Tonsillectomy for recurrent pharyngitis in adults improves quality of life for the overwhelming majority of patients, report researchers.
The major predictors of benefit from tonsillectomy were clinical factors such as the severity and frequency of sore throats, suggesting that these factors should be taken into account before surgery, say Timo Koskenkorva (University of Oulu, Finland) and co-authors.
Koskenkorva and team prospectively studied 153 adults referred for tonsillectomy because of disabling, recurrent pharyngitis involving the palatine tonsils. All patients had experienced three or more episodes of pharyngitis within the previous 12 months.
Six months’ post-surgery, 142 patients completed the Glasgow Benefit Inventory (GBI) and were included in the analysis. Two thirds of respondents were women, the median age was 27 years, and 17% of participants had experienced six or more pharyngitis episodes within the previous year.
There were no serious adverse effects of tonsillectomy. Five patients were readmitted because of severe throat pain and eight patients because of mild secondary bleeding within a week of the operation.
Overall quality of life, assessed using the GBI, increased by 27 points on average following tonsillectomy. There was wide variation in individual responses, from a 19-point decrease in one patient to a 69-point increase in another.
Of the GBI subdomains, the Physical Health Score showed the greatest improvement, with a median 83-point increase, whereas there was no change in the GBI Social Support Score.
The researchers then looked for baseline factors that predicted the change in GBI total score. Among routinely recorded clinical characteristics, four factors – the number of prior pharyngitis episodes, frequent throat pain, untreated dental caries and chronically infected tonsils – made the most significant contribution.
The predictive ability of this four-item model was only modest, however, with a correlation coefficient (r-value) between observed and fitted scores of just 0.39.
The addition of two items from a patient-completed diary – days of fever and number of throat episodes in the preceding months – improved it somewhat, although it remained modest, with an r-value of 0.55.
Writing in Clinical Otolaryngology, the authors say that while patients were generally satisfied with tonsillectomy, they were unable to accurately identify those patients who would benefit most.
“In case of uncertain indications for surgery, a period of watchful waiting of at least six months is suggested, during which the patient can record the number, duration, and severity of the episodes”, they recommend. “According to the present results it would be most useful to record the number of days with throat pain and fever which predicted patient satisfaction most accurately.”
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