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Lingual Tonsillectomy for Pediatric Persistent Obstructive Sleep Apnea: A Systematic Review and Meta-analysis
Alexander Rivero1, Megan Durr1
11 Kaiser Permanente, Oakland, California, USA.
Insights
Lingual tonsillectomy (LT) may help children with persistent obstructive sleep apnea (OSA) after initial surgery. While it can reduce apnea events and improve oxygen levels, complete resolution of OSA is uncommon.
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.
Abstract:
Objective To determine the role of lingual tonsillectomy (LT) in pediatric patients with persistent obstructive sleep apnea (OSA) after tonsillectomy and adenoidectomy (T&A). Data Sources PubMed, OVID-MEDLINE, and Cochrane Central from 2006 to 2017. Review Methods Inclusion criteria included English-language studies containing original data on LT in pediatric patients with persistent OSA. Exclusion criteria included case reports and studies without outcome measures. Two investigators independently reviewed all manuscripts and performed quality assessment using validated tools. Meta-analysis was performed. Results Of the 866 abstracts identified, 5 studies met inclusion criteria. All studies were case series (level of evidence 4). Outcome measures included apnea-hypopnea index (AHI), minimum oxygen saturation (minSaO2), comorbidity status, and adverse events. Qualitatively, all studies demonstrated reduction in AHI and increase in minSaO2 after LT. Comorbidities may not affect the success of LT for lingual tonsil hypertrophy (LTH). LT had similar adverse event rates as T&A. Meta-analysis was performed on 4 studies. LT showed a mean change in reduction of AHI and increase of minSaO2 of -6.64 (95% CI, -8.63 to -4.65) and 4.17 (95% CI, 1.25-7.08), respectively. The overall success rate, defined as postoperative AHI <5, was 52%. Conclusion LT for LTH can be a safe and effective adjunct surgery for persistent OSA in patients after T&A. LT may reduce AHI and increase minSaO2, though complete resolution of OSA is rare. Given the limited number of patients studied, no formal recommendations can be made for the routine use of LT for LTH in persistent pediatric OSA.
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