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Rachmawati EZK, Tamin S, Fardizza F, Yunizaf R, Putranto FM, Rizki NA, Wardani RS. Types of Epiglottic Collapse in Breathing Sleep Disorder and Their Impact in Clinical Practice. Int Arch Otorhinolaryngol 2024; 28:e255-e262. [PMID: 38618588 PMCID: PMC11008943 DOI: 10.1055/s-0043-1776719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/29/2023] [Indexed: 04/16/2024] Open
Abstract
Introduction Obstructive sleep apnea (OSA) is a severe form of sleep-disordered breathing (SDB) that is strongly correlated with comorbidities, in which epiglottic collapse (EC) and other contributing factors are involved. Objectives To evaluate the occurrence of EC in OSA patients through drug-induced sleep endoscopy (DISE) and to determine the factors contributing to EC. Methods A retrospective study of 37 adult patients using medical history. Patients were assessed for laryngopharyngeal reflux (LPR) and lingual tonsil hypertrophy (LTH) using reflux symptom index and reflux finding score (RFS); for OSA using polysomnography, and for airway collapse through DISE. An independent t -test was performed to evaluate risk factors, including the involvement of three other airway structures. Results Most EC patients exhibited trap door epiglottic collapse (TDEC) (56.8%) or pushed epiglottic collapse (PEC) (29.7%). Lingual tonsil hypertrophy, RFS, and respiratory effort-related arousal (RERA) were associated with epiglottic subtypes. Laryngopharyngeal reflux patients confirmed by RFS (t(25) = -1.32, p = 0.197) tended to suffer PEC; LTH was significantly associated (X2(1) = 2.5, p = 0.012) with PEC (odds ratio [OR] value = 44) in grades II and III LTH patients; 11 of 16 TDEC patients had grade I LTH. Pushed epiglottic collapse was more prevalent among multilevel airway obstruction patients. A single additional collapse site was found only in TDEC patients. Conclusion Laryngopharyngeal reflux causes repetitive acid stress toward lingual tonsils causing LTH, resulting in PEC with grade II or III LTH. Trap door epiglottic collapse requires one additional structural collapse, while at least two additional collapse sites were necessary to develop PEC. Respiratory effort-related arousal values may indicate EC.
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Affiliation(s)
- Elvie Zulka Kautzia Rachmawati
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Susyana Tamin
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fauziah Fardizza
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Rahmanofa Yunizaf
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Fikri Mirza Putranto
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Universitas Indonesia Hospital, Depok, Indonesia
| | - Niken Ageng Rizki
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
| | - Retno S. Wardani
- Department of Otorhinolaryngology-Head and Neck Surgery, Fakultas Kedokteran Universitas Indonesia, Cipto Mangunkusumo Hospital, Jakarta, Indonesia
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Roßberg W, Dagistani A, Mitovska D, Krüger C, Warnecke A, Lenarz T, Durisin M. Zungengrundhyperplasie nach Tonsillektomie und Korrelation mit dem BMI. Laryngorhinootologie 2022; 102:357-363. [PMID: 36543221 PMCID: PMC10159682 DOI: 10.1055/a-1887-6352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Zusammenfassung
Hintergrund Die Hyperplasie der Zungengrundtonsille ist eine seltene und zugleich auch potenziell gefährliche Veränderung im Bereich der oberen Atemwege. Die Pathogenese der Zungengrundhyperplasie (ZGH) ist immer noch weitgehend unbekannt. Im Rahmen dieser Studie wurde der Zusammenhang zwischen Zustand nach Tonsillektomie und kompensatorischer Zungengrundhyperplasie untersucht.
Material und Methoden In der HNO-Klinik der Medizinischen Hochschule Hannover wurden 300 Patienten konsekutiv untersucht. Im Rahmen der indirekten Laryngoskopie wurden die Zungengrundtonsille, Einsehbarkeit des Larynx sowie seiner Subregionen nach einem Schema beurteilt. Die Daten wurden anschließend in Abhängigkeit vom Status der Gaumentonsillen ausgewertet. Ergänzend wurde der Body-Mass-Index (BMI) ermittelt und mit Ergebnissen der Laryngoskopie verglichen.
