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Original Article |

Factors Associated With Hypertrophy of the Lingual Tonsils in Adults With Sleep-Disordered Breathing

Myung-Whun Sung, MD; Woo Hyun Lee, MD; Jee Hye Wee, MD; Chul Hee Lee, MD; Eunhee Kim, MD; Jeong-Whun Kim, MD, PhD
JAMA Otolaryngol Head Neck Surg. 2013;139(6):598-603. doi:10.1001/jamaoto.2013.3263.
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Published online

Importance This study shows factors affecting lingual tonsil hypertrophy (LTH) in sleep-disordered breathing.

Objective To identify the factors associated with LTH in adults with sleep-disordered breathing.

Design Retrospective analysis.

Setting Academic tertiary referral center.

Participants Ninety-seven adult patients with obstructive sleep apnea, who visited the Department of Otorhinolaryngology sleep clinic, were included from February 2009 through August 2011.

Interventions All patients underwent WatchPAT (peripheral arterial tone) examination, endoscopic examination of the upper airway, simple skull lateral radiography, and cine magnetic resonance imaging (MRI) sleep study of the upper airway tract.

Main Outcomes and Measures Prognostic factors indicating LTH in adults with sleep-disordered breathing.

Results A total of 97 subjects were included in this study. The median (interquartile range) apnea hypopnea index was 16.5/h (7.6/h-27.5/h). The median (interquartile range) thickness of the lingual tonsils as measured by MRI was 3.6 mm (1.9-5.2 mm) and 4.9 mm (2.9-6.7 mm) in the midline and paramidline of the tongue base, respectively (P < .001). Laryngopharyngeal reflux (reflux finding score >7) was present in 32 patients. The endoscopic grade of LTH agreed with the radiographic grade (κ = 0.731; P < .001). Lingual tonsil thickness as measured by MRI was correlated with the endoscopic grade of LTH (P < .001). Multivariate analysis revealed that laryngopharyngeal reflux (P < .001) and body mass index (P = .046) were independently significant factors associated with LTH as measured by MRI.

Conclusions and Relevance Reflux finding score and body mass index were significantly associated with LTH in adults with sleep-disordered breathing, whereas the respiratory parameters were not associated with LTH.

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Figure 1. Grading of lingual tonsil hypertrophy. Endoscopically, grade 1 (A), grade 2 (B), and grade 3 (C). Radiographically, grade 1 (D), grade 2 (E), and grade 3 (F).

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Figure 2. Magnetic resonance imaging. Magnetic resonance images in 2 patients with prominent lingual tonsils (A) and scanty lingual tonsils (B). The lingual tonsils were measured at 2 levels: at the uvula level (dotted line) and at the epiglottis level (solid line).

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Figure 3. The thickness of the lingual tonsils (LTs) measured on magnetic resonance imaging according to the endoscopic grades of lingual tonsil hypertrophy (P < .001). On each box, the central mark is the median, the edges of the box are the first and third quartiles, and the whiskers extend to the most extreme data points.

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