall BMI (33.3 kg/m 2 and 36.6 kg/m 2 , respectively). An additional variable that likely contributed to the overall heterogeneity includes the fact that only studies by Chen et al and Senchak et al were performed at multiple institutions, whereas the remaining studies were performed at single institutions. Funnel plots demonstrated outlying studies for AHI, AI, and lowest oxygen saturation, indicating an increased risk of publication bias for those variables.…”

Association of palatine tonsil size and obstructive sleep apnea in adults

“…Because many of the patients in this cohort underwent multilevel surgery and multilevel surgery is associated with improved OSA outcomes, we were unable to correlate PT size and effect of tonsillectomy on postoperative OSA severity. Although it has been shown that tonsillectomy improves OSA in adult patients with large tonsils, the effect in adults with small tonsils is less clear . Future, prospective studies restricted to patients undergoing isolated tonsillectomy would be needed to test the prognostic ability of PT grade versus PT volume on tonsillectomy outcome.…”

Large maxillomandibular advancements for obstructive sleep apnea: An operative technique evolved over 30 years

“…(Garcia Vega et al 2014, Gerbino et al 2014 There are several medical treatment options , Kumar et al 2014) as well as surgical treatment options , Senchak et al 2015. Given that a deficiency of the facial skeleton in the antero-posterior dimension is seen in OSA patients, advancing the facial skeleton with maxillomandibular advancements (MMAs) has been a successful surgical treatment modality.…”