Coblation intracapsular tonsillectomy outcomes in paediatric obstructive sleep disordered breathing: A Singapore...

Coblation intracapsular tonsillectomy (ICT) may offer a more favourable post-operative morbidity profile compared with extracapsular tonsillectomy for paediatric obstructive sleep-disordered breathing (oSDB). Data from the Singapore paediatric population remain limited. This study examines the outcomes of coblation ICT in children with oSDB at a tertiary centre in Singapore.

This was a single-centre prospective cohort study of 102 consecutive children aged 21 months to 15 years undergoing coblation ICT for oSDB (April-October 2023). Concurrent adenoidectomy was performed in 98.0% of patients. Primary outcomes included complications and disease-specific quality of life (QoL) via the Obstructive Sleep Apnea-18 Quality of Life (OSA-18) questionnaire (where higher scores indicate greater symptom burden and poorer quality of life), assessed pre-operatively and at 3 months. Secondary outcomes included pain, analgesia, diet, and snoring resolution.

No post-operative haemorrhage or major complications occurred. All 102 patients completed a 3-month review. The median OSA-18 score improved significantly from 74 (interquartile range [IQR] 54-89) to 29.5 (IQR 23-40) post-operatively (P<0.001), representing a shift from the moderate to the minimal impact band. The mean change of 39.3 points exceeded twice the published minimal clinically important difference (standardised response mean 2.17). Perceived QoL score improved from median 5 (IQR 4-6.6) to 8 (IQR 8-9) (P<0.001). At 3 months, 82.4% had no snoring. Postoperative pain was mild, with 75.5% requiring analgesia for 3 days or fewer.

In this uncontrolled single-arm cohort, coblation ICT with concurrent adenoidectomy was associated with low morbidity and clinically meaningful improvements in caregiver-reported outcomes. These hypothesis-generating findings warrant further investigation through multicentre comparative studies with longer follow-up.