Practice Uncertainties

Is tonsillectomy recommended in adults with recurrent tonsillitis?

BMJ 2017; 357 doi: https://doi.org/10.1136/bmj.j1450 (Published 13 April 2017) Cite this as: BMJ 2017;357:j1450
  1. Jason Powell, research fellow1,
  2. James O’Hara, consultant otolaryngologist, head and neck surgeon2,
  3. Sean Carrie, consultant otolaryngologist, head and neck surgeon3,
  4. Janet A Wilson, professor of otolaryngology, head and neck surgeon2
  1. 1Institute for Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK
  2. 2Institute of Health & Society, Newcastle University, Newcastle upon Tyne, UK
  3. 3Freeman Hospital, Newcastle upon Tyne, UK
  1. Correspondence to J Powell at jason.powell{at}doctors.org.uk

What you need to know

  • Increasing rates of adult tonsillitis affect quality of life for patients and put pressure on health services through repeated primary care consultations and hospital admissions with complications

  • Tonsillectomy is safe and effective to prevent recurrent tonsillitis; however, there is uncertainty over the stage of disease at which the operation is cost effective

  • Discuss the options of watchful waiting, antibiotics, and tonsillectomy with patients experiencing recurrent tonsillitis, and explain the risks, benefits, and costs of each

In many, tonsillitis is self-limiting and of relatively short duration. A subset of patients suffers from recurrent debilitating episodes, with impaired daily functioning and absence from work.1 Adult tonsillitis places a substantial burden on healthcare resources. Costs include primary care consultations, medical treatment, hospital admissions, and treatment of potentially life threatening complications.123 There are three approaches to the management of tonsillitis: conservative (wait and watch), antibiotics, or tonsillectomy. Tonsillectomy provides definitive treatment for recurrent tonsillitis and was performed on more than 17 000 adult patients in England in 2014-2015.4 Currently there is uncertainty around the severity of disease at which it is cost effective to perform tonsillectomy on adults with recurrent tonsillitis, as compared with conservative management.

What is the evidence of uncertainty?

Search strategy and study selection

We searched Medline, Embase, and the Cochrane Library using the terms “tonsillitis” or “tonsillectomy” or “pharyngitis.” We included studies that involved adults and were published in English between 1996 and February 2017 (table 1). We found Cochrane reviews comparing antibiotics with placebo, and comparing tonsillectomy with watchful waiting. We also found a review of qualitative outcomes in tonsillectomy, two retrospective studies investigating complications of tonsillectomy, a cross-sectional study of the complications of tonsillitis and tonsillectomy rates, and a small cohort study observing economic outcomes pre and post tonsillectomy.

View this table:
Table 1

Summary of evidence for the treatment of recurrent adult tonsillitis

In the UK, Clinical Commissioning …

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