Ambulatory powered intracapsular tonsillectomy and adenoidectomy in children younger than 3 years

Objectives: (1) To assess the safety and efficacy of outpatient intracapsular tonsillectomy, which has been recently described as a less invasive means of treating obstructive tonsillar hypertrophy, in children younger than 3 years; and (2) to challenge the standard dictum that children younger than 3 years should be admitted to the hospital after tonsil and adenoid surgery. Design: Retrospective cohort study via medical chart review and telephone interview. Settings: Pediatric otolaryngology group practice with academic affiliation. Patients: Children with symptomatic tonsillar and adenoid hypertrophy (n = 226) who underwent microdebrider-assisted intracapsular tonsillectomy between September 1, 2000, and October 1, 2002. Methods: Comparison of study group (children <3 years old, n = 38; mean age, 30.3 months; 20 boys and 18 girls) with control group (children ≥3 years, n = 188), measuring pain, oral intake, analgesic requirements, complications, need for readmission, and relief of symptoms. Results: There were no statistically significant differences in pain, oral intake, or analgesic requirements. All children, regardless of age, were discharged home within 4 hours of surgery. No child in either group required readmission, and there were no complications related to the time of discharge. Younger children experience equivalent symptomatic improvement. Conclusions: Children younger than 3 years may undergo intracapsular tonsillectomy as outpatients without sacrificing safety or efficacy.