title: Microdebrider-assisted intracapsular tonsillectomy in adults with chronic or recurrent tonsillitis.
abstract: OBJECTIVE
  We compared the effectiveness and morbidity of microdebrider-assisted total intracapsular tonsillectomy (ICTE) with conventional extracapsular tonsillectomy (ECTE) in adults with chronic or recurrent tonsillitis.
  
  
  METHODS
  Prospective randomized surgical trial.
  
  
  METHODS
  Adult patients with recurrent or chronic tonsillitis who underwent tonsillectomy between July 2010 and July 2012 in the Department of Otorhinolaryngology-Head and Neck Surgery, Medical University Innsbruck, Innsbruck, Austria, were consecutively included. Patients were randomized to receive either ICTE or ECTE. Patients and examiners were blinded to the surgical procedure. Effectiveness was assessed with the Tonsil and Adenoid Health Status Instrument (TAHSI). Various parameters of perioperative morbidity and the occurrence of tonsillar remnants were recorded.
  
  
  RESULTS
  In the 104 randomized patients, the average TAHSI score was 34.6 ± 11.7 before and 2.2 ± 5.7 after 6 months following tonsillectomy (P < 0.001). TAHSI scores improved equally in patients receiving conventional ECTE (33.6 points; 95% confidence interval (CI), 29.5 to 37.6) and in patients with ICTE (31.8 points; 95% CI, 27.7 to 35.9; between groups P = 0.6). Posttonsillectomy hemorrhage was more frequent following conventional ECTE (P = 0.03). Following ECTE, patients required more pain medication then following ICTE (P < 0.05). Tonsillar remnants were significantly more frequent after ICTE (P < 0,001). However, presence of tonsillar remnants had no influence on postoperative THASI scores (P > 0.5).
  
  
  CONCLUSIONS
  Tonsillectomy reduced symptoms of chronic or recurrent tonsillitis in adults with remarkable effectiveness. Microdebrider-assisted ICTE reduced symptoms as effectively as conventional ECTE. ICTE was associated with lower morbidity, but residual tonsils occurred in almost half of patients, costs were higher, and the intracapsular approach was more intricate and time-consuming.
  
  
  METHODS
  1b.
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Birte
authors: B
authors: Bender
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Elisabeth Constanze
authors: EC
authors: Blassnigg
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Jana
authors: J
authors: Bechthold
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Florian
authors: F
authors: Kral
authors: Department of Anesthesiology and Critical Care Medicine, Medical University Innsbruck, Innsbruck, Austria.
authors: Ursula
authors: U
authors: Riccabona
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Teresa
authors: T
authors: Steinbichler
authors: Department of Otorhinolaryngology, Medical University Innsbruck, Innsbruck, Austria.
authors: Herbert
authors: H
authors: Riechelmann
mesh_terms: D000328:Adult; D002908:Chronic Disease; D003646:Debridement / Q000295:instrumentation*; D005260:Female; D006801:Humans; D008297:Male; D011446:Prospective Studies; D012008:Recurrence; D016037:Single-Blind Method; D011795:Surveys and Questionnaires; D014068:Tonsillectomy / Q000295:instrumentation*; D014069:Tonsillitis / Q000601:surgery*; D055815:Young Adult
keywords: Tonsillectomy; adults; microdebrider; morbidity; posttonsillectomy hemorrhage; tonsillitis