Lingual Tonsil Hypertrophy in OSA: The Role of Prior Tonsillectomy and Associated Clinical Risk Factors

Abstract

Lingual tonsil hypertrophy (LTH) is increasingly recognized as a contributor to upper airway obstruction in obstructive sleep apnea (OSA). While several etiological factors have been proposed, the potential role of prior palatine tonsillectomy remains understudied in adult OSA populations. To evaluate whether a history of tonsillectomy is independently associated with increased severity of LTH in adults with OSA, and to explore additional anatomical and clinical contributors. A prior history of tonsillectomy is significantly associated with greater lingual tonsil hypertrophy in adult OSA patients, independent of obesity or craniofacial structure. These findings suggest a compensatory or immunological mechanism and support individualized evaluation in anatomically driven OSA phenotypes. LTH assessment should be considered in surgical and anesthetic planning, especially in non-obese patients with prior tonsillectomy or positional OSA.