Immediate tonsillectomy for adults with recurrent acute tonsillitis was found to be clinically and cost effective compared with conservative management.

Currently, there is insufficient evidence to support the effectiveness of tonsillectomy in adults, according to James O’Hara, MD, and colleagues. “The procedure has been seen as one of limited clinical value in adults due to very little high-quality evidence, not because there was evidence to show the intervention was not beneficial,” Dr. O’Hara says.

To address this research gap, Dr. O’Hara and colleagues randomly assigned patients with recurrent acute tonsillitis 1:1 to tonsillectomy or standard nonsurgical management. The number of sore throat days in 24 months (reported once per week) was the primary outcome. Findings were published in The Lancet.

Empowering Informed Decisions

The primary analysis included 224 patients in the immediate tonsillectomy group and 205 in the conservative management group (median age, 23; 78% women). Following adjustment for site and baseline severity, the incident rate ratio for total sore throat days in the immediate tonsillectomy group compared with the conservative management group was 0.53 (95% CI, 0.43-0.65). Bleeding was the most common adverse event (19%). There were no deaths.

“Patients should weigh the 14 days of discomfort and the one in five risk for bleeding, when the vast majority of bleeding is minor and settles spontaneously, with this potential benefit,” Dr. O’Hara says.

Further, for healthcare providers, “it is more cost-effective to treat adults with recurrent tonsillitis with tonsillectomy than it is to continue conservative treatment,” he notes.

The findings enable “the benefits of the operation to be quantified” and can assist patients in making an informed decision. “Guidance for offering a patient a tonsillectomy in the UK, which has been adopted in the US, too, includes seven episodes of tonsillitis in a year, five episodes a year for 2 years, or three episodes a year for 3 years,” Dr. O’Hara says. “Patients can expect to experience half the number of sore throat days over the following 2 years if they choose to have a tonsillectomy versus choosing to be treated conservatively for acute episodes.”