Modified uvulopalatopharyngoplasty Vs. Tonsillectomy: Which is better for tonsillar hypertrophy and OSA

SWEDEN: A research in JAMA Otolaryngology-Head & Neck Surgery reported that, Modified uvulopalatopharyngoplasty (mUPPP) was not superior to Tonsillectomy (TE) alone in managing individuals with tonsillar hypertrophy and moderate to severe OSA.

Obstructive sleep apnea (OSA) is commonly treated by uvulopalatopharyngoplasty (UPPP), which is frequently initiated with the removal of the palatine tonsils. In order to treat OSA, minimally invasive upper airway operations have been suggested because tonsillectomy may create difficulties. It is unknown whether tonsillectomy is always necessary for UPPP, especially for people with small tonsils.

The researchers sought to to find out if mUPPP can treat adult patients with tonsillar hypertrophy and moderate to severe OSA better than TE alone.

Adults with tonsillar hypertrophy (sizes 2, 3, or 4 according to the Friedman staging) and moderate to severe OSA participated in this blinded, randomized clinical trial to evaluate the efficacy of mUPPP with TE alone before surgery and six months after surgery in a university hospital in Stockholm, Sweden. From January 2016 to February 2021, participants underwent surgery; the final postoperative check-up was finished in September 2021. From January through September 2022, data analysis was carried out. The key measures were between-group variations on the Epworth Sleepiness Scale (ESS) and the Apnea-Hypopnea Index (AHI). The 93 patients in the study group, whose race and ethnicity were not taken into account, had a mean (SD) body mass index of 29.0 (2.8). 90 of them (or 97%) followed the protocol (mUPPP, n = 45; TE, n = 45).

Major findings of the study:

  • The mean (SD) AHI score (number of occurrences per hour [events/h]) for the mUPPP group fell by 43%, from 51.0 (22.6) to 28.0 (20.0) events/h, and by 56%, from 56.9 (25.1) to 24.7 (22.6) events/h, for the TE group.
  • The average between-group difference in AHI score was 9.2 events/h (95% CI, 0.5 to 17.9), with a minor effect size (Cohen d = 0.44), favoring TE.
  • The between-group difference in ESS scores was equally negligible, coming in at only 1.1 (95% CI, -1.3 to 3.4; Cohen d = 0.21).
  • The clinical relevance of either difference was not thought to exist.
  • There was a slight difference, though, and it favored TE.

The authors concluded that TE alone could be used as an alternative to mUPPP in this particular population of individuals with OSA since it is less extensive.

REFERENCE

Sundman J, Nerfeldt P, Fehrm J, Bring J, Browaldh N, Friberg D. Effectiveness of Tonsillectomy vs Modified Uvulopalatopharyngoplasty in Patients With Tonsillar Hypertrophy and Obstructive Sleep Apnea: The TEAMUP Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg. Published online November 03, 2022. doi:10.1001/jamaoto.2022.3432 

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