Lingual tonsil hypertrophy: clinical features, grading and lingual tonsil reduction effect on symptoms

Abstract

Background Patients diagnosed with hypertrophic lingual tonsil are difficult to manage. Lingual tonsil hypertrophy (LTH) besides dysphagia can cause serious conditions such as upper airway obstruction and difficult intubation. Modern tonsil removal techniques such as lingual tonsil reduction (LTR) under microscope or endoscope seems to be effective in relieving LTH clinical symptoms. However we still lack data of LTR efficacy and universally used lingual tonsil grading system, though several systems have already been proposed. Aim To assess clinical features of LTH, to evaluate lingual tonsil reduction effect on symptoms and to compare two different LTH grading systems. Methods We evaluated 101 consecutive adult patients (32 males, 69 females), with the mean age of 51,97 ± 13,53 years with LTH, proven by fibronasolaryngoscopy and who eventually underwent LTR (performed under microscope with laryngoscopic approach). 58% of patients were diagnosed with gastroesophageal reflux disease (GERD), 39% with obstructive sleep apnea (OSA), 1% with lingual tonsillitis, 2% with hematological diseases. A group of 50 healthy individuals matched with clinical group by age and gender was formed. All subjects filled out questionnaires composed of reflux symptom index (RSI) and dysphagia screening questionnaire (DSQ), validated and verified for use in Lithuania. Also original questionnaire was created for gathering sociodemographic data and evaluating the most common LTH symptoms and their severity on 10 cm visual analogue scale (0 – not troublesome, 10 – extremely troublesome), including snoring, difficulty breathing, hoarseness, cough, sore throat and difficulty swallowing before and 2 months after LTR. The LTH grade of all subjects was determined using Del Gaudio grading system (0 – no lingual tonsil; 3 – the view of epiglottis is interrupted). Fibronasolaryngoscopy recordings of 20 random subjects were separately ev.[...].