Intracapsular tonsillectomy in adults with obstructive sleep apnoea and large tonsils

PURPOSE: 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. METHODS: 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). RESULTS: 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. CONCLUSION: 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.