Tonsillectomy Improves Quality of Life in Patients With Recurrent Tonsillitis CME/CE

Tonsillectomy Improves Quality of Life in Patients With Recurrent Tonsillitis CME/CE

News Author: Megan Rauscher
CME Author: Charles Vega, MD

Complete author affiliations and disclosures, and other CME information, are available at the end of this activity.

Release Date: January 18, 2008Valid for credit through January 18, 2009

Credits Available

Physicians – maximum of 0.25 AMA PRA Category 1 Credit(s) for physicians;
Family Physicians – up to 0.25 AAFP Prescribed credit(s) for physicians;
Nurses – 0.25 nursing contact hours (None of these credits is in the area of pharmacology)
All other healthcare professionals completing continuing education credit for this activity will be issued a certificate of participation.
Physicians should only claim credit commensurate with the extent of their participation in the activity.


Learning Objectives

Upon completion of this activity, participants will be able to:

  1. Specify recommendations for tonsillectomy.
  2. Identify quality-of-life outcomes improved after tonsillectomy in children and adults.
Authors and Disclosures
Megan Rauscher
Disclosure: Megan Rauscher has disclosed no relevant financial relationships.
Charles Vega, MD
Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.
Brande Nicole Martin
Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

January 18, 2008 — For children and adults with chronic or recurrent tonsillitis, tonsillectomy leads to substantial improvements in quality of life, according to the results of two studies published as a supplement to the January issue of Otolaryngology–Head and Neck Surgery.

In the pediatric study, the parents of 92 children (mean age, 10.6 years) with recurrent tonsillitis — defined as three or more episodes of throat infection in the year prior to enrollment — completed two validated quality of life surveys before tonsillectomy as well as 6 months and 1 year after the surgery. Follow-up data were available for 58 children at 6 months and 38 children at 1 year.

“The children showed significant improvements in all six subscales of the disease-specific quality of life instrument — the Tonsil and Adenoid Health Status Instrument (TAHSI),” first author Dr. Nira A. Goldstein, of the State University of New York Downstate Medical Center in Brooklyn, told Reuters Health: The subscales are airway and breathing, infection, health care utilization, cost of care, and eating and swallowing (p < 0.001 for all), and behavior (p = 0.01).

The children also showed significant improvements in several subscales of the global quality of life instrument — the Child Health Questionnaire-PF28 — such as general health perceptions, role/social limitations, physical functioning, behavior, parental impact, and family activities (p < 0.001 for all).

“Parents also reported significantly fewer sore throats, antibiotic courses, and doctor visits,” Dr. Goldstein noted, as well as days missed from daycare or school and persistent halitosis.

“Recommendations for tonsillectomy,” Dr. Goldstein noted, “should be based on the child’s overall health status and quality of life and not just the number of culture-documented tonsil infections. Our results agree with prior studies reporting high rates of parent satisfaction after pediatric tonsillectomy.”

Similarly positive changes in quality of life were seen in a study of 72 adults (mean age, 28.0 years) with recurrent or chronic tonsillitis who completed quality of life surveys before and 6 months and 1 year after tonsillectomy.

Follow-up data, available for 42 adults at 6 months and for 40 adults at 1 year, showed significant improvements (p < 0.0001) in all TAHSI subscales, mirroring the results in the pediatric trial. The adults also had significant improvements in the physical functioning subscale of the Short Form-12 Health Survey at 1 year, Dr. David L. Witsell of Duke University School of Medicine, Durham, North Carolina, and colleagues report.

Moreover, 98% of the adults reported fewer infections in the 6 months following tonsillectomy and 76.9% expressed strong satisfaction with the outcome of the surgery. The adult patients also reported fewer cases of persistent halitosis, sore throats, and doctor visits due to sore throat.

Dr. Witsell’s team notes that “most prior studies on tonsillectomy for recurrent tonsillitis have assessed only the frequency of infections as an outcome measure.” The current study, they say, “provides prospective evidence of the effectiveness of tonsillectomy on adult quality of life.”

In an editorial accompanying the two studies, Dr. Michael G. Stewart from Weill Cornell Medical College, New York says these studies are “important contributions, and they add to our understanding of the impact of tonsillectomy in patients with recurrent tonsillitis.”

Otolaryngol Head Neck Surg. 2008;138:S1-S8, S9-S16, S17-S18.

Reuters Health Information 2008. © 2008 Reuters Ltd.

Learning Objectives for This Educational Activity

Upon completion of this activity, participants will be able to:

  1. Specify recommendations for tonsillectomy.
  2. Identify quality-of-life outcomes improved after tonsillectomy in children and adults.

