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. 2002 Aug;87(2):156–159. doi: 10.1136/adc.87.2.156

Use of tonsil size in the evaluation of obstructive sleep apnoea

A Li 1, E Wong 1, J Kew 1, S Hui 1, T Fok 1
PMCID: PMC1719186  PMID: 12138072

Abstract

Methods: Lateral neck radiograph was performed on 35 children referred consecutively to a university paediatric chest clinic for suspected OSA secondary to tonsillar hypertrophy. The tonsil size was determined by measuring the TP ratio on the radiographs. The severity of OSA was assessed by overnight polysomnography.

Results: A total of 24 boys and 11 girls (median age 6.2 years) were studied. All presented with symptoms of OSA, and tonsillar hypertrophy was detected on clinical examination. The median apnoea–hypopnoea index (AHI) was 16.93 (interquartile range: 8.41 to 28.29). The median TP ratio was 0.76 (interquartile range: 0.65 to 0.80). AHI was positively correlated with the TP ratio. The clinical tonsil size did not correlate with the AHI or the TP ratio. Using a TP ratio of 0.479, the sensitivity and specificity in predicting cases with moderate/severe OSA (AHI >10) were 95.8% and 81.8% respectively, while the positive and negative predictive values were 92.0% and 90.0% respectively.

Conclusions: Results show that in a population of children with OSA, tonsillar hypertrophy as assessed by lateral neck radiograph correlates positively with the severity of obstructive sleep apnoea. The TP ratio has high sensitivity and specificity in predicting those with moderate/severe disease and this feature may be used as a clinical screening method in prioritising patients with OSA for further assessment.

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Figure 1 .

Figure 1

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Graphic description of measurements of a lateral cephalography. A, adenoid; N, nasopharyngeal measurement; P, pharyngeal measurement; S, sella turcica; T, tonsil. A and T are measured as a perpendicular distance at their maximum convexity. T/P is the ratio of the width of the tonsil to the depth of the pharyngeal space.

Figure 2 .

Figure 2

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Frequency of presenting clinical features of OSA in the subjects (n = 35).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

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