Can a Tonsillectomy Cure Obstructive Sleep Apnea?

June 21, 2022

The prevalence of obstructive sleep apnea (OSA) has steadily increased over the last two decades, and studies suggest nearly one billion people worldwide struggle with the sleep disorder. From fatigue and excessive daytime sleepiness to irritability and mental health concerns, insufficient breathing and sleep can affect every area of your patients’ health and wellness.

There is a wide variety of treatment options available to those with sleep apnea. From CPAP to oral appliance therapy (OAT), prescribing the appropriate therapy is crucial to ensure patients get relief from the debilitating effects of OSA.

Another option in treating sleep apnea, however, is tonsil removal. While often not the first line of defense for adults with OSA, adult tonsillectomy for OSA has a surprising success rate.5 Let’s explore the connection between tonsil removal and OSA, including why it is a viable option, who is a candidate (and who is not), possible side effects, and life after a tonsillectomy.

Is Tonsillectomy a Viable Treatment Option for OSA?

When it comes to tailoring a treatment plan to OSA, it’s essential to find the root cause of the symptoms. Because the etiology can vary from person to person, narrowing down the possibilities to find the cause of OSA is crucial to finding the appropriate treatment.

The following signs are some of the most common risk factors of OSA:

  • Underdeveloped upper and lower jaws
  • Enlarged tonsils
  • Neck position or development
  • Obesity
  • Family history
  • Endocrine conditions2

At the end of the day, if you’re asking, “Does removing tonsils help with sleep apnea?” the answer is that it depends. If sleep apnea symptoms are caused by enlargement of the tonsils, a tonsillectomy could help. If not, a tonsillectomy would likely do nothing to improve your symptoms.2

Along those lines, tonsillectomies are rarely performed as the only type of treatment.2 Often, they are partnered with other solutions that can improve outcomes, such as adenoidectomies. According to a recent systematic review, “tonsillectomy and adenoidectomy are most often performed simultaneously as the primary treatment for OSA in children.” However, the success of these treatments varies based on clinical factors, including tonsil size, palate position, craniofacial abnormalities, comorbidities, and obesity.5 If enlarged tonsils are not the source of the OSA, it’s likely that a tonsillectomy would not be the only treatment needed to address a patient’s symptoms.

Who Is a Good Candidate for Tonsillectomy?

Swollen tonsils tend to be a greater cause of sleep apnea in children than adults. Tonsillectomy is the second most frequent surgical procedure performed on children, and OSA is often the reason for the surgery.3 For adults, tonsillectomies occur due to infection, biopsy, tonsillar stones, or OSA.4

Will removing tonsils and adenoids help resolve sleep apnea in adults? Possibly. It’s much less common for adults to suffer from enlarged tonsils. However, like children, adults who have OSA caused by large tonsils have also been shown to reduce their sleep apnea symptoms after surgery that involves tonsillectomy.5

However, this surgery may not result in a complete cure or resolution of symptoms. In one study, significant predictors of tonsillectomy success included preoperative body mass index (BMI) and apnea-hypopnea index(AHI).4 Patients with high BMI and AHI were less likely to have complete symptom relief after a tonsillectomy.4

The following are a few additional symptoms of OSA: 3,6

  • Loud snoring or noisy breathing during sleep
  • Mouth breathing
  • Restlessness during sleep
  • Periods of no breathing at all
  • Excessive daytime sleepiness and fatigue
  • Irritability
  • Hyperactivity throughout the day

Who Is a Bad Candidate for Tonsillectomy?

Now that we’ve answered the question “Does removal of tonsils help sleep apnea?” we can dive into when it may not be the best option. First, those who experience disordered breathing not caused by enlarged tonsils will likely find that a tonsillectomy is not the best option for them. This is because removal of the tonsils will not address the root cause of their symptoms.

Other treatment options for OSA include the following:

  • Mandibular advancement devices (MAD)
  • Oral appliance therapy (OAT)
  • Continuous positive airway pressure (CPAP)
  • Jaw surgery
  • Tracheostomy
  • Upper airway stimulation2

Alongside other therapies or surgery, lifestyle changes are often required to resolve OSA. Lifestyle changes include losing weight, exercising regularly, reducing alcohol intake, changing medications, and sleeping on your side rather than your back. If you’re overweight or obese, even a moderate loss of excess weight may help relieve constriction of your airway.2

What Are the Possible Side Effects of Surgery?

