Sleep Outcomes of Coblation Lingual Tonsillectomy in Adults

Introduction: To determine the sleep-related outcomes of lingual tonsillectomy by coblation in adult patients with obstructive sleep apnea and to identify predictors of success.

Methods: A retrospective case series of all adult patients with obstructive sleep apnea who underwent coblation lingual tonsillectomy performed by a single surgeon from April 2013 to June 2022 was conducted. Only patients with a preoperative sleep study and a postoperative sleep study 3 months after surgical intervention were included. Demographic data, medical comorbidities, and sleep study results were collected. The main outcomes of this study were surgical success, surgical cure, and surgical failure. Logistic regression analysis was performed to identify predictive factors for these outcomes.

Results: 49 patients who underwent lingual tonsillectomy for obstructive sleep apnea with preoperative and postoperative sleep studies were included. Median age was 52 years old and median preoperative BMI was 34.5. Median pre and post-operative AHI were 28 and 15.2 respectively. Surgical success and cure were 35% and 20% respectively. Concurrent procedures were also performed in included patients in 73% of cases including turbinoplasty, midline posterior glossectomy, and hyoid suspension as the most frequent concurrent procedures. On multivariable analysis of sleep outcomes, a BMI > 30 was found to be significantly associated with surgical failure (p=0.007, OR 9.41, 95% confidence interval of 1.28-47.75). For patients with a BMI < 30, surgical success and cure were 75% and 42% respectively.

Conclusions: Coblation lingual tonsillectomy is a safe procedure that can be considered as a staged or concurrent intervention to address multi-level obstruction in adult patients with obstructive sleep apnea. Patients with a BMI less than 30 have a significantly greater likelihood of surgical success or cure following this procedure.