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Tschopp S, Azalmad K, Caversaccio M, Borner U, Tschopp KP. Outcome Prediction Model for Radiofrequency Uvulopalatopharyngoplasty with Tonsillectomy in Adult Obstructive Sleep Apnea: Retrospective Cohort Study. Biomed Hub 2024; 9:118-127. [PMID: 39145137 PMCID: PMC11324267 DOI: 10.1159/000540222] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2024] [Accepted: 06/26/2024] [Indexed: 08/16/2024] Open
Abstract
Introduction Knowing an individualized outcome prediction is essential when counseling patients before surgery. We aim to identify predictors and build a model for the outcome of radiofrequency uvulopalatopharyngoplasty with tonsillectomy (rfUPPP + TE). Methods All adult patients undergoing rfUPPP + TE for sleep-disordered breathing from 2015 to 2022 in our institution were included. Preoperative evaluations included detailed upper airway examinations and standardized questionnaires. Postoperative outcomes were measured through home sleep apnea testing and repeated questionnaires 3 months post-surgery. The primary endpoint was the postoperative apnea-hypopnea index (AHI) and the AHI responders using the Sher criteria. Results We analyzed 247 patients with a mean age of 46 ± 11 years, predominantly male (88.7%), and a mean BMI of 29.0 kg/m2. The mean AHI was reduced from 26.4 ± 18.6/h preoperatively to 16.2 ± 14.6/h postoperatively. Daytime sleepiness improved from 8.9 ± 48 to 4.0 ± 3.1 and snoring from 7.9 ± 2.1 to 3.3 ± 2.2. Multivariate analysis indicated that higher tonsil grades, preoperative AHI, and snoring levels were associated with a greater reduction in AHI. Age and body weight were negative predictors for AHI reduction. For AHI responders, according to Sher, tonsil grade was the only predictor in a multivariate analysis. The ROC curve of this simple model, with a corrected AUC of 0.625, compared favorably against two established models. Conclusion Our study highlights that tonsil grade, preoperative AHI, snoring, and, to a smaller extent, age and weight are key determinants of AHI reduction, emphasizing the importance of preoperative evaluation. Despite the multifactorial nature of obstructive sleep apnea, preoperative evaluation can predict the outcome of rfUPPP + TE and guide surgical planning.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Khalid Azalmad
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerland
- Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Marco Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Urs Borner
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland
| | - Kurt Peter Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Liestal, Switzerland
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Lv C, Yang L, Ngan P, Xiao W, Zhao T, Tang B, Chen X, He H. Role of the tonsil-oropharynx ratio on lateral cephalograms in assessing tonsillar hypertrophy in children seeking orthodontic treatment. BMC Oral Health 2023; 23:836. [PMID: 37936131 PMCID: PMC10629199 DOI: 10.1186/s12903-023-03573-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Accepted: 10/24/2023] [Indexed: 11/09/2023] Open
Abstract
OBJECTIVES To analyze the diagnostic value of the tonsil-oropharynx (T/O) ratio on lateral cephalograms for evaluating tonsillar hypertrophy (TH). METHODS A cross-sectional study was performed on 185 consecutive children (101 males, 84 females; mean age 7.3 ± 1.4 years) seeking orthodontic treatment. The T/O ratios on lateral cephalograms were calculated following Baroni et al.'s method. Tonsil sizes were clinically determined according to the Brodsky grading scale. Spearman correlation coefficients between the T/O ratio and clinical tonsil size were calculated with the total sample and subgroups and then compared between subgroups. Diagnostic value was analyzed using the receiver operating characteristic (ROC) curve, sensitivity, specificity, positive and negative predictive values, and accuracy. RESULTS There was a strong correlation between the T/O ratio and clinical tonsil size in children (ρ = 0.73; P < 0.001). A significantly higher correlation coefficient was found in the Class III children. The ROC curve revealed an area under the curve of 0.90 (95% CI, 0.86-0.94; P < 0.001). The optimal cutoff value of the T/O ratio for predicting TH was 0.58, with a sensitivity of 98.7% and specificity of 64.2%. Employing the cutoff value of 0.5, the sensitivity was 100% and the specificity was 45.9%. CONCLUSIONS Measurement of the T/O ratio on lateral cephalograms may be helpful to initial screening in children for TH. Practitioners may combine the clinical examination of tonsil size with the cephalometric findings for a more comprehensive evaluation.
