Subjective Tonsil Research Articles

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Chinese guideline for the diagnosis and treatment of childhood obstructive sleep apnea (2020).

Palatine tonsil volume estimation using different methods after tonsillectomy.

This study was carried out to measure the volume of the palatine tonsil in otorhinolaryngology outpatients with complaints of adenotonsillar hypertrophy and chronic tonsillitis who had undergone tonsillectomy. To date, no study has investigated palatine tonsil volume using different methods and compared with subjective tonsil size in the literature. For this purpose, we used three different methods to measure palatine tonsil volume. The correlation of each parameter with tonsil size was assessed. After tonsillectomy, palatine tonsil volume was measured by Archimedes, Cavalieri and Ellipsoid methods. Mean right-left palatine tonsil volumes were calculated as 2.63±1.34cm3 and 2.72±1.51cm3 by the Archimedes method, 3.51±1.48cm3 and 3.37±1.36cm3 by the Cavalieri method, and 2.22±1.22cm3 and 2.29±1.42cm3 by the Ellipsoid method, respectively. Excellent agreement was found among the three methods of measuring volumetric techniques according to Bland-Altman plots. In addition, tonsil grade was correlated significantly with tonsil volume.

Grade 4 tonsillar hypertrophy associated with decreased retronasal olfactory function: a pilot study

Tonsillar hypertrophy is common in children, but it can also be present in adults. Enlarged tonsils, a significant anatomical barrier, may affect the flow of odor molecules from the oral cavity to the nasal passages, which has not yet been studied. Thus, we aimed to investigate the mass effect of palatine tonsillar hypertrophy on retronasal olfaction. This study was carried out in 146 subjects, with a mean age of 22.1 ± 2.2 years, ranging 20-29 years. An oropharyngeal examination of the participants was completed, and tonsillar hypertrophy was graded according to the subjective tonsil size scale. The participants were divided into four groups according to their tonsil size grading; then, each subject's orthonasal olfactory and retronasal olfactory functions were assessed using "Sniffin' Sticks" and retronasal olfactory testing. There were no differences observed between the groups in terms of age, gender, cigarette smoking, or alcohol consumption. In addition, there was no difference between the groups in terms of "Sniffin' Sticks" subtests and TDI scores. It was determined that the retronasal olfactory scores of the participants with grade 4 tonsil size were significantly lower than the retronasal olfactory scores of the participants with grade 1 tonsil size. The current investigation demonstrates that grade 4 tonsillar hypertrophy has significant negative effects on the retronasal route of olfactory sensing, when compared with grade 1 tonsillar hypertrophy.

Objective versus subjective measurements of palatine tonsil size in adult patients with obstructive sleep apnea/hypopnea syndrome

The objective of this study was to evaluate the relationship between subjective and objective tonsil size measurements in adult patients with obstructive sleep apnea/hypopnea syndrome (OSAHS) and compare the tonsil size measurements with the severity of disease. Fifty-one adult patients (46 males and 5 females) who failed continuous positive airway pressure therapy and underwent OSAHS surgery were recruited. Physical examinations, subjective tonsil size grading preoperatively, and objective tonsil measurements including size (length, width, and height), weight and volume immediately after surgery were recorded. The results showed significant positive correlations between subjective tonsil size grading and all the parameters of the objective tonsil measurements (p < 0.05). When comparing the subjective and objective tonsil measurements with the polysomnographic parameters, the subjective grading was significantly correlated with snoring index (p < 0.05) but showed only borderline correlation with apnea/hypopnea index. However, the objective tonsil measurements were significantly correlated with both snoring index and apnea/hypopnea index (both p < 0.05). Although the subjective tonsil size grading reflected the objective tonsil measurements, the objective tonsil measurements were more meaningful in predicting the severity of OSAHS.

