TABLE IX.D.3.
Evidence on tonsillectomy for treatment of OSA
| Study | Year | LOE | Study design | Study groups | Clinical endpoint | Conclusions |
|---|---|---|---|---|---|---|
| Smith et al.1678 | 2017 | 4 | CS | 29 OSA patients | Sher’s criteria | Tonsillectomy appears to be an effective treatment for OSA in a select population of adults with tonsillar hypertrophy. |
| Holmlund et al.1589 | 2016 | 3b | PCC | 28 OSA patients with AHI > 10, Friedman grade III and IV tonsils | Change in AHI, ESS 6 months after surgery | Tonsillectomy may be an effective treatment for adult patients with OSA and large tonsils. |
| Camacho et al.335 | 2016 | 3a | SR/MA | NA | NA | Isolated tonsillectomy can be successful as a treatment option for adult OSA, especially among patients with large tonsils, and mild to moderate OSA (AHI < 30/h). |
| Senchak et al.1500 | 2015 | 3b | PCC | 19 OSA patients | Reduction of AHI by at least 50% to an absolute index of <15 | Adult tonsillectomy alone has a beneficial effect in the treatment of OSA. |
| Tan et al.1674 | 2014 | 3b | PCS | 34 OSA patients | Sher’s criteria | Tonsillectomy alone may be considered as an effective, first-line surgical procedure in the treatment of OSA. |
| Stow et al.1679 | 2012 | 4 | RCS | 13 OSA patients with tonsillar hypertrophy | Sher’s criteria | In selected adult subjects, tonsillectomy with intercurrent nasal surgery should be considered an effective treatment for OSA. |
| Nakata et al.1676 | 2007 | 3b | PCS | 20 OSA patients | AHI decrease | The reduction in nasal resistance induced by simple tonsillectomy could play an important role in improving OSAS, similar to nasal surgery and adenoidectomy. |
| Martinho et al.1492 | 2006 | 4 | PCS | 7 OSA patients with moderate obesity and tonsil hypertrophy | AHI decrease | Tonsillectomy for OSAHS in obese patients with obstructive palatine tonsil hypertrophy caused a significant reduction in AHI. |
| Nakata et al.1675 | 2006 | 3b | PCS | 30 OSA patients with tonsillar hypertrophy | Sher’s criteria | Simple tonsillectomy is a beneficial modality to treat OSA in selected patients (larger tonsils, low body mass index). |
| Verse et al.1677 | 2000 | 3b | PCS | 11 OSA patients with tonsillar hypertrophy | Sher’s criteria | In carefully selected patients, tonsillectomy should be considered an effective and safe surgical option for the treatment of OSA. |
| Miyazaki et al.1680 | 1998 | 4 | RCS | 10 OSA patients | PSG, AHI, 3 months postoperatively | Certain subjects can be effectively treated through tonsillectomy solely. |
| Houghton et al.1681 | 1997 | 4 | RCS | 7 OSA patients | PSG, 3 months postoperatively | Adult patients with tonsillomegaly may represent a subgroup of patients with OSA who would benefit from surgery aimed at the oropharynx. |
| Cheong et al.1682 | 1990 | 4 | RCS | 14 OSA patients | Postoperative PSG | Tonsillectomy offered a simple and effective therapy for patients with tonsillar hypertrophy. |
| Aubert-Tulkens et al.1683 | 1989 | 4 | RCS | 7 severe OSA patients | Postoperative AI | In adults with long-standing sleep apnea syndrome, surgical correction of nasal or pharyngeal abnormalities should not be expected to normalize sleep and breathing. |
| Moser et al.1684 | 1987 | 4 | RCS | 6 OSA patients with adenotonsillar hypertrophy | >2 months postoperative AI | Many adults with OSA can clearly benefit from the removal of hypertrophied tonsils. |
| Rubin et al.1685 | 1983 | 4 | RCS | 23 moderate-severe OSA patients (seven underwent tonsillectomy, 16 treated by SMR) | Postoperative PSG, AI | Tonsillectomy improved the AI. |
| Orr et al.1672 | 1981 | 4 | RCS | 6 OSA patients with tonsillar hypertrophy | ESS, PSG in four patients | Even relatively mild tonsillar enlargement can play an important role in the pathogenesis of obstructive sleep apnea. |
Abbreviations: CS, case series; PCC, prospective case–control study; PCS, prospective cohort study; RCS, retrospective cohort study; SR, systematic review.