Coblation® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up

A W Hoey; N M Foden; S Hadjisymeou Andreou; F Noonan; A K Chowdhury; S R Greig; E L Sproson; D Allin; N Amin; K M Wouters; N E Jonas; D J Tweedie

doi:10.1111/coa.12849

Coblation^® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up

Clin Otolaryngol. 2017 Dec;42(6):1211-1217. doi: 10.1111/coa.12849. Epub 2017 Mar 19.

Authors

A W Hoey¹, N M Foden¹, S Hadjisymeou Andreou¹, F Noonan¹, A K Chowdhury¹, S R Greig¹, E L Sproson¹, D Allin¹, N Amin¹, K M Wouters², N E Jonas¹, D J Tweedie¹

Affiliations

¹ Department of Paediatric Otolaryngology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.
² Department of Paediatric Anaesthesia, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK.

PMID: 28198598
DOI: 10.1111/coa.12849

Abstract

Objectives: Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation^® intracapsular tonsillectomy, for both obstructive and infective indications.

Design: Prospective case series, March 2013-January 2016, all with completed follow-up.

Setting: Tertiary paediatric otolaryngological practice.

Participants: A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation^® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT).

Main outcome measures: Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure.

Results: With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery.

Conclusions: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Keywords: adenoids; evidence-based medicine; outcomes; quality of life; research; sleep-disordered breathing; tonsils.

MeSH terms

Ablation Techniques*
Adolescent
Child
Child, Preschool
Female
Follow-Up Studies
Humans
Infant
Male
Prospective Studies
Sleep Apnea, Obstructive / surgery*
Tonsillectomy / methods*
Tonsillitis / surgery*
Treatment Outcome