Individual Studies
While all studies selected for the systematic review and metanalysis
offered informative pre- and post-operative PSG data, the goals and
designs of the studies themselves were not ubiquitously tailored to
demonstrating DISE-directed tongue surgery efficacy. Some data sets
required careful extraction of relevant data for the purposes of this
review and meta-analysis.
Esteller et al conducted a prospective cohort study with 20 pediatric
patients comparing pre- and post- operative AHI and snoring intensity
visual analog scale (VAS) data. Only 7 of the 20 patients had
DISE-guided tongue surgery, all of which were multi-level (i.e.
radiofrequency lingual tonsillectomy plus revision adenoidectomy,
pharyngoplasty, and/or revision tonsillectomy). Determined by DISE,
tongue base obstruction was present in 40% of the patients. AHI
improved with tongue surgery, LSAT was not reported (Table 1). The study
reported significant decrease in the VAS score for snoring after (1.55 ±
1.701) compared to before (6.75 ± 2.337) DISE-directed surgery (p
< 0.05), with 80% of the patients’ parents reporting VAS
> 6 prior to surgery, but this data is confounded with
upper airway surgery not involving the tongue.10
He et al’s retrospective study also assessed a variety of multi-level
airway surgeries for persistent/recurrent OSA; including lingual
tonsillectomy, midline posterior glossectomy, or hyoid
myotomy/suspension. Similar to Esteller et al, the article does not
directly link PSG data to the specific type of surgery performed so it
is unclear how tongue surgery independently affected AHI. However, the
study described overall outcomes by surgery: the responder data showed
four (57%) patients who underwent lingual tonsillectomy were
responders, and three (43%) were non-responders, as previously defined.
For partial midline glossectomy, there was one (25%) responder and
three (75%) non-responders. Hyoid suspension/myotomy included one
responder (50%) and one non-responder (50%).
Ulualp et al conducted a small retrospective series with ten patients
who underwent combined tongue base reduction and lingual tonsillectomy,
half of which were syndromic, and the majority were overweight or obese.
There was overall statistically significant improvement in AHI
post-operatively, but 60% of the patients had residual OSA, and there
was no statistically significant improvement in LSAT. It is unsurprising
there was residual OSA in most patients given the high proportion of
overweight-obese patients, and it is well-understood in the literature
that this is a risk factor for persistent OSA.16
Williamson et al evaluated post-operative PSG outcomes of 168 children.
Of these patients, 101 underwent lingual tonsillectomy alone; 25,
midline posterior glossectomy alone; and 42, both. Concurrent procedures
included turbinate reduction, revision adenoidectomy, and/or
supraglottoplasty. Their mean AHI improvement was 3.52 ± 8.39, 2.55 ±
5.59, and 3.70 ± 6.07 events/hr, respectively. Each surgical group
experienced significant improvement in sleep apnea when pre- and
postoperative AHI was compared (P < 0.01). Overall, 126 (75%)
patients experienced surgical success.14