Long-Term Outcomes After Intracapsular Tonsillectomy

Research suggests that intracapsular tonsillectomy (ICT) is less morbid than extracapsular tonsillectomy. It is underutilized, in part, because of concerns regarding its effectiveness and the possible need for repeat surgery in the future. We conducted long-term follow-up patient interviews to evaluate symptom control and incidence of revision tonsillectomy in children who had undergone ICT years earlier.

A computerized collection of office notes and operative reports was queried to identify children undergoing ICT in the years 2010-2023 at an academic pediatric otolaryngology practice. We contacted these families and assessed persistence of recurrent sore throat, snoring, and upper airway obstruction and need for revision or completion tonsillectomy.

219/610 (35.9%) families of children and teenagers operated on during the study period were successfully contacted. 181/219 (82.6%) contacts elected to participate in the study. Median age at surgery was 7.6 years (range = 1.2, 21.4). Median follow-up time was 8.7 years (range = 1.9, 15.3). ICT controlled snoring/upper airway obstruction (95/104-91.3%) and severe recurrent sore throat (72/77-93.5%), with 167/181 (92.3%) respondents reporting symptom resolution. 10/181 (5.5%) respondents reported postoperative bleeding. 6/181 (3.3%) patients reported undergoing a second tonsillectomy, four of which were for upper airway obstruction. 1/181 (0.6%) child was treated for peritonsillar abscess after intracapsular tonsillectomy.

Intracapsular tonsillectomy is effective both short- and long-term for the control of symptoms of upper airway obstruction and recurrent sore throat. This study provides a modest reinforcement of existing literature that suggests significant benefit from ICT as a treatment option.