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Affiliation(s)
- Chenxing Lv
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Liu Yang
- Department of Stomatology, Hangzhou Traditional Chinese Medicine Hospital, Hangzhou, China
| | - Peter Ngan
- Department of Orthodontics, School of Dentistry, West Virginia University, Morgantown, USA
| | - Wenjie Xiao
- Department of Otorhinolaryngology-Head and Neck Surgery, Guangdong Clifford Hospital, Guangzhou, China
| | - Tingting Zhao
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Bojun Tang
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China
| | - Xiong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China
| | - Hong He
- State Key Laboratory of Oral and Maxillofacial Reconstruction and Regeneration, Key Laboratory of Oral Biomedicine Ministry of Education, Hubei Key Laboratory of Stomatology, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
- Department of Orthodontics, School and Hospital of Stomatology, Wuhan University, Wuhan, China.
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Tschopp S, Azalmad K, Tschopp K. Tonsil volume and outcome of radiofrequency uvulopalatoplasty with or without tonsillectomy in adults with sleep-disordered breathing. Eur Arch Otorhinolaryngol 2023; 280:3005-3013. [PMID: 36906856 PMCID: PMC10175372 DOI: 10.1007/s00405-023-07914-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 03/04/2023] [Indexed: 03/13/2023]
Abstract
PURPOSE Predictors for the outcome of uvulopalatopharyngoplasty with and without tonsillectomy (UPPP ± TE) in sleep-disordered breathing have not been fully established. This study investigates tonsil grade, volume, and preoperative examination in predicting radiofrequency UPP ± TE outcomes. METHODS All patients undergoing radiofrequency UPP with tonsillectomy if tonsils were present between 2015 and 2021 were retrospectively analyzed. Patients underwent a standardized clinical examination, including Brodsky palatine tonsil grade from 0 to 4. Preoperatively and 3 months after surgery, sleep apnea testing was performed using respiratory polygraphy. Questionnaires were administered assessing daytime sleepiness using the Epworth Sleepiness Scale (ESS) and snoring intensity on a visual analog scale. Tonsil volume was measured intraoperatively using water displacement. RESULTS The baseline characteristics of 307 patients and the follow-up data of 228 patients were analyzed. Tonsil volume increased by 2.5 ml (95% CI 2.1-2.9 ml; P < 0.001) per tonsil grade. Higher tonsil volumes were measured in men, younger patients, and patients with higher body mass indices. The preoperative apnea-hypopnea index (AHI) and AHI reduction strongly correlated with tonsil volume and grade, whereas postoperative AHI did not. The responder rate increased from 14% to 83% from tonsil grade 0 to 4 (P < 0.01). ESS and snoring were significantly reduced after surgery (P < 0.01), but the reduction was not influenced by tonsil grade or volume. No other preoperative factor other than tonsil size could predict surgical outcomes. CONCLUSIONS Tonsil grade and intraoperatively measured volume correlate well and predict the reduction of AHI, while they are not predictive of ESS and snoring response after radiofrequency UPP ± TE.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland. .,Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital and University of Bern, Bern, Switzerland.
| | - Khalid Azalmad
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland.,Faculty of Biology and Medicine, University of Lausanne, Lausanne, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Head and Neck Surgery, Kantonsspital Baselland, Mühlemattstrasse 13, 4410, Liestal, Switzerland
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Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea? Braz J Otorhinolaryngol 2022; 88 Suppl 5:S156-S161. [PMID: 35184978 PMCID: PMC9801021 DOI: 10.1016/j.bjorl.2021.12.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 11/07/2021] [Accepted: 12/14/2021] [Indexed: 01/03/2023] Open
Abstract
OBJECTIVES Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures). METHODS This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery. RESULTS A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm3 was linked to success during pharyngeal surgery. CONCLUSION A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA. LEVEL OF EVIDENCE Level 3, non-randomized cohort study.
