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September 23, 2016

Tonsillectomy Alone Can Cure OSA in Select Adult Patients

Among adults who suffer from obstructive sleep apnea (OSA), treatments are relatively small in number and overall relatively unappetizing for many patients to pursue.

Beyond losing weight, noninvasive treatment for OSA includes CPAP which is considered the gold standard treatment for adult OSA and involves placing a mask of sorts over the face which than delivers continuous positive pressure into the lungs preventing airway collapse and obstruction. Nightly use of an oral device (mandibular advancement device) is another non-invasive intervention that may be helpful.

Otherwise, surgical interventions to treat OSA include UPPP, base of tongue reduction, hyoid advancement procedures, tracheostomy, etc. Unfortunately, all surgical interventions are quite painful to recover from and risks could be substantial.

For patients who fail to tolerate noninvasive treatment and surgical options are considered "too" invasive for a patient to consider, tonsillectomy alone may be a viable option to improve and potentially cure OSA.

According to a 2016 meta-analysis, tonsillectomy alone has a good change of improving and potentially curing OSA in adults IF:

• AHI < 30 (mild to moderate OSA)
• Large tonsils
• Not morbidly obese

In this select patient population, tonsillectomy alone cured OSA in 84% of patients. Significant improvement including OSA cures was achieved 100% of the time. Keep in mind, improvement does not mean cure and such patients will still require CPAP management.

In comparison, in patients with severe OSA (AHI > 30), only 72.4% had improvement in OSA with a cure rate of only 34.4%.

So if traditional OSA surgical options frightens a patient, a simple tonsillectomy alone may be a worthwhile surgical option given the above information and caveats.


Reference:
Tonsillectomy for adult obstructive sleep apnea: A systematic review and meta-analysis. Laryngoscope. 2016 Sep;126(9):2176-86. doi: 10.1002/lary.25931. Epub 2016 Mar 22.


Fauquier blog
Fauquier ENT

Dr. Christopher Chang is a private practice otolaryngology, head & neck surgeon specializing in the treatment of problems related to the ear, nose, and throat. Located in Warrenton, VA about 45 minutes west of Washington DC, he also provides inhalant allergy testing/treatment, hearing tests, and dispenses hearing aids. Google+ Christopher Chang, MD Bio

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