Ergebnisse Von den 300 untersuchten Patienten war bei 89 (29,6%) eine Tonsillektomie beidseits durchgeführt worden. In der Gesamtpopulation war eine stark vergrößerte Zungengrundtonsille nur in 14 Fällen (4,6%) nachweisbar. Von diesen 14 wurde bei 4 Patienten in der Vorgeschichte eine Tonsillektomie durchgeführt. Der BMI zeigte bei Patienten mit einer normal großen Zungengrundtonsille einen Wert von 24,4 und bei Patienten mit starker Zungengrundhyperplasie 27,3.
Schlussfolgerungen Die Inzidenz der ZGH fällt nach unseren Ergebnissen mit 4,7 % gering aus. Ein Zusammenhang zwischen einem Zustand nach Tonsillektomie und kompensatorischer Zungengrundhyperplasie konnte nicht nachgewiesen werden. Es zeigte sich jedoch ein statistisch signifikanter Zusammenhang zwischen BMI und ZGH.
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Affiliation(s)
- Willi Roßberg
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Ahmad Dagistani
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Dragana Mitovska
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Caroline Krüger
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Athanasia Warnecke
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Thomas Lenarz
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
| | - Martin Durisin
- HNO, Medizinische Hochschule Hannover Klinik für Hals-Nasen-Ohren-Heilkunde, Hannover, Germany
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Kang YJ, Kim BK, Hong SD, Jung YG, Ryu G, Kim HY. Influence of Lingual Tonsillar Volume in Patients with Obstructive Sleep Apnea. LIFE (BASEL, SWITZERLAND) 2022; 12:life12111920. [PMID: 36431055 PMCID: PMC9693112 DOI: 10.3390/life12111920] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/15/2022] [Accepted: 11/16/2022] [Indexed: 11/19/2022]
Abstract
This study aimed to evaluate the influence of lingual tonsil (LT) volume measured using a three-dimensional (3D) reconstruction volume rendering program on clinical parameters and polysomnography (PSG) results. A total of 100 patients who underwent PSG, computed tomography (CT), and allergy test from April 2016 to April 2020 were randomly selected. LT volume was measured using an imaging software program that enables 3D reconstruction of CT images. PSG parameters were analyzed by dividing the subjects into two groups according to LT volume (each 50 people). Based on the medial volume of 0.863 cm3, the upper half LT volume group and the lower half LT volume group were analyzed. Clinical factors such as body weight, neck circumference, body mass index (BMI), and age showed no difference between the two groups. Among PSG parameters, supine arousal index and non-rapid eye movement (NREM) arousal index were significantly higher in the upper half LT volume group (p = 0.012, 0.037). However, there was no significant difference in apnea-hypopnea index (AHI) between the upper and lower half LT volume groups (p = 0.749). Arousal snoring index and REM arousal index also showed no difference between the two groups. The prevalence of allergic rhinitis was not different in the two groups. High LT volume is associated with NREM arousal and arousal in the supine position, but it is not related to AHI.
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Affiliation(s)
- Yung Jee Kang
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Byung Kil Kim
- Department of Otorhinolaryngology—Head and Neck Surgery, Kyungpook National University of Chilgok Hospital, Hoguk-ro, Buk-gu, Daegu 41404, Republic of Korea
| | - Sang Duk Hong
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Yong Gi Jung
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
| | - Gwanghui Ryu
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: (G.R.); (H.Y.K.)
| | - Hyo Yeol Kim
- Department of Otorhinolaryngology—Head and Neck Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, Republic of Korea
- Correspondence: (G.R.); (H.Y.K.)
