Persistent pediatric obstructive sleep apnea and lingual tonsillectomy
Presented at the Annual Meeting of the American Academy of Otolaryngology—Head and Neck Surgery, Chicago, IL, September 21-24, 2008.
Received 11 September 2008; received in revised form 16 February 2009; accepted 12 March 2009.
Abstract
Objective
To describe a new method and the indications for lingual tonsillectomy with endoscopy and coblation, and to document its utility for treating children with persistent obstructive sleep apnea after previous tonsillectomy and adenoidectomy.
Study Design and Setting
Case series with chart review in a tertiary pediatric medical center.
Subjects and Methods
Twenty-six patients aged 3 to 20 met the inclusion criteria of polysomnography-proven persistent obstructive sleep apnea after tonsillectomy and adenoidectomy, as well as diagnosis of lingual tonsillar hypertrophy made by flexible fiberoptic sleep endoscopy. Endoscopic-assisted coblation lingual tonsillectomies were performed between June 2005 and January 2008. Preoperative and postoperative nocturnal polysomnogram data were paired and analyzed statistically.
Results
Statistically significant reductions in the respiratory distress index (RDI) were seen when preoperative and postoperative data were compared (mean, 14.7 vs 8.1). There were similar reductions in the number of obstructive apneas and hypopneas. The mean minimum O2 saturation did not change. Two patients in this series developed adhesions between the epiglottis and tongue base; there appeared to be no consequence for airway or feeding issues.
Conclusion
Endoscopic-assisted coblation lingual tonsillectomy is an effective technique for the treatment of lingual tonsillar hypertrophy causing persistent obstructive sleep apnea in some children.
Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA
Corresponding author: Peter J. Koltai, MD, FAAP, Department of Otolaryngology–Head and Neck Surgery, 801 Welch Road, 2nd Floor, Stanford, CA 94305
No sponsorships or competing interests have been disclosed for this article.
ABSTRACT