BMJ, doi: 10.1136/bmj.39140.632604.55, (Published 8 March 2007)

RESEARCH

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

Olli-Pekka Alho ^1*, Petri Koivunen ¹, Tomi Penna ¹, Heikki Teppo ¹, Markku Koskela ², Jukka Luotonen ¹

¹ Department of Otolaryngology, University of Oulu, PO Box 5000, FIN-90014, Finland
² Department of Medical Microbiology, Kajaanintie 50, FIN-90029 Oulu University Hospital, Finland

^* Correspondence to: opalho{at}cc.oulu.fi.

Objective To determine the short term efficacy and safety of tonsillectomy for recurrent streptococcal pharyngitis in adults.

Design Randomised controlled trial.

Setting Academic referral centre in Finland.

Participants 70 adults with documented recurrent episodes of streptococcal group A pharyngitis.

Intervention Instant tonsillectomy (n=36) or remaining on waiting list as control (n=34).

Main outcome measures 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.

Results 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).

Conclusions 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.

Trial registration Clinical Trials NCT00136877.

---

(Accepted 9 February 2007)
CiteULike    Complore    Connotea    Del.icio.us    Digg    Reddit    StumbleUpon    Technorati    What's this?

Relevant Articles

Time to stop doing tonsillectomies?

Tim J B Crayford
BMJ 2007 334: 1019. [Extract] [Full Text] [PDF]

More advice to clinicians

Alun Tomkinson, Rosemary Fox, and Mark Temple
BMJ 2007 334: 1019. [Extract] [Full Text] [PDF]

For patient or population?

Fiona Godlee
BMJ 2007 334: 0. [Extract] [Full Text]

Recurrent pharyngo-tonsillitis

Paul Little
BMJ 2007 334: 909. [Extract] [Full Text] [PDF]

Calculating the number needed to treat for trials where the outcome is time to an event

Douglas G Altman and Per Kragh Andersen
BMJ 1999 319: 1492-1495. [Extract] [Full Text] [PDF]

Related external webpages:

Student BMJ: Critical appraisal

This article has been cited by other articles:

• Burton, M. J (2008). Commentary: Tonsillectomy--then and now. Int J Epidemiol 37: 23-25 [Full text]  
• Crayford, T. J B (2007). Time to stop doing tonsillectomies?. BMJ 334: 1019-1019 [Full text]  
• Tomkinson, A., Fox, R., Temple, M. (2007). More advice to clinicians. BMJ 334: 1019-1019 [Full text]  
• Little, P. (2007). Recurrent pharyngo-tonsillitis. BMJ 334: 909-909 [Full text]  

Rapid Responses:

Read all Rapid Responses

Sham surgical controls would be better for RCTs of established surgical techniques

Tim JB Crayford
bmj.com, 31 Mar 2007 [Full text]

Are we too scientifically orientated?

Celine M Aranjo
bmj.com, 26 Apr 2007 [Full text]

Risk factors for recurrent pharyngitis in adults

PRASANTA PADHAN
bmj.com, 6 May 2007 [Full text]

Methodological flaws and management misconceptions

Ewen F Flint
bmj.com, 8 May 2007 [Full text]

Letter in response to: Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial

Jonathon Joseph, et al.
bmj.com, 17 May 2007 [Full text]

Unnecessary tonsillectomy?

S S Musheer Hussain, et al.
bmj.com, 22 May 2007 [Full text]

Confidence interval too narrow

Michael J Campbell, et al.
bmj.com, 23 May 2007 [Full text]

Is surgery the only alternative?

Thomas Sandeman, et al.
bmj.com, 27 May 2007 [Full text]

Online poll

Find out more >>