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Sağtaş E, Mengi E, Kara CO, Şenol H. A Novel Assessment Method With Ultrasound for Obstructive Tonsillar Hypertrophy in Children. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2021; 40:1795-1801. [PMID: 33200837 DOI: 10.1002/jum.15559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES To develop a new method for the objective evaluation of airway obstruction due to tonsillar hypertrophy using ultrasound (US) in children. METHODS The oropharynx was examined in patients, and tonsil grades were evaluated according to the staging system of Brodsky et al (Int J Pediatr Otorhinolaryngol 1987; 13:149-156). The narrowest intertonsillar distance (ITD) and widest transverse length of the tongue base (TLTB) were then measured by US, and their ratio was calculated. The clinical value of US was investigated for the classification of tonsillar hypertrophies as nonobstructive or obstructive by matching the patients' clinical grades with the US data. RESULTS A total of 102 patients (age range, 2-12 years) were included in the study. According to the Brodsky staging system, 44.1% and 55.9% of the patients were in nonobstructive (stages I and II) and obstructive (stages III and IV) tonsillar hypertrophy groups, respectively. The area under the curve was 0.991 (95% confidence interval, 0.977-0.999) according to a receiver operating characteristic curve analysis between the Brodsky staging and the ITD/TLTB ratio. The optimal cutoff value for the ITD/TLTB ratio for the diagnosis of obstructive tonsillar hypertrophy was found to be 0.3 or less, which had 96.5% sensitivity and 95.6% specificity. CONCLUSIONS The degree of airway obstruction due to tonsillar hypertrophy can be objectively determined by US in children. An ITD/TLTB ratio of 0.3 or less was found to be compatible with obstructive tonsillar hypertrophy. This new and easily applicable evaluation method may provide considerable value and guidance for tonsillectomy decisions.
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Affiliation(s)
- Ergin Sağtaş
- Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Erdem Mengi
- Department of Otolaryngology-Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cüneyt Orhan Kara
- Department of Otolaryngology-Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Hande Şenol
- Department of Biostatistics, Pamukkale University School of Medicine, Denizli, Turkey
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Mengi E, Sağtaş E, Kara CO. Assessment of Tonsil Volume With Transcervical Ultrasonography in Both Children and Adults. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2020; 39:529-534. [PMID: 31495964 DOI: 10.1002/jum.15129] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 08/03/2019] [Accepted: 08/21/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVES To investigate the success of ultrasonography (USG) in the objective measurement of palatin tonsil volume in both children and adults and to compare those results with clinical findings. METHODS Eighty-five patients, who were scheduled to undergo tonsillectomy with the indications of recurrent tonsillitis and obstructive sleep apnea syndrome, were included in the study. The tonsil grades of the patients were recorded according to the Friedman tonsil grading. The tonsil size and volume were measured with transcervical USG. After tonsillectomy, the volumes of the tonsils were calculated by the displacement method. The correlation between the obtained data was evaluated. In all analyses, P < .05 was accepted as a statistical level of significance. RESULTS Fifty children and 35 adults were included in the study. In children, the mean actual volume ± SD of 100 tonsils was measured as 3.5 ± 1.45 mL, and the USG volume was 3.67 ± 1.59 mL; a high correlation was found between both methods (r = 0.842; P < .05). In adults, the mean actual volume of 70 tonsils was measured as 5.15 ± 2.25 mL, and the USG volume was 5.71 ± 2.98 mL; a moderate correlation was found between the methods (r = 0.589; P < .05). In children, a moderate correlation was found between the Friedman grading and the USG (r = 0.532; P < .05), and actual (r = 0.549; P < .05) tonsil volumes. In adults, a low correlation was found between the Friedman grading and the USG (r = 0.363; P < .05) and actual (r = 0.384; P < .05) tonsil volumes. CONCLUSIONS Ultrasonography is a useful, accessible, and noninvasive imaging method for objective measurement of tonsil volume in adults and children.