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Di Luca M, Iannella G, Montevecchi F, Magliulo G, De Vito A, Cocuzza S, Maniaci A, Meccariello G, Cammaroto G, Sgarzani R, Ferlito S, Vicini C. Use of the transoral robotic surgery to treat patients with recurrent lingual tonsillitis. Int J Med Robot 2020; 16:e2106. [PMID: 32223059 DOI: 10.1002/rcs.2106] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND This study evaluates the efficacy of lingual tonsil resection by transoral robotic surgery (TORS) in a large group of patients with recurrent lingual tonsillitis (RLT). METHODS Eighty-four patients with RLT treated with a lingual tonsil surgical resection using TORS were analyzed in terms of their postoperative results, disease recurrence, postoperative dysphagia, and quality of life. RESULTS A reduction of the mean number/year of acute lingual tonsillitis (LT) episodes emerged after surgery (5.17 vs 0.54 events), comparing the mean number of preoperative and postoperative LT episodes, a statistical significance emerged (P = .0001). The postoperative endoscopic evaluation showed 94.1% of patients with absent or poor lymphatic tissue on the tongue base. Evaluation of postoperative dysphagia showed good results with an average score of 85.9 ± 7.5. CONCLUSION This article explains how in patients with chronic LT with medical therapy failure and impaired quality of life, TORS could represent a valid therapeutic option.
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Affiliation(s)
- Milena Di Luca
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Giannicola Iannella
- Department of 'Organi di Senso', University "Sapienza", Rome, Italy.,Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | | | | | - Andrea De Vito
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Salvatore Cocuzza
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Antonino Maniaci
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Giuseppe Meccariello
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | | | - Salvatore Ferlito
- Department of Medical and Surgical Sciences and Advanced Technologies "GF Ingrassia," ENT Section, University of Catania, Catania, Italy
| | - Claudio Vicini
- Department of Head-Neck Surgery, Otolaryngology, Head-Neck, and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy.,Department ENT and Audiology, University of Ferrara, Ferrara, Italy
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Galli J, Settimi S, Salonna G, Mele DA, De Corso E, Paludetti G. Narrow Band Imaging for lingual tonsil hypertrophy and inflammation, in laryngo-pharyngeal reflux disease. Eur Arch Otorhinolaryngol 2019; 277:819-825. [PMID: 31858222 DOI: 10.1007/s00405-019-05765-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 12/09/2019] [Indexed: 12/27/2022]
Abstract
PURPOSE The objective of this study is to analyse the relationship between the endoscopic signs of laryngo-pharyngeal reflux, the lingual tonsil hypertrophy (LTH) and its inflammation, adopting Narrow Band Imaging (NBI) technology. METHODS We enrolled, as cases, patients with clinical diagnosis of laryngopharyngeal reflux disease (LPRD), a Reflux Symptom Index (RSI) ≥ 13, and a Reflux Finding Score (RFS) ≥ 7. Controls were enrolled among patients who underwent the same transnasal endoscopy, equipped with NBI, with a RSI < 13 and a RFS < 7. Nasopharynx, Lingual Tonsils (LT), Hypopharynx and Larynx were evaluated by two experienced otolaryngologists, who calculated the Reflux Finding Scale (RFS) score and focused their attention on the base of the tongue, observing its surface with NBI technology. RESULTS 82 patients with diagnosis of laryngopharyngeal reflux were enrolled as cases. Mean RFS was 11.7 (SD = 2.9). As controls, we enrolled 80 patients. Mean RFS was 2.7 (SD = 1.63). We found that RFS positivity was associated with a significant increase in LT dimension (2.5 vs 1.1, p < 0.001), with a higher LT crypt inflammation grading (1.8 vs 0.09, p < 0.001) and with a higher Roman Cobblestone pattern grading (1.48 vs 0.11, p < 0.001). A significant correlation between the crypt inflammation and the hyperemia subscore of RFS was present (r = 0.696, p < 0.0001), while it was not possible to find a correlation between crypt inflammation and either diffuse laryngeal edema (r = 0.166, p = 0.135) and posterior commissure hypertrophy (r = 0.089, p = 0.427). CONCLUSIONS NBI allowed us to identify endoscopically the presence of enlarged lingual tonsil, crypt inflammation and superficial mucosal changes, in patients affected by LPRD. LEVEL OF EVIDENCE 2 (prospective, case-control study).
