Long-Term Outcomes of Microdebrider-Assisted Endoscopic Powered Intracapsular Tonsillectomy and Adenoidectomy in Pediatric Obstructive Sleep Apnea: A Questionnaire-Based Observational Study.

OBJECTIVES

This study aimed to evaluate the long-term efficacy and safety of microdebrider-assisted endoscopic powered intracapsular tonsillectomy and adenoidectomy (PITA) in pediatric patients with obstructive sleep apnea (OSA) using caregiver-reported retrospective assessments of pre- and post-operative symptom states.

METHODS

This single-center retrospective observational study included 65 children aged < 15 years who underwent PITA and at least 1 year of postoperative follow-up. Caregivers completed a structured postoperative questionnaire, retrospectively assessing preoperative and postoperative symptom severity using the validated Japanese version of the Obstructive Sleep Apnea Questionnaire-18 (OSA-18). The questionnaire evaluated sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns. Postoperative complications, including tonsillitis, peritonsillar abscess, and perceived symptom recurrence, were also assessed. All surgeries were performed using an endoscopic PITA technique designed to preserve the tonsillar capsules.

RESULTS

Among the 65 pediatric patients (median follow-up, 48.0 months; interquartile range, 25.0-65.0), significant improvements were observed across all five OSA-18 domains. The mean preoperative scores were 5.2, 4.5, 2.3, 3.4, and 4.7 for sleep disturbance, physical symptoms, emotional distress, daytime functioning, and caregiver concerns, respectively. Postoperative scores improved to 1.7, 2.3, 1.7, 2.1, and 1.8, respectively (all, p < 0.001). Subgroup analyses showed no significant differences in outcomes based on follow-up duration (< 5 vs. ≥ 5 years) or age at surgery (≤ 4 vs. > 4 years), suggesting durable and consistent long-term benefits of PITA regardless of age or time since surgery. No peritonsillar abscesses were reported; only three patients (4.6%) experienced postoperative tonsillitis. Thirteen percent of the caregivers reported a subjective recurrence of symptoms; however, none required revision surgery.

CONCLUSION

PITA is a potentially safe and effective long-term surgical option for pediatric OSA. Retrospective caregiver evaluation revealed sustained symptom improvement, minimal postoperative complications, and high satisfaction levels.

LEVEL OF EVIDENCE: Level IV.