Comparative Prospective Study of Intracapsular Versus Extracapsular Tonsillectomy in Pediatric Obstructive Sleep Apnea

Background: Adenotonsillectomy is the first-line treatment for pediatric obstructive sleep apnoea (OSA). Intracapsular tonsillectomy (ICT) has emerged as a less invasive alternative to traditional extracapsular tonsillectomy (ECT), with potential advantages in reducing postoperative morbidity. Objective: To compare the clinical outcomes, postoperative morbidity, and efficacy of ICT versus ECT in children with OSA. Methods: This prospective comparative study included 100 children aged 6–10 years, divided into two groups: ICT ( n =50) and ECT ( n =50). All patients underwent standardized surgical procedures and were followed for 1 year. Outcome measures included postoperative pain scores, time to recovery, haemorrhage rates, and improvement in OSA severity assessed by Apnoea–Hypopnoea Index (AHI). Statistical analysis was performed using independent t-test, Chi-square test, and repeated measures ANOVA, with P < 0.05 considered significant. Results: ICT demonstrated significantly lower postoperative pain (Day 1: 4.2 ± 1.1 vs 7.1 ± 1.3; P < 0.001) and faster recovery, including earlier return to normal diet (3.2 ± 1.1 vs 6.5 ± 1.4 days; P < 0.001). Secondary haemorrhage was significantly lower in ICT (2% vs 12%; P = 0.049). Both groups showed comparable improvement in OSA, with no significant difference in postoperative AHI (1.9 ± 0.8 vs 1.6 ± 0.7; P = 0.089). Tonsillar tissue reappearance was observed in 6% of ICT patients without significant clinical recurrence. Conclusion: ICT provides equivalent efficacy with significantly reduced postoperative morbidity compared to ECT, supporting its use as a preferred surgical technique in pediatric OSA.