Adult BiZact tonsillectomy was associated with significant improvements in disease-specific quality of life and favorable patient-reported recovery through eight weeks. Patients with more severe peritonsillar adhesions experienced longer operations and greater intraoperative blood loss but had similar postoperative pain, recovery, bleeding rates, and quality-of-life improvements as those with less severe adhesions.
Researchers prospectively enrolled 220 consecutive adults aged 19 to 70 years who underwent BiZact tonsillectomy at five institutions in South Korea between February 2024 and July 2025. A total of 211 patients completed follow-up and were included in the analysis. Investigators recorded operative time, blood loss, tonsil size, and peritonsillar adhesion grade and evaluated postoperative pain, ear pain, oral intake, daily activity, bleeding events, recovery time, patient satisfaction, and health-related quality of life using the Tonsillectomy Outcome Inventory-14 (TOI-14) before surgery and at postoperative day one, week one, and week eight.
The primary outcome was change in TOI-14 score from baseline to eight weeks. Secondary outcomes included postoperative pain, bleeding, recovery of diet and daily activity, patient satisfaction, and perioperative outcomes according to peritonsillar adhesion severity.
Disease-specific quality of life improved substantially following surgery. Mean TOI-14 scores decreased from 27.6 before surgery to 2.9 at eight weeks, with improvements across all symptom domains. Throat pain and ear pain peaked during the first postoperative week before improving by week eight. Patients returned to a normal diet and daily activity after a median of 14 days, while complete pain resolution occurred after a median of 19 days.
Mean operative time was approximately 15 minutes,and mean estimated blood loss was 6.5 mL. Patient-reported postoperative bleeding occurred in 15% of patients during follow-up. Overall, 10% of patients required an unscheduled hospital evaluation for bleeding, 5% required hospital admission, and 2% underwent operative hemostasis. Patient satisfaction was high, with a mean score of 9.2 out of 10, and 67% of patients assigned the highest possible satisfaction rating.
Despite longer operative times and greater intraoperative blood loss among patients with moderate-to-severe peritonsillar adhesions, postoperative recovery was comparable across adhesion groups. Bleeding rates were similar between groups, and investigators found no statistically significant differences in postoperative pain, recovery of diet or daily activity, or improvement in TOI-14 scores.
The investigators noted several limitations. The prospective study used a single-arm design without a comparator group, preventing direct comparisons with other tonsillectomy techniques. Peritonsillar adhesion grading was based on surgeon assessment and may have varied across centers. In addition, the subgroup analysis was descriptive rather than designed to establish noninferiority, and prior peritonsillar abscess history was not collected as a standardized variable.
Overall, the the study found that BiZact tonsillectomy may be associated with improved patient-reported recovery and quality of life in adults, although the study design does not permit conclusions regarding comparative effectiveness or superiority over other surgical techniques. "However, these findings should be interpreted descriptively and should not be considered evidence of comparative safety or superiority," wrote lead study author Gene Huh, of the Department of Otorhinolaryngology-Head and Neck Surgery, Boramae Medical Center, Seoul Metropolitan Government–Seoul National University, and colleagues.
Disclosures: The authors declared no conflicts of interest.
