Multi-level surgery for obstructive sleep apnea. Lingual tonsillectomy vs. hyoid suspension in combination with radiofrequency of the tongue base.

PURPOSE: The aim of this study was to compare results in patients with obstructive sleep apnea (OSA) undergoing multi-level surgery with two different surgical approaches to treat tongue base obstruction.

STUDY DESIGN: This is a prospective, controlled clinical trial at a tertiary referral center.

METHODS: Altogether, 108 patients were separated into two groups according to the findings during drug-induced sleep endoscopy. Patients with enlarged lingual tonsils (N = 58; group A) underwent a lingual tonsillectomy (LT). Patients with small or absent lingual tonsils (N = 50; group B) underwent a hyoid suspension type 2 (HS) in combination with a radiofrequency treatment of the base of the tongue (RFT TB). In addition, all patients underwent an uvulopalatopharyngoplasty with tonsillectomy.

RESULTS: At baseline, there were no significant differences between the groups. In group A, the mean apnea hypopnea index (AHI) decreased by 49.7 %, and in group B by 48.3 %. Patients with simultaneous tonsillectomies showed significant better results as compared to patients after prior tonsillectomies (success rate 76.6 vs. 27.3 %). By comparing subgroups (with and without simultaneous tonsillectomy), patients in group A showed better results in terms of AHI reduction than patients in group B, indicating that LT may be superior to HS + RFT TB in treating OSA within our multi-level surgery concept.

CONCLUSION: Simultaneous tonsillectomy has a significant impact on objective results of multi-level surgery (MLS). Study results should be adjusted for this parameter. Having done this, MLS with LT seems to produce superior results as compared to HS + RFT TB. Nevertheless, our approach to treat patients differently according to their tongue base tonsil size did not substantially improve our surgical outcome as compared to a previous study.