Tonsillectomy in adults with obstructive sleep apnea

• Published in: The Laryngoscope 2016-12, Vol.126 (12), p.2859-2862
• Main Authors: Holmlund, Thorbjörn, Franklin, Karl A., Levring Jäghagen, Eva, Lindkvist, Marie, Larsson, Torbjörn, Sahlin, Carin, Berggren, Diana
• Format: Article
• Language: English
• Subjects: Adult; Deglutition - physiology; Female; Fluoroscopy; Humans; Hypertrophy; Male; OSA; oto-rhino-laryngologi; Oto-Rhino-Laryngology; Palatine Tonsil - pathology; Palatine Tonsil - surgery; Prospective Studies; Sleep; Sleep apnea; Sleep Apnea, Obstructive - physiopathology; Sleep Apnea, Obstructive - surgery; Surgery; Throat surgery; tonsilar hypertrophy; tonsillar hypertrophy; tonsillectomy; Tonsillectomy - adverse effects
• ISSN: 0023-852X; 1531-4995; 1531-4995
• DOI: 10.1002/lary.26038

Objectives/Hypothesis To study whether tonsillectomy is effective on obstructive sleep apnea (OSA) in adults with large tonsils. Study Design A multicenter prospective interventional study. Methods The study comprised 28 patients with OSA, an apnea–hypopnea index of > 10, large tonsils (Friedman tonsil size 3 and 4), and age 18 to 59 years. They were derived from 41 consecutive males and females with large tonsils referred for a suspicion of sleep apnea to the ear, nose, and throat departments in Umeå, Skellefteå, and Sunderbyn in northern Sweden. The primary outcome was the apnea–hypopnea index, measured with polygraphic sleep apnea recordings 6 months after surgery. Secondary outcomes included daytime sleepiness, as measured with the Epworth Sleepiness Scale, and swallowing function, using video‐fluoroscopy. Results The apnea–hypopnea index was reduced from a mean of 40 units per hour (95% confidence interval [CI] 28–51) to seven units per hour (95% CI 3–11), P < 0.001, at the 6‐month follow‐up after surgery. The apnea–hypopnea index was reduced in all patients and 18 (64%) were cured. The Epworth Sleepiness Scale was reduced from a mean of 11 (95% CI 8–13) to 6.0 (95% CI 4–7), P < 0.001. A swallowing dysfunction was found in seven of eight investigated patients before surgery. Of those, swallowing function improved in five patients after surgery, whereas no one deteriorated. Conclusion Tonsillectomy may be effective treatment for adult patients with OSA and large tonsils. Tonsillectomy may be suggested for adults with OSA and large tonsils. Level of Evidence 4. Laryngoscope, 126:2859–2862, 2016