Coblation® intracapsular tonsillectomy (tonsillotomy) in children: A prospective study of 500 consecutive cases with long-term follow-up.

OBJECTIVES: Intracapsular tonsillectomy (tonsillotomy) has been used internationally, mainly in the management of obstructive sleep apnoea, rather than recurrent tonsillitis, with few published data evaluating its use for this latter indication. We present long-term prospective data from 500 paediatric cases undergoing Coblation® intracapsular tonsillectomy, for both obstructive and infective indications. DESIGN: Prospective case series, March 2013-January 2016, all with completed follow-up. SETTING: Tertiary paediatric otolaryngological practice. PARTICIPANTS: A total of 500 consecutive patients (6 months to 18 years, mean 5.1 years) undergoing Coblation® intracapsular tonsillectomy (with or without adenoidectomy), for obstructive and/ or infective indications, almost exclusively under the care of the senior author (DJT). MAIN OUTCOME MEASURES: Validated parent-reported T-14 tonsil symptom questionnaires were used in all cases pre- and postoperatively, including in the long term. Parents also recorded duration of analgesia, time to return to school, any complications and whether they would recommend the procedure. RESULTS: With a mean follow-up 7.4 months, symptom control has been excellent (mean total T-14 score (/70) 31.01 preoperatively, 2.68 postoperatively, P<.0000001), with similar trends for obstructive and infective domains. Two small secondary haemorrhages required readmission and observation only (0.4%); otherwise, no complications, delayed discharges or readmissions occurred; 12/500 (2.4%) have since undergone revision tonsil surgery, 10 for obstructive and 2 for infective symptoms, the majority in very young children, with revision adenoidectomy at the same time. More than 99% of parents would recommend the surgery. CONCLUSIONS: Our experience of this technique has been very positive, with excellent control of both obstructive and infective symptoms, and exceptionally low rates of complications. Further work will be required to allow conclusive demonstration of its advantages over extracapsular tonsillectomy.

Generation of attosecond electron packets via conical surface plasmon electron acceleration.

We present a method for the generation of high kinetic energy attosecond electron packets via magnetostatic and aperture filtering of conical surface plasmon (SP) accelerated electrons. The conical SP waves are excited by coupling an ultrafast radially polarized laser beam to a conical silica lens coated with an Ag film. Electromagnetic and particle tracking models are employed to characterize the ultrafast electron packets.

Terahertz Plasmonic Field-Induced Conductivity Modulation in Gold.

We report the observation of terahertz (THz) electric field induced conductivity modulation in sub-wavelength gold plasmonic media. Through all-THz pump-probe time-resolved transmission spectroscopy, we demonstrate that the presence of induced surface charges influences near-field mediated light propagation. The phenomenon is ascribed to the enhanced metal conductivity due to enhanced surface density of conduction electrons. The surface induced charge dynamics are revealed via phase-dependent time-resolved signatures. The phenomenon is a prelude to a wide class of ultrafast active THz plasmonic devices and paves the way for plasmonic field effects devices, similar to semiconductor ones.

Electron acceleration and kinetic energy tailoring via ultrafast terahertz fields.

We propose a mechanism for tuning the kinetic energy of surface plasmon generated electron pulses through control of the time delay between a pair of externally applied terahertz pulses. Varying the time delay results in translation, compression, and broadening of the kinetic energy spectrum of the generated electron pulse. We also observe that the electrons' kinetic energy dependence on the carrier envelope phase of the surface plasmon is preserved under the influence of a terahertz electric field.