At Montefiore Einstein’s Department of Otorhinolaryngology–Head & Neck Surgery, intracapsular tonsillectomy has long been the preferred surgical approach for children with obstructive sleep apnea (OSA) and recurrent tonsillitis. While this technique is increasingly common, Montefiore Einstein, as early adopters of this technique, brings years of experience and consistent clinical practice to its use, offering patients a well-established and refined approach.

“Traditional tonsillectomy removes the entire tonsil and capsule, but that often comes with considerable pain, bleeding, dehydration and longer recovery times,” explains Tripti K. Brar, MBBS, MS, attending physician at Montefiore Einstein and Assistant Professor of Pediatric Otolaryngology at Albert Einstein College of Medicine. “Intracapsular tonsillectomy removes most of the tonsil but preserves the capsule. This approach has demonstrated to lead to fewer complications, a faster recovery and a reduced need for narcotics or other pain medications."

“We prioritize clear communication with families,” adds John P. Bent, MD, attending physician at Montefiore Einstein and Professor of Otorhinolaryngology–Head and Neck Surgery and Pediatrics at Albert Einstein College of Medicine. “While we can perform traditional tonsillectomy, we want parents and providers to understand the risks involved with that method. While the mortality rate with the full removal technique is very low nationally, it’s not zero. With intracapsular tonsillectomy, I am not aware of any fatalities. That’s a significant distinction.”

This less invasive technique has proven especially effective for pediatric patients, but its application has expanded. “We now offer intracapsular tonsillectomy to teenagers and adults dealing with chronic issues like halitosis and tonsil stones,” notes Dr. Bent.

In addition to these expanded applications, the department offers additional specialized techniques for sleep-disordered breathing. Dr. Brar routinely performs drug-induced sleep endoscopy (DISE) to observe airway behavior during sedated sleep, offering real-time insight into the patient’s condition. This allows for more tailored treatment of sleep-disordered breathing, especially in cases that don't respond to tonsillectomy alone.

Another area of Dr. Brar’s work is exploring the use of hypoglossal nerve stimulation—an effective treatment for a subset of pediatric patients with OSA over the age of 13 years. The device, which stimulates the tongue to move forward during sleep to open the airway, has more commonly been used in older patients but it’s indications have recently expanded to include some children over the age of 13 years.

Through close collaboration with specialists, Montefiore Einstein has been able to improve the patient experience. For example, through coordination with the anesthesiology team, the department has safely discharged select patients under age 3 on the same day of surgery in cases where standard guidelines typically favor overnight stays.

Montefiore Einstein continues to evolve its approach to otorhinolaryngology care, combining innovation, experience and safety to meet the needs of every patient.