Importance  

Morbidity after traditional extracapsular tonsillectomy (ECTE) is high in adolescents and adults. Alternatively, intracapsular tonsillectomy (ICTE) may have a similar efficacy and reduce postoperative morbidity.

Objective  

To investigate the recovery time and morbidity after ICTE compared to ECTE in 16- to 65-year-olds with recurrent or chronic tonsillitis.

Design, Setting, and Participants  

The FINITE randomized, patient-blinded, 3-arm clinical trial compared ECTE, intracapsular coblation tonsillectomy (ICTEc), and intracapsular microdebrider tonsillectomy (ICTEm) in the treatment of patients aged 16 to 65 years with recurrent and chronic tonsillitis. The trial was conducted from September 2019 to January 2023 with a 1-month follow-up. The study was conducted at 1 secondary and 1 tertiary hospital in Finland. The data were analyzed between January 2023 and January 2025.

Interventions  

The ECTE vs ICTEc vs ICTEm ratio was 1:1:1.

Main Outcomes and Measures  

The main outcome was postoperative recovery time. The clinically significant difference between groups in recovery time was predefined to be 3 days favoring the ICTE groups.

Results  

A total of 366 patients, aged 16 to 65 years who were diagnosed with recurrent or chronic tonsillitis and scheduled for tonsillectomy, were eligible for inclusion in the FINITE study. After exclusions, 179 patients were randomized (mean [SD] age, 26.7 [8.8] years; 39 [22%] male and 138 [78%] female), and 161 patients (94%) completed the 1-month follow-up. The mean (SD) postoperative recovery time was similar in the 3 groups: 12.1 (4.7) days in the ECTE group, 11.1 (4.6) days in the ICTEc group, and 10.3 (4.6) days in the ICTEm group. In the secondary outcome analysis, swallowing pain intensity was lower in the ICTEc and ICTEm group compared to the ECTE group during postoperative days 1 to 10 and 12, and days 2 to 12, respectively. Daily activity impairment due to pain interference resolved faster in the ICTE groups.

Conclusions and Relevance  

In patients aged 16 to 65 years with recurrent or chronic tonsillitis who participated in this randomized clinical trial, recovery times of ICTE and ECTE did not differ to statistical significance. ICTE resulted in a lower pain intensity and faster resolution of pain interference compared to ECTE.