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Tonsillectomy both clinically and cost effective for adults

Published: 23 May 2023

Tonsil removal is both clinically and cost effective for adults who get recurrent severe sore throats, NIHR-funded research finds.

Experts found that patients undergoing the surgery had 50% less sore throats over two years, compared to those who didn't have the operation.

The treatment was cost effective for over 16s compared to using painkillers and ad hoc antibiotics, researchers found.

The NATTINA trial is the biggest study of its kind to investigate the treatment. It is led by researchers at Newcastle University. The results were published in the Lancet journal.

Tonsillectomy involves cutting out two lumps of lymphoid tissue found at either side of the back of the throat. It is an operation widely used to improve patients’ quality of life.

But 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 while 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.”

Researchers randomised almost 500 people for the trial. Participants received either early tonsillectomy, or other treatment such as painkillers and antibiotics.

Participants were only recruited if they met the current national guidance for tonsillectomy. This is 7 episodes of tonsillitis in a year, 5 per year for 2 years, or 3 episodes for 3 years.

Those who had surgery suffered half the number of days with sore throats over the following 2 years. This included the 2 weeks of sore throats following the procedure.

The findings showed it is more cost effective for the NHS to offer the surgery to eligible patients, than other treatments.

Dr O’Hara added: “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 1 in 5 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 (HTA) Programme which funded the research, 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."

NIHR’s Clinical Research Network (CRN) supported the study.

Read the study’s project page.

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