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Affiliation(s)
- Jacopo Galli
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Stefano Settimi
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy.
| | - Giampiero Salonna
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Dario Antonio Mele
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
| | - Eugenio De Corso
- Institute of Otolaryngology, Head and Neck Surgery, Fondazione Policlinico Universitario "A.Gemelli" - IRCCS, Rome, Italy
| | - Gaetano Paludetti
- Institute of Otolaryngology, Head and Neck Surgery, School of Medicine and Surgery, Università Cattolica del Sacro Cuore, Largo F. Vito 1, 00168, Rome, Italy
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Çoban K, Köycü A, Aydın E. Lingual Tonsil Hypertrophy in Patients With Allergic Rhinitis. Am J Rhinol Allergy 2019; 34:87-92. [PMID: 31522521 DOI: 10.1177/1945892419875086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background Lingual tonsils, part of the Waldeyers’ Ring, are located in base of the tongue. They are commonly observed in childhood, due to increased immunological activity. Several factors such as laryngopharyngeal reflux, younger age, smoking, and obesity are associated with hypertrophy of lingual tonsils (LTH) in adulthood. However, the relation between allergic rhinitis and LTH is not clearly highlightened in the literature so far. Objective To investigate the role of allergic rhinitis in the development of LTH. Methods Adult patients who were diagnosed with allergic rhinitis were included in the study group. The control group consisted of age- and sex-match healthy volunteers. Complete otorhinolaryngology examination including fiberoptic endoscopic evaluation was performed to both groups. Blood samples were obtained for total immunglobulin E levels, and skin prick tests were performed to both groups. Patients with allergy complaints and positive skin prick tests were included in the study group, while healthy volunteers with negative skin prick tests were enrolled in the control group. The grading for LTH was achieved by a physician who was blind to the study. Results The incidence of LTH was significantly higher in the study group when compared to the control group ( P = .001). Similarly, the incidence of grade 3 LTH was significantly higher in the study group compared to the controls ( P = .002). Conclusion According to our results, LTH is more frequently observed in patients with allergic rhinitis. Grade 3 representing larger LTH is more commonly seen in patients with allergic rhinitis.
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Affiliation(s)
- Kübra Çoban
- Otorhinolaryngology Department, Medical Faculty, Başkent University, Ankara, Turkey
| | - Alper Köycü
- Otorhinolaryngology Department, Medical Faculty, Başkent University, Ankara, Turkey
| | - Erdinc Aydın
- Otorhinolaryngology Department, Medical Faculty, Başkent University, Ankara, Turkey
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Non-HPV Papillary Lesions of the Oral Mucosa: Clinical and Histopathologic Features of Reactive and Neoplastic Conditions. Head Neck Pathol 2019; 13:71-79. [PMID: 30693457 PMCID: PMC6405796 DOI: 10.1007/s12105-019-01001-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 01/02/2019] [Indexed: 12/20/2022]
Abstract
Excluding human papillomavirus (HPV)-driven conditions, oral papillary lesions consist of a variety of reactive and neoplastic conditions and, on occasion, can herald internal malignancy or be part of a syndrome. The objectives of this paper are to review the clinical and histopathological features of the most commonly encountered non-HPV papillary conditions of the oral mucosa. These include normal anatomic structures (retrocuspid papillae, lingual tonsils), reactive lesions (hairy tongue, inflammatory papillary hyperplasia), neoplastic lesions (giant cell fibroma), lesions of unknown pathogenesis (verruciform xanthoma, spongiotic gingival hyperplasia) and others associated with syndromes (for instance Cowden syndrome) or representing paraneoplastic conditions (malignant acanthosis nigricans). Common questions regarding differential diagnosis, management, and diagnostic pitfalls are addressed, stressing the importance of clinico-pathologic correlation and collaboration.
