Intracapsular Tonsillectomy for Keratosis Pharyngeous: Postoperative Recovery and Surgical Efficacy

Abstract

Objectives:

(1) Compare the postoperative recovery of patients undergoing intracapsular tonsillectomy to subcapsular tonsillectomy for keratosis pharyngeous. (2) Determine the surgical efficacy of intracapsular tonsillectomy in preventing recurrent symptoms in patients with keratosis pharyngis.

Methods:

A prospective, single-blinded, randomized controlled trial of adult patients ages 18 years or older diagnosed with keratosis pharyngis between December 2010 and February 2013 was performed. Patients were randomized to receive either intracapsular or subcapsular tonsillectomy with the coblator. Postoperative pain scores and amount of pain medication taken were recorded daily for 2 weeks postoperatively. A 6-month follow-up questionnaire was used to assess the efficacy of the procedure based on persistent symptoms.

Results:

Twenty-two patients completed the study, with 11 in each group. There was a statistically significant difference in the amount of pain medication consumed on postoperative days 8, 9, and 10, with the intracapsular group consuming less medication (P = .0293, .0146, .035). There was also a statistically significant difference in the recurrence of tonsilloliths at the 6-month follow-up point (P = .0291). Patients who had an intracapsular tonsillectomy had a significantly higher recurrence rate than those patients who had a subcapsular tonsillectomy.

Conclusions:

In adult patients undergoing tonsillectomy for keratosis pharyngis, an intracapsular, coblation tonsillectomy resulted in lower consumption of pain medication than subcapsular tonsillectomy. However, intracapsular coblation tonsillectomy resulted in a higher rate of recurrence of tonsilloliths. The benefit of decreased pain medication usage in the intracapsular cohort may be offset by the increased likelihood that symptoms will recur.