Abstract
BackgroundHypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea. The underlying etiology of lingual tonsil hypertrophy (LTH) in the adult patient is unclear and likely multifactorial. Previous studies have suggested that the lingual tonsils may undergo compensatory hyperplasia post-tonsillectomy in children, although it is unknown if this occurs or persists into adulthood. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults.MethodsAdult patients presenting for consultation to an academic Rhinology/General Otolaryngology practice were eligible for enrollment. Demographic data including age, body mass index (BMI), Reflux Symptom Index (RSI), history of allergy, and history of tonsillectomy was collected via questionnaire. Endoscopic photographs of the base of tongue and larynx were captured. These were graded for LTH and Reflux Finding Scale (RFS) by blinded examiners. Statistical analysis was performed by comparing the mean LTH value to the variables of interest using two-tailed T-test. P < .05 was considered significant.ResultsOne hundred two subjects were enrolled. Age ranged from 18 to 78. 28 patients had previous tonsillectomy. This was not associated with a significant increase in lingual tonsil tissue (r = −0.05, p = 0.61). RFS >7 or RSI >13 was considered positive for laryngopharyngeal reflux. There was no difference in LTH based on RSI positivity (p = 0.44). RFS positivity correlated with increased lingual tonsil tissue (p < 0.05). BMI >30 was associated with increased lingual tonsil hypertrophy (p < 0.05).ConclusionsAn elevated body mass index and positive Reflux Finding Score are associated with lingual tonsil hypertrophy in adults. Reflux symptom index, history of allergy and history of childhood tonsillectomy are not associated with LTH.
Highlights
Hypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea
A prospective cross-sectional study enrolling consecutive patients presenting for routine consultation at an academic Rhinology and General Otolaryngology – Head & Neck Surgery practice was performed from March 2014 to June 2014
Lingual tonsil hypertrophy can play a major role in obstructive sleep apnea (OSA) and in difficult intubations, yet little attention has been paid to the etiology
Summary
Hypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea. The underlying etiology of lingual tonsil hypertrophy (LTH) in the adult patient is unclear and likely multifactorial. Previous studies have suggested that the lingual tonsils may undergo compensatory hyperplasia post-tonsillectomy in children, it is unknown if this occurs or persists into adulthood. The lingual tonsils are composed of reactive lymphoid tissue at the base of the tongue. Hypertrophy of the lingual tonsils can present clinically as globus, dysphagia, and cause difficultly with exposure of the glottis during intubation. Lingual tonsil hypertrophy (LTH) can contribute to obstructive sleep apnea (OSA) at the level. There is an emerging body of evidence that suggests environmental allergies may cause laryngeal symptoms, the symptom overlap and comorbidity between. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults
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