Simultaneous Tonsillectomy and Nasal Surgery in Adult Obstructive Sleep Apnea

Abstract

In selected adult subjects, tonsillectomy with intercurrent nasal surgery should be considered an effective treatment for OSA and may reduce the requirement for continuous positive airway pressure, oral appliances, or further therapeutic intervention.

Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis

“…67,68 Studies were excluded for the following reasons: only posttonsillectomy data was available, 24 no polysomnography or quantitative sleepiness data, 20,29,34,38,44,48,56,57,[60][61][62]64,65 the patient(s) underwent a tonsillectomy alone; however, the studies only reported data for the entire group which included additional surgeries, 28,41,[50][51][52][53] the patient(s) underwent another procedure simultaneously, 10,22,27,42,45,46,55,58,67,69 or the articles were review articles with no new data. 23,30 Seventeen studies 21,25,26,[31][32][33][35][36][37]39,40,42,49,54,…”

“…Tonsil sizes were reported as: hypertrophied, 37,49 large, 31 enlarged, 21,26,43 extremely enlarged, 33 grades 2-4, 40,66 or grades 3-4. 25,35,39,54,59,63…”

“…It must be pointed out, however, that the patients selected for tonsillectomy in these studies had hypertrophied, 37,49 large, 31 enlarged, 21,26,43 extremely enlarged, 33 grades 2 to 4, 40,66 or grades 3 to 4 tonsils. 25,35,39,54,59,63 Therefore, because none of the studies evaluated patients with small, nonhypertrophied, or grade 1 tonsils, the findings cannot be generalized to all adult patients. Only two studies reported outcomes for patients with grade 2 tonsils: Nakata et al 40 (3 of 7 patients were successfully treated) and Senchak et al, 66 in which two of two Surgical cure defined an AHI < 5 events/hour posttonsillectomy.…”

ENT-specific therapy of obstructive sleep apnoea in adults

“…In a current study by Stow et al [16], patients were sub-divided into three groups according to OSA severity (mild RDI 10-25, moderate RDI 25-35, severe RDI > 35). In a current study by Stow et al [16], patients were sub-divided into three groups according to OSA severity (mild RDI 10-25, moderate RDI 25-35, severe RDI > 35).…”

Nose and Sleep Breathing Disorders

“…septoplasty, turbinectomy, polypectomy, turbinoplasty) correlate with a signifi cant reduction in objective OSA indicators, such as the apnoea-hypopnoea index (AHI) or nocturnal oxygen desaturation. Three studies suggested the efficacy of combined nasal and pharyngeal surgery on polysomnography parameters (Li et al 2005 ;Stow et al 2012 ) or snoring (Carroll et al 2012 ). Friedman et al have also suggested that sometimes postoperative polysomnographic data may be worse for mild OSA patients after nasal obstruction relief (Friedman et al 2000 ).…”