Randomized, controlled, multisite study of intracapsular tonsillectomy using low-temperature plasma excision

Objective: To determine the efficacy of intracapsular tonsillectomy using low-temperature plasma excision for improving the quality of the postoperative experience and for treating obstructive symptoms through 12 months postoperatively. Design: Prospective, randomized, controlled, single-blind study. Setting: Multiple private or institutional otolaryngology clinics. Patients: Fifty-five children (aged 3-12 years) with obstructive tonsillar hypertrophy. Intervention: Patients were randomly assigned and blinded to undergo either intracapsular tonsillectomy using low-temperature plasma excision (n=27) or total tonsillectomy using conventional electrosurgery (n=28). Main Outcome Measures: Operative data, 14-day recovery variables, and obstructive symptoms were prospectively collected through 12 months. Results: During the first 14 days, significantly fewer children in the intracapsular group reported nausea (P = .01) or lost weight (P = .003). The intracapsular group had a significantly faster resolution of pain (P = .01), had an earlier return to a normal diet (P = .004), ceased taking pain medication sooner (P = .002), and returned to normal activity sooner (P = .04). Postoperatively, the intracapsular group had more residual tonsil tissue than the total tonsillectomy group (P = .002 for the 3- and 12-month visits). However, the incidence of recurring obstructive symptoms, pharyngitis, and antibiotic use was similar in both treatment groups during the 12 months. Conclusions: Postoperative morbidity normally associated with traditional (total) tonsillectomy was significantly reduced after intracapsular tonsillectomy using low-temperature plasma excision. The residual tonsillar tissue associated with this technique was of no clinical consequence.