Intracapsular tonsillectomy in adults with obstructive sleep apnoea and large tonsils

Conventional (extracapsular) tonsillectomy is a well-established treatment for obstructive sleep apnoea (OSA) in adults with tonsillar hypertrophy. Our objective was to determine whether an intracapsular tonsillectomy (ICTE) with a 90% removal of tonsils could be sufficient. The secondary objective was to evaluate if 10 days of sick leave is enough for adults after ICTE.

This prospective cohort study included adults aged 16-65 years with moderate to severe OSA (apnoea-hypopnoea index [AHI] ≥ 15) and tonsillar hypertrophy. All patients underwent ICTE using coblation. The main outcome was surgical success as defined by a > 50% decrease in the overall AHI and a decrease in the overall AHI to < 20. Surgical cure was defined by a decrease in the overall AHI to < 5. To track recovery, participants completed the Brief Pain Inventory. Patient reported outcomes were assessed using the Insomnia Severity Index (ISI), Epworth Sleepiness Scale (ESS), and Glasgow Benefit Inventory (GBI).

Twenty patients underwent surgery, and sixteen completed the 6-month follow-up. The surgical success rate was 68.8%, and the surgical cure rate was 43.8%. Mean (± SD) AHI lowered from 37.4 (± 19.8) to 11.8 (± 16.1) events per hour (p = .003). Mean AI lowered from 13.3 (± 13.9) to 4.1 (± 11.9) events per hour (p = .002). Ten days of sick leave was enough for 81.3% of patients.

In adults with large tonsils and OSA, removing 90% of tonsil tissue may be effective. After intracapsular surgery, ten days may be a sufficient recovery time.