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Iannella G, Magliulo G, Montevecchi F, De Vito A, Polimeni A, De Vincentiis M, Meccariello G, D'Agostino G, Gobbi R, Cammaroto G, Stomeo F, Pang KP, Rotenberg B, Vicini C. Lingual tonsil lymphatic tissue regrowth in patients undergoing transoral robotic surgery. Laryngoscope 2018; 129:2652-2657. [PMID: 30582182 DOI: 10.1002/lary.27775] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 11/07/2022]
Abstract
OBJECTIVES/HYPOTHESIS To evaluate a possible regrowth of lingual tonsil lymphatic tissue in patients submitted to lingual tonsil resection with transoral robotic surgery (TORS). STUDY DESIGN Retrospective Study. METHODS Medical records of patients surgically treated by means of TORS to remove excessive lymphatic tissue of the lingual tonsil were retrospectively reviewed. Postoperative endoscopic data after long-term follow-up were analyzed to investigate possible lymphatic tissue regrowth. Preoperative and postoperative lingual tonsil lymphatic tissue were classified according to the standardized Friedman's grading scale ranging from 0 to 4. RESULTS Sixty-eight patients (41 male and 27 female; mean age = 51.3 years) were considered suitable for the study analysis. Clinical regrowth was observed in six (8.8%) patients: four (5.9%) and two (2.9%) patients with grade 2 and 3 lymphatic hypertrophy, respectively. No correlation between the grade of regrowth, the time interval from surgery, and the volume of lymphatic tissue removed was found. CONCLUSIONS The lymphatic tissue regrowth after TORS resection appears to be very low. LEVEL OF EVIDENCE 4 Laryngoscope, 129:2652-2657, 2019.
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Affiliation(s)
| | - Giuseppe Magliulo
- Department of Sensory Organs, University "Sapienza", Rome, Italy.,Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Filippo Montevecchi
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Andrea De Vito
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Antonella Polimeni
- Department of Oral and Maxillofacial Sciences, University "Sapienza", Rome, Italy
| | | | | | - Giovanni D'Agostino
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Riccardo Gobbi
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Giovanni Cammaroto
- Otolaryngology-Head and Neck and Oral Surgery Unit, Morgagni Pierantoni Hospital, Forlì, Italy
| | - Francesco Stomeo
- Department of ENT and Audiology, University of Ferrara, Ferrara, Italy
| | - Kenny P Pang
- Department of Otolaryngology, Asia Sleep Centre, Paragon, Singapore
| | - Brian Rotenberg
- Department of Otolaryngology, Western University, London, Ontario, Canada
| | - Claudio Vicini
- Department of ENT and Audiology, University of Ferrara, Ferrara, Italy
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Surgical ablation of lingual tonsils in the treatment of obstructive sleep apnea. Eur Ann Otorhinolaryngol Head Neck Dis 2018; 136:19-23. [PMID: 30503688 DOI: 10.1016/j.anorl.2018.11.001] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES/HYPOTHESIS The retrolingual space is one of the potential sites of obstruction identified in patients with obstructive sleep apnea syndrome (OSAS). Hypertrophied lingual tonsils (LT) can obstruct the airway at this level. The goal of this study was to measure the tolerance and efficacy of lingual tonsillectomy in patients with OSAS. STUDY DESIGN A retrospective chart review was conducted recruiting all patients with OSAS confirmed on sleep recording, who either had failed or refused medical treatment and who underwent lingual tonsillectomy. MATERIALS AND METHODS Diagnosis of LT hypertrophy was made by full ENT clinical examination using a flexible endoscopy, completed by MRI and followed by drug-induced sleep endoscopy. The surgical intervention was carried out endoscopically by diode laser or coblation. The primary endpoint to measure efficacy was drop in apnea-hypopnea index (AHI) on sleep recording at 6 months. Secondary endpoints comprised reduced snoring and Epworth Sleepiness Scale (ESS) and postoperative symptom tolerance. RESULTS Eleven patients aged 44.3±12.6 years were included. AHI dropped from 29.5±21.7/h to 11.6±9.6/h: i.e., by 60% (P=0.005). Five patients had AHI<10/h: i.e., cure rate of 45%. ESS dropped from 13±3.4 to 8.1±4.9 (P=0.012). No complications were observed. CONCLUSIONS LT ablation seemed effective in OSAS with retrolingual obstruction in failure of medical treatment. LEVEL OF EVIDENCE 4.
