Surgical ablation of lingual tonsils in the treatment of obstructive sleep apnea

Abstract Objectives/Hypothesis The retrolingual space is one of the potential sites of obstruction identified in patients with obstructive sleep apnea syndrome (OSAS). Hypertrophied lingual tonsils (LT) can obstruct the airway at this level. The goal of this study was to measure the tolerance and efficacy of lingual tonsillectomy in patients with OSAS. Study design A retrospective chart review was conducted recruiting all patients with OSAS confirmed on sleep recording, who either had failed or refused medical treatment and who underwent lingual tonsillectomy. Materials and methods Diagnosis of LT hypertrophy was made by full ENT clinical examination using a flexible endoscopy, completed by MRI and followed by drug-induced sleep endoscopy. The surgical intervention was carried out endoscopically by diode laser or coblation. The primary endpoint to measure efficacy was drop in apnea-hypopnea index (AHI) on sleep recording at 6 months. Secondary endpoints comprised reduced snoring and Epworth Sleepiness Scale (ESS) and postoperative symptom tolerance. Results Eleven patients aged 44.3 ± 12.6 years were included. AHI dropped from 29.5 ± 21.7/h to 11.6 ± 9.6/h: i.e., by 60% ( P  = 0.005). Five patients had AHI  P  = 0.012). No complications were observed. Conclusions LT ablation seemed effective in OSAS with retrolingual obstruction in failure of medical treatment. Level of evidence 4.