Can lingual tonsillectomy improve persistent pediatric obstructive sleep apnea?

BACKGROUND The most common cause of pediatric obstructive sleep apnea (OSA) is adenotonsillar hypertrophy. As such, palatine tonsillectomy with or without adenoidectomy is the first-line treatment for OSA, which can significantly improve the sleep and behavioral disturbances associated with OSA in the majority of patients. However, even after adenotonsillectomy, a reported 20% to 40% of patients have persistent OSA as measured by polysomnography. A general consensus among pediatric sleep specialists defines pediatric OSA based on polysomnography parameters of an apnea-hypopnea index (AHI) >1 per hour, a pulse oximetry level <92%, or both. One recognized site of obstruction contributing to some instances of refractory OSA after adenotonsillectomy is lingual tonsil hypertrophy. The diagnosis and treatment of lingual tonsil hypertrophy has been relatively challenging due to limited assessment of the pediatric airway on routine physical exam and to varied surgical techniques. This article explores whether lingual tonsillectomy can improve OSA as evaluated by polysomnography.