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Affiliation(s)
- Erdem Mengi
- Department of Otolaryngology and Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
| | - Ergin Sağtaş
- Department of Radiology, Pamukkale University School of Medicine, Denizli, Turkey
| | - Cüneyt Orhan Kara
- Department of Otolaryngology and Head and Neck Surgery, Pamukkale University School of Medicine, Denizli, Turkey
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Pilot study of the potential of 3D ultrasound to measure tonsillar volume and hypertrophy. Int J Pediatr Otorhinolaryngol 2019; 126:109612. [PMID: 31408743 DOI: 10.1016/j.ijporl.2019.109612] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Revised: 07/28/2019] [Accepted: 07/28/2019] [Indexed: 11/21/2022]
Abstract
OBJECTIVE Obstructive sleep apnea (OSA), results in approximately 4-5 million outpatient visits per year in the United States. In pediatric patients, OSA is primarily caused by adenotonsillar hypertrophy, and therefore, adenotonsillectomy remains an effective surgical treatment. We investigate whether 3D ultrasound (3DUS) imaging can accurately and objectively assess tonsillar hypertrophy for the potential identification and stratification of candidates for adenotonsillectomy. METHODS A prospective study was performed evaluating pediatric patients (N = 17) between the ages of 4-14 years who were undergoing adenotonsillectomy for OSA symptoms. On the day of surgery, tonsillar ultrasound was performed by a single attending radiologist. Tonsillectomy was performed and each tonsils' principal axes and physical volume by water submergence were measured. The findings were compared using paired T-test, Pearson correlation coefficient and Bland-Altman analysis. RESULTS The average tonsillar physical measurements of length, width and height were 1.54 ± 0.28, 2.0 ± 0.31 cm and 2.72 ± 0.41 cm, and 1.73 ± 0.17, 1.61 ± 0.21 mm and 2.98 ± 0.28 mm from physical and 3DUS estimations, respectively (P < 0.001 for all measurements). The average tonsillar volume was 3.84 ± 1.23 ml and 4.30 ± 1.15 ml from physical and 3DUS measurements, respectively (p = 0.04). The Bland-Altman mean difference ± 95% limit of agreement between length, width, height, and volume results from the two measurements were -0.186 ± 2.01 cm, -0.393 ± 6.33 cm, 0.25 ± 7.71 cm, and 0.45 ± 2.32 ml, respectively. CONCLUSION While 3DUS is feasible, it may not be an accurate estimate of tonsillar volume for assessing hypertrophy. A larger study will be required to establish the accuracy of 3DUS measurements of tonsillar volume.
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Tschopp S, Tschopp K. Tonsil size and outcome of uvulopalatopharyngoplasty with tonsillectomy in obstructive sleep apnea. Laryngoscope 2019; 129:E449-E454. [PMID: 30848478 DOI: 10.1002/lary.27899] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2018] [Revised: 01/25/2019] [Accepted: 02/12/2019] [Indexed: 11/09/2022]
Abstract
OBJECTIVES/HYPOTHESIS To investigate the relationship of tonsil volume and grade on outcomes of uvulopalatopharyngoplasty (UPPP) with tonsillectomy in patients with obstructive sleep apnea (OSA). STUDY DESIGN Retrospective cohort analysis. METHODS Data of 70 consecutive patients undergoing UPPP with tonsillectomy between 2015 and 2018 were analyzed. Patients with an apnea-hypopnea index (AHI) <10/hr or concomitant surgery other than nasal surgery were excluded. Tonsil volume was measured intraoperatively. Preoperatively and 3 months after surgery we assessed the AHI using respiratory polygraphy, daytime sleepiness using the Epworth Sleepiness Scale (ESS), and a visual analog scale for the snoring index (SI). RESULTS Tonsil grade and volume both showed a significant correlation with preoperative AHI. Postoperative AHI was not significantly different between grades and volume. The AHI reduction after surgery increased significantly with larger volume and higher tonsil grade. For all grades, the postoperative ESS was significantly reduced compared to the preoperative value, but was not significantly correlated with tonsil volume. Preoperative and postoperative SI was not significantly correlated between tonsil grade or volume. In all grades, SI was significantly reduced after surgery. CONCLUSIONS In our study, we found that large tonsils are responsible for higher preoperative AHI values, and their removal leads to greater reduction of initial AHI. However, the postoperative effect on daytime sleepiness and snoring reduction is not significantly correlated with tonsil size and volume, indicating that these parameters are mainly influenced by other factors. The knowledge of the significance of tonsil size and volume is important for ear, nose, and throat physicians when counseling OSA patients. LEVEL OF EVIDENCE 2c Laryngoscope, 129:E449-E454, 2019.