Because a tonsillectomy is an invasive procedure, it comes with its own set of possible complications. Many patients experience a sore throat and other side effects in the days after surgery.4

The following are common postoperative discomforts after a tonsillectomy:4

  • Pain in the neck, ears, or jaw
  • Moderate-to-severe throat pain for one to two weeks
  • Mild fever
  • Anxiety or sleep disturbances
  • Nausea and/or vomiting

Can OSA Persist after Surgery?

Tonsil removal often improves OSA symptoms; however, it is possible for symptoms to persist even after the surgery. Tonsillectomy is effective for OSA in 80 percent of normal-weight children with tonsillar hypertrophy, but only effective in 20 to 30 percent of obese children.2 Similarily, success rates for adults vary.4

For example, a few risk factors could lead to lasting OSA, including craniofacial or mandibular anomalies, obesity, severe OSA prior to surgery, genetic disorders, asthma, and neuromuscular disorders. In these cases, it’s likely that the tonsil removal did not remove the obstruction itself. This means that the obstruction could be in the nose, nasal cavity, larynx, or pharyngeal walls.2

What surgical complications can occur?

In general, recovery time for a tonsillectomy is usually about 10 days to two weeks. However, like all surgeries, tonsillectomy comes with certain risks, such as the following: 4

  • Reactions to anesthetics: Anesthesia can cause minor issues like headaches, nausea, or muscle soreness. There are also long-term risks; however, these are rare.
  • Bleeding: Bleeding may occur during surgery or healing. Severe bleeding during surgery is rare, but it would require additional treatment in the hospital.
  • Infection: Surgery can lead to infection that would require additional treatment.
  • Swelling: Initially, swelling of the tongue and roof of the mouth can cause breathing problems. However, long-term complications, as well as new bleeding, high fever (above 102F), dehydration, and difficulty breathing, should be taken very seriously.4

Tonsillectomies can be a great option for some patients with obstructive sleep apnea. However, it’s essential to weigh the costs and benefits for each patient to create a personalized treatment plan. A multidisciplinary team of health care providers is necessary to decide the best treatment options for each patient—with special consideration of the root cause of the symptoms.

To learn more about OSA and its symptoms, causes, and treatments, visit us at thevivosinstitute.com/blog.

References

  1. Benjafield, A. V., Ayas, N. T., Eastwood, P. R., Heinzer, R., Ip, M. S. M., Morrell, M. J.,& Malhotra, A. (2019). Estimation of the global prevalence and burden of obstructive sleep apnoea: a literature-based analysis. The Lancet. Respiratory Medicine, 7(8), 687–698. doi:10.1016/S2213-2600(19)30198-5
  2. Jain, N., Rodin, J., Boon, M. S., & Huntley, C. T. (2021). A systematic approach to the evaluation and management of obstructive sleep apnea: The Jefferson Protocol. American Journal of Otolaryngology, 42(2), 102866. doi:10.1016/j.amjoto.2020.102866
  3. Mitchell, R. B., Archer, S. M., Ishman, S. L., Rosenfeld, R. M., Coles, S., Finestone, S. A.& Nnacheta, L. C. (2019). Clinical practice guideline: Tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery: Official Journal of American Academy of Otolaryngology-Head and Neck Surgery, 160(1_suppl), S1–S42. doi:10.1177/0194599818801757
  4. Patel, S. D., Daher, G. S., Engle, L., Zhu, J., & Slonimsky, G. (2022). Adult tonsillectomy: An evaluation of indications and complications. American Journal of Otolaryngology, 43(3), 103403. doi:10.1016/j.amjoto.2022.103403
  5. Reckley, L. K., Fernandez-Salvador, C., & Camacho, M. (2018). The effect of tonsillectomy on obstructive sleep apnea: an overview of systematic reviews. Nature and Science of Sleep, 10, 105–110. doi:10.2147/NSS.S127816
  6. Spicuzza, L., Caruso, D., & Di Maria, G. (2015). Obstructive sleep apnoea syndrome and its management. Therapeutic Advances in Chronic Disease, 6(5), 273–285. doi:10.1177/2040622315590318