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Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial.

ABSTRACT: To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults. Design Randomised controlled trial.Academic referral centre in Finland.70 adults with documented recurrent episodes of streptococcal group A pharyngitis.Instant tonsillectomy (n=36) or remaining on waiting list as control (n=34).Percentage change in the risk of an episode of streptococcal pharyngitis at 90 days. Rates of all episodes of pharyngitis and days with symptoms and adverse effects.The mean (SD) follow-up was 164 (63) days in the control group and 170 (12) days in the tonsillectomy group. At 90 days, streptococcal pharyngitis had recurred in 24% (8/34) in the control group and 3% (1/36) in the tonsillectomy group (difference 21%; 95% confidence interval 6% to 36%). The number needed to undergo tonsillectomy to prevent one recurrence was 5 (3 to 16). During the whole follow-up, the rates of other episodes of pharyngitis and days with throat pain and fever were significantly lower in the tonsillectomy group than in the control group. The most common morbidity related to tonsillectomy was postoperative throat pain (mean length 13 days, SD 4).Adults with a history of documented recurrent episodes of streptococcal pharyngitis were less likely to have further streptococcal or other throat infections or days with throat pain if they had their tonsils removed.Clinical Trials NCT00136877.

SUBMITTER: Alho OP

PROVIDER: S-EPMC1865439 | biostudies-literature | 2007 May

REPOSITORIES: biostudies-literature

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Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial.

Alho Olli-Pekka OP Koivunen Petri P Penna Tomi T Teppo Heikki H Koskela Markku M Luotonen Jukka J

BMJ (Clinical research ed.) 20070308 7600

<h4>Objective</h4>To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults. Design Randomised controlled trial.<h4>Setting</h4>Academic referral centre in Finland.<h4>Participants</h4>70 adults with documented recurrent episodes of streptococcal group A pharyngitis.<h4>Intervention</h4>Instant tonsillectomy (n=36) or remaining on waiting list as control (n=34).<h4>Main outcome measures</h4>Percentage change in the risk of an episode of st ...[more]

PMID: 17347187

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Project description:BackgroundLimited evidence exists as to the benefit of tonsillectomy in adult patients. We sought to determine the short-term efficacy of tonsillectomy for recurrent pharyngitis in adults.MethodsWe conducted a randomized, controlled, parallel-group trial at a tertiary care ear, throat and nose centre in Oulu, Finland, between October 2007 and December 2010. Adult patients with recurrent pharyngitis were randomly assigned to the control group (watchful waiting) or the tonsillectomy group. Our primary outcome was the difference in the proportion of patients with severe pharyngitis (severe symptoms and C-reactive protein level > 40 mg/L) within 5 months. Our secondary outcomes included differences between groups in proportions of patients who had episodes of pharyngitis with or without medical consultation, rates of pharyngitis and numbers of days with symptoms.ResultsOf 260 patients referred for tonsillectomy because of recurrent pharyngitis, we recruited 86 participants for our study. Of these, 40 patients were randomly allocated to the control group, and 46 were randomly allocated to the tonsillectomy group. One patient in the control group and no patients in the tonsillectomy group had a severe episode of pharyngitis (difference 3%, 95% confidence interval [CI] -2% to 7%). Seventeen patients in the control group (43%) and 2 patients in the tonsillectomy group (4%) consulted a physician for pharyngitis (difference 38%, 95% CI 22% to 55%). Overall, 32 patients in the control group (80%) and 18 patients in the tonsillectomy group (39%) had an episode of pharyngitis during the 5-month follow-up (difference 41%, 95% CI 22% to 60%). The rate of pharyngitis and number of symptomatic days were significantly lower in the tonsillectomy group than in the control group.InterpretationThere was no significant difference in the number of episodes of severe pharyngitis between the control and treatment groups, and episodes were rare. However, tonsillectomy resulted in fewer symptoms of pharyngitis, consequently decreasing the number of medical visits and days absent from school or work. For this reason, surgery may benefit some patients.Trial registrationClinicalTrials.gov, no. NCT00547391.

Project description:BackgroundInguinal hernia belongs to the most common surgical pathology worldwide. Approximately, one third is asymptomatic. The value of watchful waiting (WW) in patients with asymptomatic or mildly symptomatic inguinal hernia has been established in a few randomised controlled trials (RCTs). The aim of this study was to assess long-term outcomes of a RCT comparing WW and elective surgery.MethodsIn the original study, men aged ≥50 years with an asymptomatic or mildly symptomatic inguinal hernia were randomly assigned to WW or elective repair. In the present study, the primary outcome was the 12-year crossover rate to surgery, secondary outcomes were time-to-crossover, patient regret, pain, quality of life and incarceration. Dutch Trial Registry: NTR629.FindingsOut of 496 originally analysed patients, 488 (98.4%) were evaluable for chart review (WW: n = 258, surgery: n = 230), and 200 (41.0%) for telephone contact (WW: n = 106, surgery: n = 94) between November 2021 and March 2022 with a median 12 years follow-up (IQR 9-14). After 12 years, the estimated cumulative crossover rate to surgery was 64.2%, which was higher in mildly symptomatic than in asymptomatic patients (71.7% versus 60.4%, HR 1.451, 95% CI: 1.064-1.979). Time-to-crossover was longer in asymptomatic patients (50% after 6.0 years versus 2.0 years, p = 0.019). Patient regret was higher in the WW group (37.7 versus 18.0%, p = 0.002), as well as pain/discomfort (p = 0.031). Quality of life did not differ (p = 0.737). In the WW group, incarceration occurred in 10/255 patients (3.9%).InterpretationDuring 12-year follow-up, most WW patients crossed over to surgery, significantly earlier with mildly symptomatic hernia. Considering the relatively low incarceration rate, WW might still be an option in asymptomatic patients with a clear preference and being well-informed about pros and cons.FundingThe initial trial was funded by the Netherlands Organisation for Health Research and Development (ZonMW). This long-term study did not receive funding.

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Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial.

Publications

Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial.

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