Tonsillectomy Effective In Adults

OULU, Finland, May 4 -- Tonsillectomy is an effective remedy for adults with recurrent bouts of group A streptococcal pharyngitis, according to researchers here.

In a randomized prospective study, tonsillectomy sharply reduced the number of acute episodes of pharyngitis, compared with watchful waiting, found Olli-Pekka Alho, M.D., Ph.D., of the University of Oulu.

There were no serious adverse effects other than about two weeks of throat pain after the surgery, Dr. Alho and colleagues reported in the May 5 issue of the BMJ.

"Traditionally, tonsillectomy has been used to prevent recurrent streptococcal throat infections," the researchers said, but a recent systematic review concluded there was no evidence that it works in adults.

In effort to fill the gap, Dr. Alho and colleagues enrolled 70 adults with recurrent streptococcal pharyngitis, defined as three or more episodes in six months or four episodes in a year.

Thirty-six patients were randomized to immediate surgery, and 34 remained on the waiting list as controls, the researchers said. The primary outcome was the percentage change in the risk of an episode of streptococcal pharyngitis at 90 days.

The study found:

• At 90 days, streptococcal pharyngitis had recurred in eight of the control patients, or 24%.
• One patient (3%) in the tonsillectomy group had a recurrence.
• The difference was statistically significant at P=0.011.
• The mean number of medical consultations for pharyngitis was 0.9 in the control group and 0.1 in the tonsillectomy group, a difference that was significant at P=0.002.
• The mean number of episodes of pharyngitis was 2.1 in the control group and 0.6 in the tonsillectomy group, which was significant at P=0.001.

The controls also had significantly more days with sore throat and fever, the researchers reported. Rhinitis was higher, but not significantly so.

Because the controls were on a waiting list for surgery, Dr. Alho and colleagues said, the follow-up period for the study was relatively short. Nevertheless, they said, "we think that the immediate effect of tonsillectomy reflects its overall usefulness."

The short follow-up, however, makes it difficult to apply the results to a clinical setting, said Paul Little, MBBS, of the University of Southampton in England.

In an accompanying editorial, Dr. Little argued that those on the waiting list showed improvement during the 90-day follow-up and might have improved still more over time.

"This begs the question of whether the benefit of immediate tonsillectomy would be reduced if the follow-up was longer," he said.

Also, the small size of the trial means that confidence intervals are wide and the researchers did not give details on the severity of the episode of pharyngitis, so it "it is difficult to provide firm advice to patients," he said.