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To characterize the incidence of lingual tonsil hypertrophy (LTH) in adults with and without obstructive sleep apnea (OSA) and to determine any potential correlation between them.Retrospective chart review.Single-center database, September 2016 to April 2017.Lingual tonsil grade (LTG) determined by awake endoscopy was collected as well as other physical examination findings, such as Friedman tongue position, palatine tonsil size, and neck circumference. STOP-BANG scores and polysomnography data were collected to characterize OSA. Incidence of clinically meaningful LTH (defined as LTG 3 and LTG 4) was compared between OSA and non-OSA groups.Ninety-three patient charts were studied in total. There was no significant difference between patients with and without OSA in the incidence of clinically meaningful LTH (OSA, 13.5%; non-OSA, 14.6%; P = .872). Patients with and without OSA were compared by grade: LTG 1, 13.5% (OSA) vs 35.6% (non-OSA); LTG 2, 73.1% (OSA) vs 48.8% (non-OSA); LTG 3, 13.5% (OSA) vs 14.6% (non-OSA). There were no significant correlations between OSA status and LTG (ρ = 0.190, P = .069).The incidence of LTH is uncommon, even among those with OSA, and does not seem to differ between patients with and without OSA. Neck circumference appears to be a better clinical indicator than lingual tonsil tissue for the likelihood of a patient having OSA.