Intracapsular tonsillectomy

Q: I [identifying information deleted] have been treated with antibiotics 7 times in the last 12 months for 'strep throat.' It is likely that I will have a tonsillectomy soon.

I am looking for information about intracapsular tonsillectomies for adults. So far, ENTs I have talked to here seem to think it's not a surgery that works in adults. (They may not have any experience doing it which may be the issue as well.) I am writing to you because your website mentions that you have performed these surgeries.

I have looked for research confirming that it can work in adults, but have found nothing especially helpful. I am also looking for information concerning who in New England might be willing to do an adult intracapsular tonsillectomy.

Any information or help that you can provide would be incredibly helpful. I am considering writing a research proposal concerning the topic if I can not find decent research on the topic.

Thank you for your time.

A: You're right. It is difficult finding information on the web regarding adult intracapsular tonsillectomy. Here's something from Bryn Mawr Hospital:

For adults, the new procedure may not be as effective as it is in children because the tonsils will have become scared and rubbery from repeated infections, compared with the fluffy tonsils of a child. "Adult tonsils don't shave out as easily, but we will try the partial tonsillectomy first," he said. "If the procedure becomes difficult, we can convert to a traditional tonsillectomy."

I have been doing adult intracapsular tonsillectomies for the last 12 to 18 months, and I know a lot of my colleagues are doing the same. I would agree with the above author that some adults are poor candidates for this -- those whose tonsils are scarred down. Adults with larger tonsils, more typical of what we see in children, are better candidates. The trouble with scarred tonsils is that it becomes challenging if not impossible to leave behind a thin layer of tonsil tissue, which is the aim of the intracapsular technique.

As you have no doubt heard, adult tonsillectomy can be very painful, and the intracapsular technique is a definite improvement with regard to post-op pain. In my experience, even those adults who end up having a complete tonsillectomy still seem to do better post-operatively. Thus, I agree with the above author who always tries the intracapsular method first.

Hopefully, I can get a few of my colleagues to add their thoughts, too.

D.