Objective vs Subjective Measurements of Palatine Tonsil Size in Patients with OSA

Objective: Study the difference between subjective and objective palatine tonsil size measurements in patients with obstructive sleep apnea (OSA) syndrome. Method: Bilateral tonsillectomy was enrolled as a part of the OSA surgery. Subjective tonsil size was valuated using the 0-4 scale. Tonsil size was also objectively measured. The relationship of the subjective and objective tonsil measurements and polysomnography (PSG) was assessed. Results: Fifty-one OSA patients (46 men, 5 women; mean age 42.1 years; mean apnea/hypopnea index, AHI 47.5/h; mean BMI 26.9) were reviewed. Objective tonsil height, width, thickness, weight and volume were strongly correlated with subjective tonsil size by Spearman correlation. Evaluation of possible outliers with Pearson correlation indicated objective tonsil measurements were the better predictor of preoperative AHI and snoring index than subjective tonsil size. Conclusion: Both objective and subjective tonsil measurements were not correlated with age, BMI, or other anatomic parameters of the upper airway. Subjective tonsil size measurements correlate with objective tonsil measurements; however, only objective tonsil measurements may help the prediction of objective PSG-measured OSA severity.

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

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.

Systematic Review of Pediatric Tonsil Size and Polysomnogram‐Measured Obstructive Sleep Apnea Severity

Systematically review the biomedical literature for data comparing clinical, subjective tonsil size (0-4+ scale) to objectively measured obstructive sleep apnea syndrome (OSAS) using polysomnography (PSG). PubMed database. A comprehensive PubMed MeSH search was conducted to identify articles comparing subjective tonsil size to objectively measured OSAS. Inclusion criteria included pediatric patients only, sample size greater than 5, and sufficient data to extract for analysis. Exclusion criteria included patients with obesity or craniofacial syndromes. Twenty articles were included in the final data set. The mean sample size was 161 (range, 32-700) and grand mean age was 6.7 (range, 2.7-11.7). Case series (evidence based medicine [EBM] level 4) was the predominant study design (16 studies). Eleven of 20 studies concluded there was an association between subjective tonsil size and objective OSAS, whereas 9 did not. Varying statistical techniques were used including simple diagnostic tables (k = 8), linear or logistic regression (k = 19), correlation (k = 5), and analysis of variance (k = 2). A customized quality assessment of each study was performed. Studies showing no association between tonsil size and OSAS had a higher quality score than studies showing an association (3.22 vs 2.36, P = .0317). The association between subjective pediatric tonsil size using 0-4+ scale and objective OSAS severity is weak at best. High-quality studies suggest no association. Providers must recognize the limitations of using tonsil size in clinical decision making.

Does subjective tonsillar grading reflect the real volume of palatine tonsils?

Objectives The aim of this prospective clinical study was to compare the subjective tonsil size (grade) with real palatine tonsil volume, body mass index, body surface area, age, and gender. Patients and methods Two hundred and ninety-two patients with the diagnosis of recurrent acute tonsillitis, ages 3–15 years, (156 male and 136 female) who underwent tonsillectomy were enrolled into this study. The correlation of subjective tonsil size to objective tonsil volume, body mass index, body surface area, age, and gender size was investigated. The statistical correlations were evaluated by Pearsons’ bivariate correlation method. Results There was statistically significant correlation between objective volume of tonsils and subjective grading of tonsils ( p < 0.001). There was statistically significant correlation between objective volume of tonsils (both right and left tonsil) and body mass index ( p = 0.008 and 0.013) respectively. There was statistically significant correlation between objective volume of tonsils and body surface area ( p = 0.009). There was statistically significant correlation between volume of tonsils and age ( p = 0.017). Conclusions Objective tonsil volume is correlated with subjective tonsil size, body mass index, body surface area and age in patients with recurrent acute tonsillitis. Follow-up of palatine tonsil status (volume) of patients with recurrent acute tonsillitis may be decided according to the subjective tonsil size. The correlations of aforementioned parameters to objective tonsil volume should be searched for other pathologies of palatine tonsils.