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Affiliation(s)
- Samuel Tschopp
- Department of Otorhinolaryngology, Kantonsspital Baselland, Liestal, Switzerland
| | - Kurt Tschopp
- Department of Otorhinolaryngology, Kantonsspital Baselland, Liestal, Switzerland
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Correlation between Brodsky Tonsil Scale and Tonsil Volume in Adult Patients. BIOMED RESEARCH INTERNATIONAL 2018; 2018:6434872. [PMID: 30474041 PMCID: PMC6220413 DOI: 10.1155/2018/6434872] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 09/14/2018] [Accepted: 10/11/2018] [Indexed: 11/27/2022]
Abstract
Purpose To evaluate the value of Brodsky tonsil scale in predicting the objective tonsil volume and to identify the potential factors that might interfere with the accuracy of prediction. Methods A total of 87 adult patients who underwent single tonsillectomy or uvulopalatopharyngoplasty (UPPP) procedure including tonsillectomy in our hospital between Jan 2015 and Dec 2016 were included. The data of Brodsky tonsil scale evaluated preoperatively and objective tonsil volume evaluated postoperatively were collected for analysis. Results Among the 87 adult patients included, 85 patients underwent bilateral tonsillectomy, while only 2 underwent unilateral procedure. Therefore, a total of 172 tonsils were included. Significant positive correlations were established between Brodsky scale and objective volume for either right (R = 0.647), left (R = 0.664), or overall tonsils (R = 0.654) (all p < 0.001). However, volume overlaps could be found between 2+ and 3+ tonsils. Age [odds ratio (OR) = 4.053, p = 0.003] and body mass index (BMI; OR=1.740, p = 0.044) were found to be independent factors that could influence the consistency between the Brodsky scale and objective volume. As a result, a formula “Index = -1.409+1.399×age+0.554×BMI” was constructed for the evaluation of the consistency. Conclusion Tonsil grading was significantly correlated with tonsil volume; preoperative tonsil grading that reflected the real tonsil volume was regarded as the protocol for the evaluation of the tonsil size. Age and BMI were independent factors that could affect the consistency between tonsil grade and tonsil volume. A mathematical model was estimated to predict the consistency accurately.
