Tonsil volume, tonsil grade and obstructive sleep apnea: is there any meaningful correlation?

Abstract

OBJECTIVES:The aims of this study were to evaluate the correlation between oropharyngeal examination and objective palatine tonsil volume in snoring adults and verify the influence of the oropharyngeal anatomy, body mass index, age, and severity of obstructive sleep apnea on actual tonsil volume. In addition, we aimed to assess the influence of tonsil size on obstructive sleep apnea in adults.INTRODUCTION:Pharyngeal wall geometry is often altered in adults who have obstructive sleep apnea, and this might influence the findings of the oropharyngeal examination that, in turn, are the key factors when considering surgical management for this condition. Furthermore, the correlation between the actual tonsil volume and the severity of obstructive sleep apnea in adults is currently unknown.METHODS:We prospectively studied 130 patients with obstructive sleep apnea or primary snoring who underwent pharyngeal surgery with intraoperative measurement of tonsil volume. We compared tonsil volume with preoperative polysomnography, oropharyngeal examination, and anthropometric data.RESULTS:We found a significant correlation between actual tonsil volume and subjective tonsil grade. We also found a significant correlation between tonsil volume and the apnea-hypopnea index. Using a multivariate linear regression model, tonsil volume was found to be significantly correlated with age, body mass index, and oropharyngeal examination, but not with polysomnography. Clinically, only the rare tonsil grade IV was indicative of more severe obstructive sleep apnea.CONCLUSIONS:There is a strong correlation between clinical tonsil grade and objective tonsil volume in snoring adults, and this correlation exists regardless of the presence or severity of obstructive sleep apnea. Pharyngeal tissue volume likely reflects the body mass index rather than obstructive sleep apnea severity.

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

“…8 Unlike other methods of measuring tonsillar volume, measuring surgically excised tonsil specimen is the most accurate method. 1 Volume discplacement method has been followed by many to measure the total tonsil volume, but when measuring the oropharyngeal tonsil volume, surgical dissection of the specimen has to be carried out at the mucosal reflection site and exact division might not be obtained. 1 Radiological methods have been used to assess the grading and determine the volume of the tonsils.…”

“…1 Volume discplacement method has been followed by many to measure the total tonsil volume, but when measuring the oropharyngeal tonsil volume, surgical dissection of the specimen has to be carried out at the mucosal reflection site and exact division might not be obtained. 1 Radiological methods have been used to assess the grading and determine the volume of the tonsils. 9 Other simple cost effective useful method for measuring tonsil volume would be to take the photograph of the surgically excised tonsils and measure their volume, this will also reduce the inter observer bias.…”

“…There is a good correlation between clinical tonsil grade and objective tonsil volume in adult snorers and obstructive sleep apnea (OSA) patients. 1 However, the mucosal folds/reflections from palatoglossus and palatopharyngeus will determine the intra oral projection of tonsil. To our knowledge, relationship between clinical grading, oropharyngeal tonsil volume and total tonsil volume has been investigated in OSA patients but a very few in recurrent tonsillitis patients.…”

Measurement of Blood Loss during Adenotonsillectomy in Children and Factors Affecting It

“…Tonsillar enlargement can be graded according to subjective measurement [9]. Grade 1 Tonsils are in the tonsillar fossa.…”

Palatine tonsil volume estimation using different methods after tonsillectomy

“…Tonsillectomy is one of the most common surgical operations in otorhinolaryngology (Cahali et al 2011). It can be performed in both children and adults.…”