Tonsillectomy As a Treatment of Obstructive Sleep Apnea in Adults With Tonsillar Hypertrophy

Abstract

Objectives: High surgical success rates for adenotonsillectomy in children with sleep-related breathing disorders have been described in various studies. The purposes of the present study were to observe how often a substantial tonsillar hypertrophy is associated with obstructive sleep apnea (OSA) in adults and to evaluate the efficiency of a bilateral tonsillectomy. Study Design: Data from a prospective study with 11 adults who underwent tonsillectomy as single treatment for sleep-related breathing disorders were evaluated based on the severity level of their preoperative apnea-hypopnea index (AHI). Material and Methods: Within 3 years, 11 patients with a substantial tonsillar hypertrophy underwent attended polysomnography in the sleep laboratory. Tonsillectomy was performed, and postoperative complications and polysomnographic findings were reviewed. Follow-up time was 3 to 6 months. Results: Nine of 11 patients (81.8%) were diagnosed with OSA. Five of these patients exhibited severe OSA, four patients had mild OSA, and two patients were simple snorers with an AHI below 10. The surgical response rates (defined as decrease in the postoperative AHI >50% and a postoperative AHI of less than 20) were 80.0% in severe apneics and 100% in mild apneics. No serious complications occurred. Conclusions: Substantial tonsillar hypertrophy can rarely cause OSA in adults. In the carefully selected patient a tonsillectomy should be considered an effective and safe surgical option for the treatment of this disorder.

Clinical grading of tonsils: does it truly represent total tonsil volume in patients with recurrent tonsillitis

“…It has an implication in the management of the OSA, careful selection of patients for tonsillectomy has to be made before giving this option for OSA patient as substantial tonsillar hypertrophy rarely causes OSA. 10 In a study by Hasan Yasan et al, the correlation subjective tonsil size to the objective tonsil volume body mass index, body surface area, age and gender, size was investigated and found a statistically significant correlation between objective volume of tonsils and subjective grading of tonsils, also with body mass index. 11 However subjective tonsil size assessment in children has a limited value especially in size 2 and 3, but subjective tonsil size reflects real palatine tonsil size in adults and hence predicting the real volume preoperatively.…”

A Comparison of Different Success Definitions in Non-Continuous Positive Airway Pressure Treatment for Obstructive Sleep Apnea Using Cardiopulmonary Coupling

“…Studies for CPAP therapy were excluded. Treatment success was defined by the following 6 criteria used in the literature: (1) posttreatment AHI < 10/h 11,14,17 ; (2) posttreatment AHI < 20/h 15,20 ; (3) reduction in the AHI > 50% and posttreatment AHI < 10/h 27 ; (4) reduction in the AHI > 50% and posttreatment AHI < 15/h 12,28 ; (5) reduction in the AHI > 50% and posttreatment AHI < 20/h 10,13,18,21,23,25,26 ; and (6) a reduction in the AHI > 50%. 24,29 …”

“…Most criteria were based on the AHI value ( Table 1). [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29] However, sleep clinicians encounter patients who state that their quality of sleep improved with non-CPAP treatment, even though their AHI had not improved. Therefore, we analyzed each criterion, based on sleep quality, as assessed by the cardiopulmonary coupling (CPC) technique.…”

A study on evaluation of pre and postoperative polysomnography for obstructive sleep apnea patients

“…This result correlates with the study conducted by Verse et al where the result was 100% in mild group and 80.8% in severe OSA group. 18 In our study the study population had a BMI of average 25, therefore patients with moderate OSA also responds to tonsillectomy if the obstruction is due to enlarged tonsil alone. But the disadvantage is lack of adequate population group.…”