Journal List > J Rhinol > v.23(1) > 1044367

Han, Lee, Mo, and Lee: A Case of Huge Lingual Tonsillar Hypertrophy Causing Obstructive Sleep Apnea in Adult

Abstract

Obstructive sleep apnea is characterized by repeated episodes of obstructive apnea and hypopnea. Lingual tonsillar hypertrophy causing obstructive symptoms is a rare disease in adults. Recently, we experienced a case of obstructive sleep apnea due to massive lingual tonsillar hypertrophy. The patient had tonsillectomy as a child and underwent adenoidectomy three years prior to the current presentation due to snoring and sleep apnea. However, symptoms did not improve and were recently aggravated. The upper airway evaluation and polysomnography revealed excessive lingual tonsillar hypertrophy and severe obstructive sleep apnea. An enlarged lingual tonsil was successfully removed using a Coblator. No recurrence was observed, and the obstructive sleep apnea was resolved postoperatively.

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Fig. 1.
Preoperative endoscopic findings. Nasopharyngeal airway was patent with mild tubal tonsillar hypertrophy around eustachian tube orifice (A). Enlarged lingual tonsil on tongue base was observed and the larynx could not be seen because of large lingual tonsil (B).
jr-23-60f1.tif
Fig. 2.
Preoperative contrast-en-hanced CT showed the hypertrophy of lingual tonsil (LT) which markedly obstructed the airway. Axial (A) and sagittal view (B).
jr-23-60f2.tif
Fig. 3.
Pathologic findings. On microscopic view, reactive follicles with normal lymphoid tissue were identified (H&E, ×25) (A). The reactive lymphoid tissue showed excessive increase of the germinal center (H&E, ×50) (B).
jr-23-60f3.tif
Fig. 4.
Endoscopic findings (A) and cephalometric lateral radiograph (B) at 5 months after operation. The endoscopic findings showed reduced lingual tonsil and the normal laryngeal column. The cephalometric lateral radiograph showed that the airway is patent.
jr-23-60f4.tif
Table 1.
Preoperative and postoperative polysomnography in subjects undergoing lingual tonsillectomy
  Preoperative Postoperative
Apnea-hypopnea index 46.2 2.2
Respiratory distress index 46.7 5.5
Snoring time (%) 61.9 10.5
Mean O2 saturation (%) 80 95
Lowest O2 saturation (%) 62 90
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