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

BMJ 2007; 334 doi: (Published 03 May 2007) Cite this as: BMJ 2007;334:939
  1. Olli-Pekka Alho, professor in otolaryngology1,
  2. Petri Koivunen, consultant in otolaryngology1,
  3. Tomi Penna, specialist in otolaryngology1,
  4. Heikki Teppo, specialist in otolaryngology1,
  5. Markku Koskela, chief physician2,
  6. Jukka Luotonen, chief physician1
  1. 1Department of Otolaryngology, University of Oulu, PO Box 5000, FIN-90014, Finland
  2. 2Department of Medical Microbiology, Kajaanintie 50, FIN-90029 Oulu University Hospital, Finland
  1. Correspondence to: O-P Alho opalho{at}
  • Accepted 9 February 2007


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.


  • We thank Tuomas Holma for treating some of the patients, Tuula Gehör and Pirkko Kokko (trial nurses), and Raili Puhakka (research assistant).

  • Contributors: O-PA was primarily responsible for designing, initiating, and conducting the study and data analysis and drafting of the manuscript and is guarantor. TP and HT participated in conducting the study and critical review of the manuscript. PK, MK, and JL participated in the study design, conducting the study, data analysis, and critical review of the manuscript.

  • Funding: None.

  • Competing interests: None declared.

  • Ethical approval: Oulu University hospital ethics committee.

  • Accepted 9 February 2007
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