Lingual Tonsillectomy for Pediatric Persistent Obstructive Sleep Apnea: A Systematic Review and Meta-analysis

Area of Science:

• Otolaryngology
• Pediatric Sleep Medicine
• Surgical Research

Background:

• Obstructive sleep apnea (OSA) is a common condition in children.
• Tonsillectomy and adenoidectomy (T&A) is a primary treatment for pediatric OSA.
• Persistent OSA after T&A necessitates further investigation into treatment options.

Purpose of the Study:

• To evaluate the efficacy and safety of lingual tonsillectomy (LT) as an adjunct surgical treatment for pediatric patients with persistent obstructive sleep apnea (OSA) following prior tonsillectomy and adenoidectomy (T&A).

Main Methods:

• A systematic review and meta-analysis of English-language studies published between 2006 and 2017 was conducted.
• Inclusion criteria focused on original data concerning LT in pediatric patients with persistent OSA, excluding case reports.
• Quality assessment and meta-analysis were performed on data from eligible studies.

Main Results:

• Five studies met the inclusion criteria, all being case series (Level of Evidence 4).
• Lingual tonsillectomy demonstrated qualitative improvements in apnea-hypopnea index (AHI) and minimum oxygen saturation (minSaO2).
• Meta-analysis of four studies indicated a mean reduction in AHI of -6.64 and an increase in minSaO2 of 4.17, with an overall success rate of 52% (postoperative AHI <5).

Conclusions:

• Lingual tonsillectomy (LT) appears to be a safe and potentially effective adjunctive surgical option for managing persistent obstructive sleep apnea (OSA) in pediatric patients who have already undergone tonsillectomy and adenoidectomy (T&A).
• While LT can lead to improvements in AHI and minSaO2, complete resolution of OSA is rare.
• Due to the limited number of patients studied, routine recommendations for LT in persistent pediatric OSA cannot be made at this time.