Tonsillectomy both clinically and cost effective for adults

Scientists say tonsil removal is both clinically and cost effective for adults who get recurrent severe sore throats.

The biggest study of its kind, carried out by Newcastle University, revealed that patients who had a tonsillectomy had 50% less sore throats over two years, compared to patients who did not undergo tonsillectomy. Publishing today (17 May) in The Lancet, the study was funded by the National Institute for Health and Care Research (NIHR).

Experts also found that a tonsillectomy for those aged 16 years and over was cost effective in comparison to treatment with painkillers and ad hoc antibiotics.

Tonsillectomy assurance

A tonsillectomy, cutting out the two lumps of lymphoid tissue found at either side of the back of the throat, is an operation that has been widely used to improve the quality of life for patients.  

However, in recent years, less adult tonsillectomies have been reportedly carried out on NHS patients.

Dr James O’Hara, Clinical Senior Lecturer at Newcastle University and Consultant Ear, Nose and Throat surgeon at Newcastle Upon Tyne Hospitals NHS Foundation Trust, said: “Tonsillectomy has been branded as an ‘intervention of limited clinical value’ due to a lack of studies to support the operation.

“Over the last 20 years, the number of tonsillectomies being performed in the UK has halved whilst hospital admissions for complicated tonsillitis have more than doubled.

“There has been variation across the UK in referrals from primary care for tonsillitis, with some patients having to experience three times the recommended number of episodes before being referred for a tonsillectomy.

“Our research should level the threshold for referral for this problem, and clinicians can now be assured that tonsillectomy is effective for those who suffer with recurrent tonsillitis.”

In the study, commissioned by the NIHR, almost 500 patients were randomised to either early tonsillectomy or given treatment such as painkillers and antibiotics.

Participants were only recruited if they met the current national guidance for offering tonsillectomy - seven episodes of tonsillitis in a year, five per year for two years, or three episodes for three years.

Those in the clinical trial who underwent the operation suffered half the number of days with sore throats over the following two years, including the two weeks of sore throats following the procedure.

Cost effective procedure

The Newcastle-led research also showed that it is more cost effective for the NHS to offer tonsillectomy to eligible patients than to treat them by other conventional methods.

Dr O’Hara said: “Whilst we now know that tonsillectomy is effective, patients still need to weigh up the potential benefits in reducing longer-term sore throats with 14 days of pain following the operation.

“There is also a risk of one in five patients bleeding following the operation, with some having to return to hospital. Further research is needed to improve the tonsillectomy operation to make it less painful and reduce the risk of bleeding.”

Professor Andrew Farmer, Director of NIHR’s Health Technology Assessment Programme, said: “These new results provide important findings suggesting that tonsillectomy benefits this group of patients compared to repeated courses of antibiotics and painkillers.

“Once again, high quality independently funded research is providing evidence which could improve health and social care practice and treatments."

Newcastle University and Newcastle Hospitals are both part of Newcastle Health Innovation Partners (NHIP). NHIP is one of eight prestigious Academic Health Science Centres (AHSCs) across the UK, bringing together partners to deliver excellence in research, health education and patient care.

Reference:

Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial. Janet Wilson et al. The Lancet. 

Patient case study

Secondary school teacher, Elinor Barwick, was the first patient recruited to the Newcastle-led trial as her recurrent acute tonsillitis was impacting her life.

Elinor had suffered terrible sore throats for many years, however, things got significantly worse when she became a teacher as she needed to speak all the time, leaving her in a lot of pain and discomfort.

Elinor’s tonsillitis often meant it was hard to swallow both liquids and food. In addition, her tonsillitis would leave her unable to speak as her throat would become extremely tight and swollen, and she would develop flu-like symptoms – all of which would impact her job and quality of life.

Elinor, of Gosforth, Newcastle, was recruited to trial and was one of the participants given the tonsillectomy procedure.

The mother-of-one said: “Recurrent tonsillitis would impact my life as it would leave me in a lot of pain and, at times, made day-to-day life very difficult.

“When I was asked to be part of the trial I didn’t hesitate to say ‘yes’ because it was being led by Newcastle University and would benefit patients like myself.

“Since I have had my tonsils removed, I’ve not had a day off work due to tonsillitis and my quality of life has very much improved as I no longer suffer from severe sore throats.

“It is great that research into the importance of tonsillectomies in adults with recurrent acute tonsillitis has taken place in Newcastle to help patients like myself in the future.”

Ends