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Previously presented at the Triological Society Meeting at the Combined Otolaryngology Spring Meeting, April 2015 in Boston, MA as a poster presentation.
Background
The lingual tonsils are composed of reactive lymphoid tissue at the base of the tongue. Hypertrophy of the lingual tonsils can present clinically as globus, dysphagia, and cause difficultly with exposure of the glottis during intubation. Lingual tonsil hypertrophy (LTH) can also contribute to obstructive sleep apnea (OSA) at the level of the oropharynx. In children, compensatory LTH has been observed after routine tonsillectomy [1]. Recently, Sung et al. examined factors that were associated with lingual tonsil hypertrophy in Korean patients with OSA. Obesity and endoscopic evidence of reflux were found to be associated with LTH [2]. More recently, Friedman et al. have further studied endoscopic examination of the lingual tonsils in order to standardize a grading scale [3].
To date, no study has examined with relationship with tonsillectomy as a child and LTH as an adult. There is also an emerging body of evidence that suggests environmental allergies may cause laryngeal symptoms, however, the symptom overlap and comorbidity between allergy and LTH has yet to be fully elucidated [4, 5]. The purpose of this study was to determine what factors are associated with LTH in a population of Canadian adults.
Methods
Research ethics board approval was obtained at Western University (London, Ontario, Canada) for this project (HSREB # 104994). A prospective cross-sectional study enrolling consecutive patients presenting for routine consultation at an academic Rhinology and General Otolaryngology - Head & Neck Surgery practice was performed from March 2014 to June 2014. All patients older than 18 and requiring flexible nasopharyngoscopy as part of their physical examination were considered eligible for inclusion. Exclusion criteria included age less than 18, non-English speaking, illiteracy, and a history of previous sleep apnea surgery as an adult. Patients completed a questionnaire for demographic data, and completed the Reflux Symptom Index (RSI). An RSI of greater than 13 was considered positive for reflux [6]. Demographic factors examined included age, body mass index (BMI), history of diagnosed OSA, history of environmental allergies and history of childhood tonsillectomy. Tonsillectomy was considered to have been performed in childhood if the patient had tonsillectomy performed before the age of 18.
During...