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Jara SM, Weaver EM. Association of palatine tonsil size and obstructive sleep apnea in adults. Laryngoscope 2017; 128:1002-1006. [PMID: 29205391 DOI: 10.1002/lary.26928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 08/16/2017] [Accepted: 08/22/2017] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The relationship between palatine tonsil (PT) size and obstructive sleep apnea (OSA) has not been well established in adults. The purpose of this study was to test the association between PT grade, PT volume, and OSA severity in U.S. adult patients. STUDY DESIGN Cross-sectional study of all patients (age ≥ 18 years) who underwent pharyngeal surgery for OSA that included palatine tonsillectomy with tonsil volume measurement from January 2011 to June 2016. METHODS Medical records were reviewed for PT grade (measured on clinical exam by the Brodsky tonsil grading scale), PT volume (measured intraoperatively by water displacement), and apnea-hypopnea index (AHI). Associations were evaluated with multivariate linear regression adjusting for age, sex, body mass index (BMI), smoking status, lingual tonsil volume (AHI models only), and multilevel surgery aside from lingual tonsillectomy (PT volume vs. AHI model only). RESULTS The cohort (N = 83) was middle-aged (mean age 43 ± 12 years), predominantly male (61%), obese (mean BMI 33 ± 7 kg/m2 ), and had severe OSA (mean AHI 32 ± 28). After adjustment for confounders, PT grade was strongly associated with PT volume (beta = 1.8, 95% confidence interval [CI]: [1.0, 2.6], P < 0.001) and with AHI (beta = 13.5, 95% CI: [3.5, 23.6], P = 0.01); PT volume was not associated with AHI (beta = -0.2, 95% CI: [-2.2, 1.9], P = 0.89). CONCLUSION In contrast to past studies, subjective PT grade (vs. objective PT volume) was more strongly associated with AHI. These data suggest the space that the tonsils occupy within the oropharyngeal airway, instead of their actual measured volume, may be more predictive of OSA severity in a cohort of U.S. adult patients. LEVEL OF EVIDENCE 2c. Laryngoscope, 128:1002-1006, 2018.
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Affiliation(s)
- Sebastian M Jara
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A
| | - Edward M Weaver
- Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, Washington, U.S.A.,Surgery Service, Veterans Affairs Puget Sound Health Care System, Seattle, Washington, U.S.A
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Sağıroğlu A, Acer N, Okuducu H, Ertekin T, Erkan M, Durmaz E, Aydın M, Yılmaz S, Zararsız G. Palatine tonsil volume estimation using different methods after tonsillectomy. Anat Sci Int 2016; 92:500-508. [PMID: 27307085 DOI: 10.1007/s12565-016-0350-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2016] [Accepted: 05/26/2016] [Indexed: 11/24/2022]
Abstract
This study was carried out to measure the volume of the palatine tonsil in otorhinolaryngology outpatients with complaints of adenotonsillar hypertrophy and chronic tonsillitis who had undergone tonsillectomy. To date, no study has investigated palatine tonsil volume using different methods and compared with subjective tonsil size in the literature. For this purpose, we used three different methods to measure palatine tonsil volume. The correlation of each parameter with tonsil size was assessed. After tonsillectomy, palatine tonsil volume was measured by Archimedes, Cavalieri and Ellipsoid methods. Mean right-left palatine tonsil volumes were calculated as 2.63 ± 1.34 cm3 and 2.72 ± 1.51 cm3 by the Archimedes method, 3.51 ± 1.48 cm3 and 3.37 ± 1.36 cm3 by the Cavalieri method, and 2.22 ± 1.22 cm3 and 2.29 ± 1.42 cm3 by the Ellipsoid method, respectively. Excellent agreement was found among the three methods of measuring volumetric techniques according to Bland-Altman plots. In addition, tonsil grade was correlated significantly with tonsil volume.
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Affiliation(s)
- Ayşe Sağıroğlu
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, 38039, Turkey.
| | - Niyazi Acer
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, 38039, Turkey
| | - Hacı Okuducu
- Department of Otorhinolaryngology, Maya Eye and Ear, Nose, Throat Hospital, Kayseri, Turkey
| | - Tolga Ertekin
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, 38039, Turkey
| | - Mustafa Erkan
- Department of Otorhinolaryngology, Erciyes University, Faculty of Medicine, Kayseri, Turkey
| | - Esra Durmaz
- Department of Otorhinolaryngology, Konya Numune Hospital, Konya, Turkey
| | - Mesut Aydın
- Department of Otorhinolaryngology, Kayseri Education and Research Hospital, Kayseri, Turkey
| | - Seher Yılmaz
- Department of Anatomy, Erciyes University School of Medicine, Kayseri, 38039, Turkey
| | - Gökmen Zararsız
- Department of Biostatistics and Medical Informatics, Erciyes University School of Medicine, Kayseri, Turkey
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