Palatine tonsil volume estimation using different methods after tonsillectomy

Haematologic Markers and Tonsil-to-Body Weight Ratio to Assist Adenotonsillar Hypertrophy Diagnosis

Aims Diagnosis of Adenotonsillar Hypertrophy (ATH), the leading cause of pediatric Obstructive Sleep Apnea (OSA), depends on physical exam via Brodsky's staging of tonsils. This study investigates the associations of ATH with patient parameters, and balances in-office tonsil hypertrophy appraisal against true organ mass. Materials and Methods A prospective cohort was formed of 103 children operated for ATH, and 31 matched controls. Demographic, clinical and tympanographic data, as well as Complete Blood Count (CBC) indices were compared. Absolute and relative to total body weight tonsil specimen mass were correlated with Brodsky's score. Results Tonsillar size indices were significantly raised in ATH patients. Elevated leukocytes (P = 0.012) and increased neutrophil percentage (P = 0.025) conveyed higher ATH risk. Subjective evaluation of tonsils graded 1 or 2 correlated significantly with absolute (P = 0.001) and relative (P = 0.006) objective measurements. Brodsky's score 3 and 4 displayed marginal significant association with relative (P = 0.050) but not with true (P = 0.989) mass. Conclusion An occult hematologic inflammatory response was detected in ATH children. Clinical estimation of severely hypertrophic tonsils should be adjusted for total body weight. Trial Registration Number: NCT03541434 (clinicaltrials.gov).

Is there a relationship between tonsil volume and the success of pharyngeal surgery among adult patients with obstructive sleep apnea?

OBJECTIVES

Hypertrophic palatine tonsils play a role in the blockage of the upper airway, one of the known causes of Obstructive Sleep Apnea (OSA). Therefore, it is possible that there is an association between tonsil size and the success of pharyngeal surgery during OSA treatment. The main objective of this study was to evaluate the relationship between tonsil grade and volume, as well as to establish whether a relationship exists between tonsil size and the success rate of pharyngeal surgery (tonsillectomy and pharyngoplasty with barbed sutures).

METHODS

This retrospective study includes forty-four adult patients who underwent tonsillectomy and pharyngeal surgery with barbed sutures for the treatment of simple snoring and OSA between January 2016 and September 2019. Patients who had been previously tonsillectomized or those for whom tonsil volume measurement was lacking were excluded. All patients underwent a pre-operative physical exploration at the clinic exam room and a sleep study. Prior to surgery a Drug Induced Sleep Endoscopy (DISE) was performed. Tonsil volume was measured intraoperatively using the water displacement method. The same sleep study was repeated six months following surgery.

RESULTS

A significant correlation was found between tonsil grade and volume and between such measurements and the blockage observed at the level of the oropharynx during the DISE. Moreover, an association was observed between tonsil volume, but not tonsil grade, and the success of tonsillectomy and pharyngoplasty with barbed sutures. A tonsil volume greater than 6.5 cm³ was linked to success during pharyngeal surgery.

CONCLUSION

A correlation exists between tonsil grade and tonsil volume. A bigger tonsil volume is associated with a greater success rate of oropharyngeal surgery during treatment of OSA.

LEVEL OF EVIDENCE

Level 3, non-randomized cohort study.

Benign Palatine Tonsil Volume Variation Following Bilateral Tonsillectomy in Adults

Background

There is a lack of data on normal size discrepancy in benign tonsils. The current school of thought for otolaryngologists is to remove tonsils that look clinically asymmetric on the basis of occult malignancy. However, many of these tonsils turn out to be benign after microscopic evaluation. The data in this article provide a reference range of size variation that can be seen in benign adult tonsils. Such new information can be incorporated into the surgeon’s preoperative discussion with patients with respect to informed consent and patient reassurance.

Methods

A chart review was conducted to identify pathology-proven benign bilateral tonsillectomies in the adult population. The review timeframe was from January 2012 to December 2017 (inclusive). All patients underwent surgery in an Eastern Health facility in Newfoundland and Labrador, Canada. In total, 403 cases were identified that fulfilled the inclusion criteria.

Results

Out of the 403 cases studied, the average tonsillar volume was 42.81 cm³. When differentiating between men and women, it can be seen that men have a higher average tonsil size (52.4 cm³) than women (37.85 cm³). The average difference in tonsil volume for all cases was 24.3%, with a standard deviation of 19.2%. Moreover, for men, the average difference in tonsil volume was 24.2%, with a standard deviation of 19.74%. Similarly, for women, the average difference in tonsil volume was 24.36%, with a standard deviation of 18.94%.

Conclusions

Findings from this study show that, on average, benign tonsils can vary in size by approximately 24% and that such a difference does not necessarily indicate malignancy.

Correlation between Brodsky Tonsil Scale and Tonsil Volume in Adult Patients

Purpose

To evaluate the value of Brodsky tonsil scale in predicting the objective tonsil volume and to identify the potential factors that might interfere with the accuracy of prediction.

Methods

A total of 87 adult patients who underwent single tonsillectomy or uvulopalatopharyngoplasty (UPPP) procedure including tonsillectomy in our hospital between Jan 2015 and Dec 2016 were included. The data of Brodsky tonsil scale evaluated preoperatively and objective tonsil volume evaluated postoperatively were collected for analysis.

Results

Among the 87 adult patients included, 85 patients underwent bilateral tonsillectomy, while only 2 underwent unilateral procedure. Therefore, a total of 172 tonsils were included. Significant positive correlations were established between Brodsky scale and objective volume for either right (R = 0.647), left (R = 0.664), or overall tonsils (R = 0.654) (all p < 0.001). However, volume overlaps could be found between 2+ and 3+ tonsils. Age [odds ratio (OR) = 4.053, p = 0.003] and body mass index (BMI; OR=1.740, p = 0.044) were found to be independent factors that could influence the consistency between the Brodsky scale and objective volume. As a result, a formula “Index = -1.409+1.399×age+0.554×BMI” was constructed for the evaluation of the consistency.

Conclusion

Tonsil grading was significantly correlated with tonsil volume; preoperative tonsil grading that reflected the real tonsil volume was regarded as the protocol for the evaluation of the tonsil size. Age and BMI were independent factors that could affect the consistency between tonsil grade and tonsil volume. A mathematical model was estimated to predict the consistency accurately.