A case-control comparison of lingual tonsillar size in children with and without Down syndrome

Lingual tonsillar hypertrophy is a common cause of persistent obstructive sleep apnea following adenotonsillectomy in the pediatric population and may be more prevalent in patients with Down syndrome (DS). We sought to quantify lingual tonsil size in pediatric DS patients and compare these findings to those of nonsyndromic children using cervical spine (c-spine) radiographs.

Case control study.

Retrospective review of c-spine radiographs from 105 pediatric DS patients and 89 age- and gender-matched non-DS controls was conducted. Films performed for possible airway compromise or trauma were excluded. Lingual tonsil size and narrowest lumen diameter of the nasopharynx, oropharynx, and hypopharynx were measured.

Radiographically identifiable lingual tonsillar tissue was identified in 34% of children with DS and 30% of controls (P = .21); lingual tonsillar hypertrophy (≥10 mm) was seen in 5% and 0% respectively (P = .074). Nasopharyngeal diameter was smaller in patients with DS compared to controls (5.2 mm vs. 6.3 mm, P = .026), whereas lingual tonsil size was significantly larger in DS patients (2.1 mm vs. 0.8 mm, P = .0008). In multivariate analysis, lingual tonsil size was positively correlated with increasing age in the DS population (r = 0.38, P < .0001) but not in controls.

Lingual tonsillar enlargement is more common in patients with DS than in controls, with an increased prevalence in older DS patients. C-spine radiographs are routinely carried out in these children and appear to be useful in identifying lingual tonsillar hypertrophy. Further trials should be carried out to compare c-spine findings and physical exam or magnetic resonance imaging to validate this method of evaluation.