Dataset Information

Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis.

ABSTRACT:

Background

The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis.

Methods

A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. Outcome 6 months later (T180) was documented using the Glasgow Benefit Inventory (GBI) and the Specific Benefits from Tonsillectomy Inventory (SBTI). Correlation analyses between CHT and PTA group as well as between the different time points within each group concerning the serological parameters and the outcome parameters were performed.

Results

At T-1, patients in the CHT group presented with significantly higher lymphocytes counts (relative and absolute), basophils (relative and absolute) and eosinophils but less white-cells, monocytes, neutrophils (absolute and relative), alpha-1, alpha-2, beta globulins, immunoglobulin and lower C-reactive protein and procalcitonin values than patients in the PTA group (all p?ConclusionsThis pilot study showed a specific serological pattern for patients with chronic tonsillitis with a specific pattern of changes after tonsillectomy. But there is no established role for biomarkers currently used in clinical practice to predict the outcome of tonsillectomy for chronic tonsillitis.

SUBMITTER: Bohne S

PROVIDER: S-EPMC3701599 | biostudies-literature | 2013 Jul

REPOSITORIES: biostudies-literature

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Publications

Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis.

Bohne Silvia S Siggel Robert R Sachse Svea S Kiehntopf Michael M Bauer Michael M Straube Eberhard E Guntinas-Lichius Orlando O

Journal of negative results in biomedicine 20130701

<h4>Background</h4>The aim of the present study was to explore serological biomarkers which predict the outcome of tonsillectomy for chronic tonsillitis.<h4>Methods</h4>A case study in a University ENT department of 24 adult patients with chronic tonsillitis (CHT) in comparison to 24 patients with acute peritonsillar abscess (PTA) was performed. Blood samples for clinical routine hematological and serological parameters were assessed prior to surgery (T-1) and five days (T5) after tonsillectomy. ...[more]

PMID: 23816317

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Project description:BackgroundTonsillectomy is one of the most frequently performed surgeries in children and young adults worldwide. For decades, tonsillectomy was the surgical treatment of choice for recurrent acute tonsillitis. Tonsillotomy was used in some countries as an alternative to tonsillectomy only for the treatment of obstructive sleep apnea in young children. In recent years, an increase of tonsillotomy also to treat recurrent acute tonsillitis can be observed. Therefore, the German Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) to investigate whether tonsillotomy offers advantages compared to tonsillectomy. The meta-analysis of the IQWiG including studies until 2016 revealed that the long-term benefits and harms of tonsillotomy compared to tonsillectomy are unclear. Consequently, the G-BA performed a European call for a clinical trial. A consortium of the German Professional Association of ENT-surgeons (BVHNO), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), and the Jena University Hospital were finally selected to perform the TOTO study.MethodsTOTO is a multicenter, 1:1 two-arm, randomized non-blinded non-inferiority trial. Four hundred fifty-four patients ≥ 3 years of age will be randomly allocated to undergo either tonsillotomy or tonsillectomy as surgical treatment of recurrent acute tonsillitis. All participants will be followed up for a total of 24 months. The primary outcome is the number of sore throat days experienced over the 24-month follow-up.DiscussionTOTO is designed to evaluate the effectiveness and efficiency of tonsillectomy versus tonsillectomy for the management of patients with recurrent acute tonsillitis. Tonsil disease and surgery have a major impact on preschool and school children as well as on economically active young adults, with individual and societal costs through loss of school visits, earnings, and productivity. If tonsillotomy is at least as effective as tonsillectomy but with reduced morbidity, this would reduce costs to the healthcare system and society.Trial registrationGerman Clinical Trials Register DRKS00020823 . Registered on 04 September 2020.

Project description:Background: Tonsillectomy is a common surgery in the US, with possible postoperative complications. While small studies indicate postoperative depressive symptoms may occur, large-scale evidence is lacking on the tonsillectomy-depression link. Methods: We conducted a retrospective cohort study using the TriNetX US collaborative network, offering de-identified electronic health data from 59 collaborative healthcare organizations (HCOs) in the United States. In this study, people being diagnosed of chronic tonsillitis between January 2005 and December 2017 were enrolled. Patients deceased, with previous record of cancers or psychiatric events before index date were excluded. 14,874 chronic tonsillitis patients undergoing tonsillectomy were propensity score matched 1:1 to controls for age, sex, and race. New-onset depression risks were evaluated over 5 years post-tonsillectomy and stratified by age and sex. Confounders were adjusted for including demographics, medications, comorbidities and socioeconomic statuses. Results: After matching, the difference of key baseline characteristics including age, sex, comedications status and obesity status was insignificant between tonsillectomy and non-tonsillectomy groups. Tonsillectomy had a 1.29 times higher 5-year depression risk versus matched controls (95% CI, 1.19-1.40), with elevated risks seen at 1 year (HR=1.51; 95% CI, 1.28-1.79) and 3 years (HR=1.30; 95% CI, 1.18-1.43). By stratifications, risks were increased for both males (HR=1.30; 95% CI, 1.08-1.57) and females (HR=1.30; 95% CI, 1.18-1.42), and significantly higher in ages 18-64 years (HR=1.37; 1.26-1.49), but no significance observed for those 65 years and older. After performing sensitivity analyses and applying washout periods of 6, 12, and 36 months, the outcome remained consistent with unadjusted results. Conclusion: This real-world analysis found tonsillectomy was associated with a 30% higher 5-year depression risk versus matched non-tonsillectomy patients with chronic tonsillitis. Further mechanistic research is needed to clarify the pathophysiologic association between depression and tonsillectomy. Depression is not commonly mentioned in the current post-tonsillectomy care realm; however, the outcome of our study emphasized the possibility of these suffering condition after operation. Attention to psychological impacts following tonsillectomy is warranted to support patient well-being, leading to better management of post-tonsillectomy individuals.

