Tonsillectomy and OSAs

In the adult population, tonsillectomy is the appropriate first line treatment in select patients. (Epstein 2009, Evidence Based Clinical Guideline)) After thorough examination, if the primary site of obstruction is hypertrophied tonsils, tonsillectomy has been shown to be a very effective treatment regardless of the severity of the OSA. (Verse 2000, Level 3) While most of the articles supporting adult tonsillectomy for OSA are small, the results of these 7 articles strongly support this treatment. In Verse 2000, many of the studies prior to 2000 are reviewed. In this review, patients had a mean preoperative Apnea-Hypopnea Index (AHI) of 54.6 and mean post operative AHI of 3.6.

Surgical treatment of pediatric sleep disordered breathing with tonsillectomy and adenoidectomy is the recommended first line treatment.  In the pediatric population, resolution of OSA occurs  in 82% of patients who are treated with T&A. (Brietzke 2006, Meta-analysis) The effects of T&A include normalization of AHI, improvement of quality of life (QOL) measures, improved behavior, improved academic performance, and  improved neurocognitive functioning. In snoring pediatric patients with symptoms of sleep disordered breathing in whom AHI is not normalized, or in whom AHI was not elevated preoperatively, significant improvement are seen in all QOL measures, neurocognitive functioning and behavior. (Chervin 2006,Level 2 evidence)

References
1. Epstein, Lawrence J. (Chair); Kristo, David; Strollo, Jr., Patrick J. ; Clinical Guidelines for the Evaluation, Management and Long-term Care of Obstructive Sleep Apnea in Adults, Journal of Clinical Sleep Medicine, Vol.5, No. 3, 2009.

2. Verse, Thomas; Kroker, Beatrice; Pursig, Wolfgang, Tonsillectomy as a Treatment of Obstructive Sleep Apnea  in Adults with Tonsillar Hypertrophy, Laryngoscope, 110: 1559, 2000.

3. Brietzke S, Gallagher D, The effectiveness of tonsillectomy and adenoidectomy in the treatment of pediatric obstructive sleep apnea/hypopnea syndrome: A meta-analysis
Otolaryngol Head Neck Surg, 134(6), 979-984, 2006.

4. Chervin RD, Ruzicka DL, Giordani BJ, et al. Sleep-disordered breathing, behavior, and cognition in children before and after adenotonsillectomy. Pediatrics 117:769-78,2006.

Adopted 5/3/2010

Important Disclaimer Notice

Policy statements are approved by the American Academy of Otolaryngology—Head and Neck Surgery, Inc. or Foundation (AAO-HNS/F) Boards of Directors and are typically generated from AAO-HNS/F committees. Once approved by the Academy or Foundation Board of Directors, they become official policy statements and are added to the existing policy statement library. In no sense do they represent a standard of care. The applicability of policy statements as guidance for a procedure must be determined by the responsible physician in light of all the circumstances presented by the individual patient. Adherence to these clinical policy statements will not ensure successful treatment in every situation. As with all AAO-HNS/F guidance, this policy statement should not be deemed inclusive of all proper treatment decisions or methods of care, nor exclusive of other treatment decisions or methods of care reasonably directed to obtaining the same results.