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Patient-Reported Outcomes of Palatopharyngeal Surgery Without Tonsillectomy: A Meta-Analysis
Samuel Tschopp1, Flora Meinert1, Georgios Mantokoudis1
1Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
Objective:
To compare patient-reported outcome measures (PROMs) across different palatopharyngeal surgical modifications without tonsillectomy for snoring and obstructive sleep apnea (OSA).
Data Sources:
MEDLINE, Embase, Web of Science, ClinicalTrials, CINAHL, Cochrane Library, ICTRP.
Review Methods:
We conducted a systematic review and meta-analysis, including original studies of adult patients undergoing palatopharyngeal surgery without tonsillectomy for snoring and OSA. To reduce confounding, we excluded tonsillectomy, as tonsil size is a major predictor of outcome. Primary PROMs included changes in daytime sleepiness, as measured by the Epworth Sleepiness Scale (ESS), and snoring intensity, assessed on a visual analog scale, analyzed by surgical technique using random-effects models.
Results:
Fifty-five studies with 1815 patients were included. Overall, palatopharyngeal surgery without tonsillectomy reduced ESS by a mean of 3.3 points (95% CI, 2.7 to 3.9) and snoring intensity by 4.1 points (95% CI, 3.7 to 4.6). Among surgical techniques, suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and powered instruments showed the largest reductions in both daytime sleepiness and snoring. Meta-regression analyses showed no evidence for declining treatment effectiveness with longer follow-up durations for both PROMs. Heterogeneity across studies was considerable, with a moderate overall risk of bias.
Conclusion:
Palatopharyngeal surgery without tonsillectomy effectively improves patient-reported daytime sleepiness and snoring intensity, with outcomes varying by surgical techniques. Suture palatopharyngoplasty, muscle relocation, cold-steel techniques, and the use of powered instruments appear to be most effective in improving PROMs. These results inform surgical planning and counseling in patients seeking surgical treatment for snoring and daytime sleepiness.
Trial Registration:
PROSPERO: CRD42024559063.
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