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Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis
Kun-Tai Kang1, Peter J Koltai2, Chia-Hsuan Lee1
1Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei2Department of Otolaryngology, Taipei Hospital, Ministry of Health and Welfare, New Taipei City, Taiwan.
Insights
Lingual tonsillectomy improves sleep apnea in children by reducing the apnea-hypopnea index and increasing oxygen saturation. However, residual sleep apnea and complications require careful management.
Area of Science:
- Otolaryngology
- Pediatric Sleep Medicine
- Surgical Outcomes Research
Background:
- Lingual tonsil hypertrophy is linked to pediatric obstructive sleep apnea (OSA).
- Surgical outcomes of lingual tonsillectomy for pediatric OSA have not been previously meta-analyzed.
Purpose of the Study:
- To evaluate the therapeutic outcomes of lingual tonsillectomy in children diagnosed with obstructive sleep apnea (OSA).
Main Methods:
- A systematic literature search was conducted across PubMed, MEDLINE, EMBASE, and Cochrane Reviews.
- Four studies involving 73 children with OSA and lingual tonsil hypertrophy were included.
- Polysomnographic data were extracted to analyze changes in apnea-hypopnea index (AHI) and minimum oxygen saturation.
Main Results:
- Lingual tonsillectomy resulted in a mean AHI reduction of 8.9 events/hour and a 6.0% increase in minimum oxygen saturation.
- Success rates were 17% for a postoperative AHI < 1 and 51% for a postoperative AHI < 5.
- Complications included airway obstruction, bleeding, and pneumonia.
Conclusions:
- Lingual tonsillectomy is an effective treatment for pediatric OSA due to lingual tonsil hypertrophy, improving key sleep metrics.
- Residual OSA is common, and careful monitoring for postoperative complications is essential.
Importance:
Evidence indicates correlations between lingual tonsil hypertrophy and pediatric obstructive sleep apnea (OSA). However, to our knowledge, a meta-analysis of surgical outcomes for lingual tonsillectomy in children with OSA has not been conducted.
Objective:
To evaluate the therapeutic outcomes of lingual tonsillectomy for treatment of pediatric OSA.
Data Sources:
The study protocol was registered on PROSPERO (CRD42015027053). PubMed, MEDLINE, EMBASE, and the Cochrane Reviews databases were searched independently by 2 authors for relevant articles published by September 2016.
Study Selection:
The literature search identified English-language studies that used polysomnography to evaluate children with lingual tonsil hypertrophy and OSA after lingual tonsillectomy alone. The search keywords were lingual tonsil, lingual tonsillectomy, sleep endoscopy, sleep apnea, and child.
Data Extraction And Synthesis:
Polysomnographic data from each study were extracted. A random-effects model pooled postoperative sleep variable changes and success rates for lingual tonsillectomy in treating pediatric OSA.
Main Outcomes And Measures:
Four outcomes for lingual tonsillectomy were analyzed. These included net postoperative changes in the apnea-hypopnea index (AHI), net postoperative changes in the minimum oxygen saturation, the overall success rate for a postoperative AHI less than 1, and the overall success rate for a postoperative AHI less than 5.
Results:
This meta-analysis consisted of 4 studies (mean sample size, 18.25 patients), with a total of 73 unique patients (mean [SD] age, 8.3 [1.1] years). Fifty-nine percent (27 of 46) of the patients were male, and 1 of the 4 studies did not specify number of males. Lingual tonsillectomy was indicated for persistent OSA after adenotonsillectomy in all cases. Lingual tonsil hypertrophy was evaluated using computed tomography or magnetic resonance imaging in 1 study, sleep endoscopy in 2 studies, and cine magnetic resonance imaging in 1 study. The mean change in the AHI after lingual tonsillectomy was a reduction of 8.9 (95% CI, -12.6 to -5.2) events per hour. The mean change in the minimum oxygen saturation after lingual tonsillectomy was an increase of 6.0% (95% CI, 2.7%-9.2%). The overall success rate was 17% (95% CI, 7%-35%) for a postoperative AHI less than 1 and 51% (95% CI, 25%-76%) for a postoperative AHI less than 5. Postoperative complications that developed included airway obstruction, bleeding, and pneumonia.
Conclusions And Relevance:
Lingual tonsillectomy is an effective surgical management for children with OSA caused by lingual tonsil hypertrophy, and it achieves significant improvement in the AHI and the minimum oxygen saturation. However, children frequently have residual OSA after lingual tonsillectomy, and postoperative complications must be carefully managed.
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