title: The Role of Tonsillectomy in Adults with Tonsillar Hypertrophy and Obstructive Sleep Apnea.
abstract: Objective To determine if tonsillectomy alone is an effective treatment in improving obstructive sleep apnea in adult subjects with tonsillar hypertrophy and to evaluate the effect of tonsillectomy on patient-reported quality-of-life indices. Study Design Case series with planned data collection. Setting Academic hospital. Subjects and Methods Thirty-four subjects completed enrollment and intervention from January 2011 to January 2016. Subjects completed pre- and postoperative quality-of-life questionnaires, including the Insomnia Severity Index, Epworth Sleepiness Scale, and the Functional Outcomes of Sleep Questionnaire-10. Surgical response to treatment was defined by a >50% decrease in the Apnea-Hypopnea Index and a decrease in the overall Apnea-Hypopnea Index to <20. Wilcoxon matched-pairs signed-rank tests were used to test each variable to assess for a change from pre- to postintervention. Subjects were then split into 3 BMI subgroups, with results also evaluated by Wilcoxon matched-pairs signed-rank tests. Results There was a significant difference discovered between the mean preoperative Apnea-Hypopnea Index of 31.57 and the mean postoperative value of 8.12 ( P < .001). All patient-reported outcomes improved significantly following tonsillectomy. After stratifying all outcome variables (Apnea-Hypopnea Index, Epworth Sleepiness Scale, Insomnia Severity Index, and Functional Outcomes of Sleep Questionnaire-10) by sex, race, and tonsil size, no statistically significant difference was noted among any of these subgroups. There was a 78% surgical response to treatment. Conclusion Tonsillectomy appears to be an effective treatment for obstructive sleep apnea in a select population of adults with tonsillar hypertrophy.
authors.affiliation: 1 Department of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.
authors.forename: Matthew M
authors.initials: MM
authors.lastname: Smith
authors.affiliation: 2 Department of Public Health Sciences, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Ed
authors.initials: E
authors.lastname: Peterson
authors.affiliation: 3 Department of Otolaryngology-Head and Neck Surgery, Henry Ford Hospital, Detroit, Michigan, USA.
authors.forename: Kathleen L
authors.initials: KL
authors.lastname: Yaremchuk
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D006984:Hypertrophy; D008297:Male; D014066:Palatine Tonsil / Q000473:pathology* / Q000601:surgery; D011788:Quality of Life; D057566:Self Report; D012720:Severity of Illness Index; D020181:Sleep Apnea, Obstructive / Q000601:surgery*; D007319:Sleep Initiation and Maintenance Disorders; D011795:Surveys and Questionnaires; D014068:Tonsillectomy; D016896:Treatment Outcome
keywords: adult tonsillar hypertrophy; adult tonsillectomy; obstructive sleep apnea