Palatine tonsil size in obese, overweight, and normal-weight children with sleep-disordered breathing

Objective To assess palatine tonsil size relative to degree of obesity in children with sleep-disordered breathing (SDB). Study Design Case-control study. Setting Tertiary care rhinology clinic. Subjects and Methods We compared the subjective and objective tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), tonsil weight (TWt), and tonsil volume (TV), in 26 obese children and 26 age- and gender-matched control children with SDB, and in 29 overweight children and 29 matched controls with SDB. Results Despite similar subjective tonsil size in obese and control children, the objective tonsil size, including TH, TW, TT, and TWt, was larger in obese than in control children, and the mean TV was significantly greater in obese than in control children with SDB (8.53 ± 3.30 mL vs 6.90 ± 2.05 mL; 95% confidence interval [CI] of the difference 0.03-3.25; P = 0.019). In contrast, mean TV (7.38 ± 3.43 mL vs 7.65 ± 1.97 mL; 95% CI −1.92 to 1.37; P = 0.320) as well as the other parameters of objective palatine tonsil size, including TH, TW, TT, and TWt, did not differ significantly between overweight children and controls. Conclusion Obese children with SDB had larger palatine tonsils than did normal-weight children with SDB. This finding suggests that larger palatine tonsils may have a greater effect on upper airway obstruction in obese than in normal-weight children with SDB.

Palatine tonsil size and its correlation with subjective tonsil size in patients with sleep-disordered breathing

Objective To investigate the correlation of subjective tonsil size with real palatine tonsil size and to compare the differences of each parameter according to subjective tonsil size and between children and adults. Study Design Prospective evaluation of subjective tonsil size (0-4+) and real palatine tonsil size, including tonsil height (TH), tonsil width (TW), tonsil thickness (TT), total tonsil volume (TTV), and embedded tonsil volume (ETV) within the tonsillar fossa. Setting Tertiary-care rhinologic clinic. Subjects and Methods We measured TH, TW, TT, TTV, and ETV in 277 children and 63 adults with sleep-disordered breathing (SDB). Results In both children and adults, subjective tonsil size was significantly correlated with TTV, TH, TW, and TT (correlation coefficients 0.199-0.427 for children and 0.462-0.551 for adults). In children, TTV increased in proportion to subjective tonsil size, but about 45 percent and 34 percent of tonsils markedly deviated from the mean value of their TTV in size 2 and 3 groups, respectively. In adults, TTV of subjective tonsil size 3 and 4 groups was significantly larger than that of size 1 and 2 groups. Conclusions Real palatine tonsil size correlated with subjective tonsil size in both children and adults with SDB. Although there is a statistical correlation in children between TTV and subjective tonsil size, there is significant discordance in size 2 and 3 groups, thus greatly limiting the value of subjective tonsil size assessment in the majority of children. However, adult subjective tonsil size may reflect real palatine tonsil size and may help predict it preoperatively.

Pediatric tonsil size: Objective vs subjective measurements correlated to overnight polysomnogram

Objective To compare subjective and objective tonsil size measurements (weight, volume, intertonsillar distance) along with simple pharyngeal measurements in the prediction of pediatric obstructive sleep apnea hypopnea syndrome (OSAHS) severity. Study Design Prospective case series. Subjects and Methods Tonsil size (0-4+) and Mallampati/Friedman palate position were subjectively measured. During adenotonsillectomy, tonsil size was objectively measured along with simple pharyngeal dimensions. Spearman rank correlation coefficients were calculated and forward and reverse stepwise multivariate regression modeling was used to assess the prediction of preoperative OSAHS severity as determined by polysomnogram (PSG). Evaluation of possible outlier influence was also performed. Results Thirty-four pediatric patients (median age, 4; range, 2-9) were included. Objective tonsil weight (Spearman's ρ = 0.6143, P = 0.0002), tonsil volume (ρ = 0.4960, P = 0.0039), and intertonsillar distance (ρ = −0.7559, P < 0.0001) were strongly correlated with subjective tonsil size but not with age, body mass index (BMI), or preoperative apnea-hypopnea index (AHI). Regression modeling demonstrated that only measured tonsil weight (β = 1.43, P = 0.003), age (β = −3.21, P = 0.001), and hard palate length (β = 0.979, P = 0.003) were significant predictors of the preoperative AHI (R 2 = 0.5358). Evaluation of possible outliers indicated tonsil weight was the most robust predictor of preoperative AHI. Conclusion Subjective tonsil size measurements correlate well with objective tonsil volume measurements. However, only objective tonsil measurements were significantly predictive of objective PSG-measured OSAHS severity.