Project description:RationaleIdentifying frailty by the presence of a critical number of frailty markers has been difficult to operationalize in the intensive care unit (ICU), where patients often cannot complete performance measures or answer complex questions.ObjectivesTo assess the construct and predictive validity of a questionnaire-based approach to identifying frailty in adult ICU patients.MethodsWe conducted an observational cohort study of adults admitted to a medical or surgical ICU at one of two hospitals in New York. We asked patients or surrogates about demographic information, frailty markers, and prehospital disability status. ICU physicians completed the Clinical Frailty Scale (CFS), a judgment-based frailty assessment tool. We examined the relationship between individual frailty markers, CFS, and demographic correlates of frailty such as age, prehospital living arrangement, and prehospital disability. We assessed the predictive validity of possible frailty phenotypes, using hospital and 6-month outcomes.ResultsAmong 95 study participants (mean age [SD], 57.1 [17.5] yr), 80% reported one or more of seven frailty markers (median [interquartile range], 3 [1-4]). The most common frailty markers were impaired mobility (60%), impaired physical activity (60%), and decreased strength (44.2%). Patients with more frailty markers were older (mean age [SD] of those with at least three frailty markers: 62.3 [17.7] vs. 51.6 [15.8] yr; P?<?0.001) compared with those with fewer than three markers, and were more likely to be judged frail by CFS (57.0 vs. 19.6%; P?=?0.001), although of the 49 patients with three or more frailty markers, CFS identified 36.7% as not frail. Malnutrition and fatigue or low energy were not significantly associated with other frailty correlates. Survivors with more frailty markers were more likely to die or report increased disability at follow-up. In multivariate models, a frailty phenotype defined as at least three of the seven frailty markers performed similarly to CFS in predicting death or increased disability at 6 months (adjusted odds ratio [95% confidence interval], 3.3 [1.2-9.0] vs. 3.8 [1.2-11.7]) for CFS.ConclusionsAsking patients or surrogates about frailty markers may be a valid approach to identifying critically ill adults with a frailty phenotype associated with increased risk of adverse outcomes. Larger studies measuring frailty markers may provide insight into factors that impact short- and long-term outcomes after ICU admission.

Project description:IntroductionThe standard surgical treatment for recurrent or chronic tonsillitis is extracapsular tonsillectomy. Recent studies show that intracapsular tonsillectomy has the potential to reduce the postoperative morbidity of patients undergoing tonsil surgery. The Finnish Intracapsular Tonsillectomy (FINITE) trial aims to provide level I evidence to support the hypothesis that the recovery time from tonsil surgery can be reduced with intracapsular tonsillectomy. Additionally, from this trial, major benefits in quality of life, reduction of postoperative complications, treatment costs and throat symptoms might be gained.Methods and analysisThe FINITE trial is a prospective, randomised, controlled, patient-blinded, three-arm clinical trial. It is designed to compare three different surgical methods being extracapsular monopolar tonsillectomy versus intracapsular microdebrider tonsillectomy versus intracapsular coblation tonsillectomy in the treatment of adult patients (16-65 years) suffering from recurrent or chronic tonsillitis. The study started in September 2019, and patients will be enrolled until a maximum of 200 patients are randomised. Currently, we are in the middle of the study with 125 patients enrolled as of 28 February 2022 and data collection is scheduled to be completed totally by December 2027. The primary endpoint of the study will be the recovery time from surgery. Secondary endpoints will be the postoperative pain scores and the use of analgesics during the first 3 weeks of recovery, postoperative haemorrhage, quality of life, tonsillar remnants, need for revision surgery, throat symptoms, treatment costs and sick leave. A follow-up by a questionnaire at 1-21 days and at 1, 6, 24 and 60 months will be conducted with a follow-up visit at the 6-month time point.Ethics and disseminationEthical approval was obtained from the Medical Ethics Committee of the Hospital District of Southwest Finland (reference number 29/1801/2019). Results will be made publicly available in peer-reviewed scientific journals.Trial registration numberNCT03654742.

Dataset Information

Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis.

Background

Methods

Results

Publications

Clinical significance and diagnostic usefulness of serologic markers for improvement of outcome of tonsillectomy in adults with chronic tonsillitis.

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