Lingual tonsillar hypertrophy (LTH) may contribute to a difficult airway. It may be unexpected if the patient is asymptomatic.

Risk factors for lingual tonsillar hypertrophy include:

(1) history of difficult intubation

(2) history of previous tonsillectomy (possibly causing hyperplasia of residual lymphoid tissue)

(3) obesity

(4) obstructive sleep apnea or snoring

(5) sore throat or globus sensation

(6) dysphagia

(7) chronic cough

(8) change in voice


A patient with one or more of these risk factors can be screened for LTH with a simple laryngeal mirror.


Trauma to the tonsil during intubation can result in bleeding which can further exacerbate the intubation problems

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