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Radiographic and histologic characterization of tongue base tissues obtained by transoral robotic surgery in patients with obstructive sleep apnea. Auris Nasus Larynx 2018; 46:89-94. [PMID: 29929870 DOI: 10.1016/j.anl.2018.06.004] [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: 04/02/2018] [Revised: 05/04/2018] [Accepted: 06/11/2018] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our aim was to radiographically and histologically characterize the tongue base tissues removed after robotic surgery and to analyze their relationship with polysomnographic measurements in obstructive sleep apnea. METHODS Medical records, radiographs and histologic specimen of the patients who underwent transoral robotic tongue base reduction surgery were retrospectively reviewed. Findings in computed tomography (CT) images, histopathological features of the removed tongue base tissues, and respiratory parameters in polysomnography were compared and analyzed. RESULTS Surgical specimens and CT images were available from 13 patients (aged 29-61 years). Histologic examination showed that the removed tissues comprised four layers-epithelial, lymphoid follicular, glandular, and muscle tissue. The median (interquartile range) thickness of the epithelial, lymphoid, and glandular layers was 0.29 (0.24-0.44) mm, 3.37 (1.67-4.75) mm, and 3.75 (3.45-4.10) mm, respectively. The lymphoid layer thickness on CT was correlated with that in the histologic section (r=0.967, p<0.001). However, the thickness of each layer had no significant correlation with the polysomnographic parameters. CONCLUSION The tongue base tissue removed by transoral robotic surgery in OSA patients comprised four distinctive layers including epithelial, lymphoid follicular, glandular and muscular layers. These layered structures could also be discriminated in the CT images.
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11
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Tang JA, Friedman M. Incidence of Lingual Tonsil Hypertrophy in Adults with and without Obstructive Sleep Apnea. Otolaryngol Head Neck Surg 2017; 158:391-394. [DOI: 10.1177/0194599817740333] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
Objectives To characterize the incidence of lingual tonsil hypertrophy (LTH) in adults with and without obstructive sleep apnea (OSA) and to determine any potential correlation between them. Study Design Retrospective chart review. Setting Single-center database, September 2016 to April 2017. Subject and Methods Lingual tonsil grade (LTG) determined by awake endoscopy was collected as well as other physical examination findings, such as Friedman tongue position, palatine tonsil size, and neck circumference. STOP-BANG scores and polysomnography data were collected to characterize OSA. Incidence of clinically meaningful LTH (defined as LTG 3 and LTG 4) was compared between OSA and non-OSA groups. Results Ninety-three patient charts were studied in total. There was no significant difference between patients with and without OSA in the incidence of clinically meaningful LTH (OSA, 13.5%; non-OSA, 14.6%; P = .872). Patients with and without OSA were compared by grade: LTG 1, 13.5% (OSA) vs 35.6% (non-OSA); LTG 2, 73.1% (OSA) vs 48.8% (non-OSA); LTG 3, 13.5% (OSA) vs 14.6% (non-OSA). There were no significant correlations between OSA status and LTG (ρ = 0.190, P = .069). Conclusion The incidence of LTH is uncommon, even among those with OSA, and does not seem to differ between patients with and without OSA. Neck circumference appears to be a better clinical indicator than lingual tonsil tissue for the likelihood of a patient having OSA.