Clinical Context

Tonsillectomy has been established to improve multiple outcomes in children, including the frequency of recurrent tonsillitis and sleep-disordered breathing. The beneficial nature of the procedure has led the American Academy of Otolaryngology–Head and Neck Surgery to recommend tonsillectomy for children with 3 or more documented tonsil infections per year. In Japan, tonsillectomy is recommended after 4 episodes of tonsillitis in 2 consecutive years.

Although tonsillectomy may improve disease outcomes, there are less data on its impact on the quality of life in pediatric patients, and there are even less data regarding this outcome among adults. The 2 reports from the Tonsillitis Outcomes: Toward Reaching Evidence in Adults and Tots (TO TREAT) study group focus on this issue.

Study Highlights

  • Goldstein and colleagues
    • Study participants were between the ages of 2 and 16 years and had either chronic tonsillitis or 3 or more documented episodes of acute tonsillitis in the last year.
    • All subjects underwent total tonsillectomy. Different surgical techniques were allowed as long as all the palatine tonsil tissue was removed in 1 procedure.
    • The main study outcomes were the TAHSI and Child Health Questionnaire-PF28 (CHQ-PF28), which is a general measure of children’s quality of life. These outcomes were measured before surgery and at 6 and 12 months postoperatively.
    • 92 children were enrolled in 19 practice locations across the United States. The mean age of the participants was 10.6 years.
    • 43.7% of participants completed 1 year of follow-up.
    • Parents reported fewer sore throats, antibiotic courses, days missed from daycare or school, and clinician visits.
    • TAHSI scores were improved in all subscales at 6 months and 1 year.
    • Most measures on the CHQ-PF28 were significantly improved at 6 and 12 months after tonsillectomy, with only the mental health and self-esteem domains not improved by surgery.
  • Witsell and colleagues
    • Patients eligible for participation in the study were at least 18 years old and had 3 or more documented episodes of acute tonsillitis in the last year. Patients with chronic tonsillitis were also included.
    • All subjects underwent total tonsillectomy.
    • The main outcomes of the study were the TAHSI and the 12-item short form of SF-36 Health Survey (SF-12 Health Survey), which is a general measure of quality of life. These outcomes were measured before surgery and at 6 and 12 months postoperatively.
    • 72 subjects enrolled in the study. The mean age of the participants was 28 years, and nearly 70% of subjects reported 4 or more episodes of tonsillitis in the previous year.
    • 56% of participants completed 1 year of follow-up.
    • TAHSI scores were improved in all subscales at 6 and 12 months after tonsillectomy, including scores for infection, health care utilization, eating, cost of care, behavior, and airway and breathing.
    • The mental and physical components of the SF-12 Health Survey were improved at 6 months vs baseline. At 1 year, only the physical component of the survey was significantly improved from baseline.

Pearls for Practice

  • The American Academy of Otolaryngology–Head and Neck Surgery recommends tonsillectomy for children with 3 or more documented tonsil infections per year.
  • The current studies demonstrate that tonsillectomy can improve quality of life among both children and adults.

According to the American Academy of Otolaryngology–Head and Neck Surgery, what is the minimum number of tonsil infections per year to prompt consideration for tonsillectomy in children?
2
3
4
5
Quality of life was improved after tonsillectomy in which of the following patient cohorts in the current TO TREAT investigations?
Children only
Children and adults
Adults only
Neither children nor adults

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Target Audience

This article is intended for primary care clinicians, otolaryngologists, and other specialists who care for patients with recurrent tonsillitis.

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The goal of this activity is to provide medical news to primary care clinicians and other healthcare professionals in order to enhance patient care.

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Authors and Disclosures

As an organization accredited by the ACCME, Medscape, LLC requires everyone who is in a position to control the content of an education activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as financial relationships in any amount, occurring within the past 12 months, including financial relationships of a spouse or life partner, that could create a conflict of interest.

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News Author

Megan Rauscher
Megan Rauscher is a freelance writer for Reuters Health.

Disclosure: Megan Rauscher has disclosed no relevant financial relationships.

CME Author

Charles P. Vega, MD
Associate Professor; Residency Director, Department of Family Medicine, University of California, Irvine

Disclosure: Charles Vega, MD, has disclosed an advisor/consultant relationship to Novartis, Inc.

Brande Nicole Martin
is the News CME editor for Medscape Medical News.

Disclosure: Brande Nicole Martin has disclosed no relevant financial information.

Reuters Health Information 2008. ©2008 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.

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