Overall Higher Quality of Life in Children, Adults Six Months After Tonsillectomy

Newswise — Recurrent and chronic infections of the tonsils and adenoids remains a common medical disorder, necessitating the adenotonsillectomy. More than 300,000 surgical procedures requiring the removal of tonsils and adenoids are performed each year for such infections. Yet the clinical reasons for recommending an adenotonsillectomy remain poorly defined and controversial, as evidenced by the differing population rate of adenotonsillectomy in different regions of the United States and other countries.

This controversy on the need for this surgical procedure persists because the actual benefits of adenotonsillectomy are unclear when compared to observation and medical treatment of infections. There is a strong belief in the pediatrics community that the natural history of recurrent tonsillitis is that the disorder will resolve on its own or in other words, after a period of watchful waiting and medical treatment of infections, the recurrent infections will diminish or stop, and the affected children's quality of life will return to baseline.

The otolaryngology community feels equally strongly that children with significant infectious history who have undergone adenotonsillectomy for recurrent tonsillitis have better outcomes - improved quality of life (QOL) and fewer infections " than children that do not undergo surgery. In adults, the effectiveness of tonsillectomy or adenotonsillectomy has been supported largely by retrospective surveys regarding overall satisfaction or improvement in throat pain or discomfort after the procedure. However, these studies lack a validated survey for scientifically exploring overall patient improvement in quality of life due to the adenotonsillitis and fail to describe the psychosocial domains where the improvement occurs.

Although there is now evidence that the quality of life impact of tonsil and adenoid disease is significant, the quality of life of children and adults after adenotonsillectomy for recurrent or chronic infection has not been studied prospectively. A new study sets to evaluate the general and disease-specific quality of life after adenotonsillectomy for recurrent and/or chronic infection in children and adults.

This study, "TO TREAT" or Tonsillitis Outcomes Toward Reaching Evidence in Adults and Tots, was conducted under the sponsorship of the BEST ENT Clinical Research Network, (Building Evidence for Successful Treatments in ENT) a national, community practice-based clinical research network conducted by the National Center for the Promotion of Research in Otolaryngology, coordinated through the Duke Clinical Research Institute. The network includes more than 200 members nationwide who conduct, support, and promote clinical research in order to advance evidence-based otolaryngology and better patient care. The findings are to be presented at the 109th Annual Meeting & OTO EXPO of the American Academy of Otolaryngology—Head and Neck Surgery Foundation, being held September 25-28, 2005, at the Los Angeles Convention Center, Los Angeles, CA. Methodology: Adult patients and the parents of pediatric patients completed a validated outcomes instrument " the Tonsil and Adenoid Health Status Instrument (TAHSI) " before and six months after tonsillectomy. The TAHSI is scored into six subscales addressing different aspects of tonsil and adenoid disease: eating/swallowing; airway/breathing; infections; healthcare utilization; cost of care; and behavior. Parents of children and adults also completed age-specific QOL instruments " the CHQ-PF 28 or the SF-12, respectively. Some 92 children were enrolled in the pediatric arm of the study at 11 sites, with 24 investigators; of these, 59 (64 percent) have completed six-month follow-up. Sixteen sites with 31 investigators enrolled 72 adults in the study; 41 of these patients (57 percent) have completed a six-month follow-up.

Results: Both children and adults participated in this study. Key findings from each cohort follow:

Children: In the pediatric sample, 34 males and 58 females participated, with an average age of 10.2 years (range 4-19 years). More than 60 percent of these children had experienced four or more episodes of tonsillitis per year; almost 50 percent of the participating children had taken five or more antibiotic prescriptions during the previous year, thus increasing their risk for developing antibiotic resistance.

Children underwent adenotonsillectomy if they had had three or more documented tonsil infections in the previous year and had failed medical therapy. Highly significant improvements following the surgery were found on the TAHSI in the areas of airway, number of infections, utilization of healthcare resources, swallowing, and cost of healthcare. In the global quality of life assessment, similarly significant improvements were found in the domains of physical functioning, social limitations, parental impact, and impact on the family.

Adults: In the adult sample, 52 females and 20 males participated, with an average age of 27.1 years (range 20-49 years). Almost 70 percent of these patients had experienced four or more tonsil infections per year; but in contrast to the pediatric patients, fewer than one-third of the adults had used four or more antibiotics.

Adults underwent adenotonsillectomy if they had had three or more documented tonsil infections in the previous year and had failed medical therapy. Highly significant improvements following the surgery were found on the TAHSI in the areas of numbers and severity of infection, utilization of healthcare resources, cost of healthcare, and bad breath (halitosis). Both physical and emotional functioning showed significant improvement following the tonsillectomy at six months follow-up.

Conclusions: This multi-center, community practice-based quality of life outcome study showed highly significant improvements in disease-specific and overall quality of life in children and adults six months after tonsillectomy, providing preliminary data to support the clinical effectiveness of that surgical intervention on patient health and quality of life.