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Affiliation(s)
- Jessica A. Tang
- Chicago ENT: Advanced Center for Specialty Care, Chicago, Illinois, USA
| | - Michael Friedman
- Chicago ENT: Advanced Center for Specialty Care, Chicago, Illinois, USA
- Rush University Medical Center, Chicago, Illinois, USA
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Kang KT, Koltai PJ, Lee CH, Lin MT, Hsu WC. Lingual Tonsillectomy for Treatment of Pediatric Obstructive Sleep Apnea: A Meta-analysis. JAMA Otolaryngol Head Neck Surg 2017; 143:561-568. [PMID: 28208178 DOI: 10.1001/jamaoto.2016.4274] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
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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Affiliation(s)
- Kun-Tai Kang
- Department 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
| | - Peter J Koltai
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Chia-Hsuan Lee
- Department 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
| | - Ming-Tzer Lin
- Department of Internal Medicine, Hsiao Chung-Cheng Hospital, New Taipei City, Taiwan5Sleep Center, National Taiwan University Hospital, Taipei
| | - Wei-Chung Hsu
- Department of Otolaryngology, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei5Sleep Center, National Taiwan University Hospital, Taipei
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Harris MS, Rotenberg BW, Roth K, Sowerby LJ. Factors associated with lingual tonsil hypertrophy in Canadian adults. J Otolaryngol Head Neck Surg 2017; 46:32. [PMID: 28412967 PMCID: PMC5392952 DOI: 10.1186/s40463-017-0209-z] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Accepted: 03/28/2017] [Indexed: 11/30/2022] Open
Abstract
Background Hypertrophy of the lingual tonsil tissue in the adult patient is thought to contribute to the pathophysiology of obstructive sleep apnea. The underlying etiology of lingual tonsil hypertrophy (LTH) in the adult patient is unclear and likely multifactorial. Previous studies have suggested that the lingual tonsils may undergo compensatory hyperplasia post-tonsillectomy in children, although it is unknown if this occurs or persists into adulthood. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults. Methods Adult patients presenting for consultation to an academic Rhinology/General Otolaryngology practice were eligible for enrollment. Demographic data including age, body mass index (BMI), Reflux Symptom Index (RSI), history of allergy, and history of tonsillectomy was collected via questionnaire. Endoscopic photographs of the base of tongue and larynx were captured. These were graded for LTH and Reflux Finding Scale (RFS) by blinded examiners. Statistical analysis was performed by comparing the mean LTH value to the variables of interest using two-tailed T-test. P < .05 was considered significant. Results One hundred two subjects were enrolled. Age ranged from 18 to 78. 28 patients had previous tonsillectomy. This was not associated with a significant increase in lingual tonsil tissue (r = −0.05, p = 0.61). RFS >7 or RSI >13 was considered positive for laryngopharyngeal reflux. There was no difference in LTH based on RSI positivity (p = 0.44). RFS positivity correlated with increased lingual tonsil tissue (p < 0.05). BMI >30 was associated with increased lingual tonsil hypertrophy (p < 0.05). Conclusions An elevated body mass index and positive Reflux Finding Score are associated with lingual tonsil hypertrophy in adults. Reflux symptom index, history of allergy and history of childhood tonsillectomy are not associated with LTH.
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Affiliation(s)
- Matthew S Harris
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Brian W Rotenberg
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada
| | - Kathryn Roth
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada
| | - Leigh J Sowerby
- Department of Otolaryngology - Head & Neck Surgery, Schulich School of Medicine & Dentistry, Western University, London, ON, Canada. .,St. Joseph's Healthcare, Western University, 268 Grosvenor Street, London, ON, N6A 4 V2, Canada.
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Camacho M, Noller MW, Zaghi S, Reckley LK, Fernandez-Salvador C, Ho E, Dunn B, Chan D. Tongue surgeries for pediatric obstructive sleep apnea: a systematic review and meta-analysis. Eur Arch Otorhinolaryngol 2017; 274:2981-2990. [DOI: 10.1007/s00405-017-4545-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 03/20/2017] [Indexed: 12/27/2022]
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Bakshi SS. Letter to Editor on "Factors Associated with Hypertrophy of the Lingual Tonsils". Otolaryngol Head Neck Surg 2015; 153:1078-9. [PMID: 26621929 DOI: 10.1177/0194599815605493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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