Factors Associated with Hypertrophy of the Lingual Tonsils

Abstract

Objective To identify factors that may be associated with lingual tonsil hypertrophy (LTH). Study Design Case series with chart review. Setting Tertiary academic center. Subjects and Methods Retrospective chart review identified 380 patients from August 2013 to April 2014 with graded lingual tonsils, documented during routine flexible laryngoscopy. Lingual tonsils were graded using a 0 to 4 scale: 0 = complete absence of lymphoid tissue, 1 = lymphoid tissue scattered over tongue base, 2 = lymphoid tissue covers entirety of tongue base with limited thickness, 3 = lymphoid tissue 5 to 10 mm in thickness, 4 = lymphoid tissue >1 cm in thickness (rising above the tip of epiglottis). Reflux symptom index (RSI collected during patient intake), presence of obstructive sleep apnea hypopnea syndrome (OSAHS; confirmed by polysomnogram), smoking habits, and basic demographics were gathered. Chi-square and linear multivariate regression analyses were used to identify significant relationships with LTH levels. Results Overall, 59.8% were male with a mean age of 50.2 ± 16.5 years and BMI of 30.1 ± 18.0. Chi-square analysis revealed no significant relationship between OSAHS and LTH ( P = .059). When RSI was stratified to ≥10 or <10, a Cochran-Armitage test supported the trend hypothesis that as RSI increases, lingual tonsil grading increases. Significant univariate correlates included younger age ( r = −0.307, P < .001) and smoking ( r = 0.186, P = .002). Multivariate regression revealed the combination of younger age, increasing RSI, and smoking ( r = −0.297, P < .001) to be a significant correlate. Conclusion LTH does not seem to be associated with OSAHS or BMI in this group of patients. High RSI, younger age, and gender may be factors associated with increased lingual tonsil thickness.