Recurrent Tonsillitis

WILLIAM S. MCKERROW, Consultant Otolaryngologist, Raigmore Hospital, Inverness, United Kingdom

Questions Addressed

• Is tonsillectomy effective in severe tonsillitis in children and adults?

Summary of Interventions Unknown effectiveness Tonsillectomy versus antibiotics To be covered in future issues of Clinical Evidence Intermittent antibiotics Long-term antibiotics

Definition Tonsillitis is infection of the parenchyma of the palatine tonsils. Recurrent severe tonsillitis results in significant morbidity, including time lost from school or work. The definition of severe recurrent tonsillitis is arbitrary, but criteria used recently as a measure of severity were five or more episodes of true tonsillitis a year, symptoms for at least a year, and episodes that are disabling and prevent normal functioning.¹

Incidence/Prevalence Acute tonsillitis is more common in childhood.

Etiology/Risk Factors Common bacterial pathogens include beta hemolytic and other streptococci. Bacteria are cultured successfully only from a minority of people with tonsillitis. The role of viruses is uncertain.

Prognosis We found no good data on the natural history of tonsillitis or recurrent sore throat in children or adults. Participants in randomized controlled trials (RCTs) who were randomized to medical treatment (courses of antibiotics as required) have shown a tendency toward improvement over time.^2,3

Clinical Aims To abolish tonsillitis; to reduce the frequency and severity of recurrent throat infections; to improve general well-being, behavior, and educational achievement, with minimal adverse effects.

Clinical Outcomes Number and severity of episodes of tonsillitis or sore throat; requirement for antibiotics and analgesics; time off work or school; behavior, school performance, and general well-being; morbidity and mortality of surgery; and adverse effects of drugs.

Evidence-Based Medicine Findings

SEARCH DATE: CLINICAL EVIDENCEUPDATE SEARCH AND APPRAISAL
DECEMBER 2001

Tonsillectomy vs. Antibiotics

Limited evidence from one RCT suggests that tonsillectomy may benefit some children with severe tonsillitis. We found no good evidence on tonsillectomy in adults. We found that many important outcome measures have not been considered.

Adapted with permission from McKerrow WS. Recurrent tonsillitis. Clin Evid 2002;7:477-80.

REFERENCES

1. Management of sore throat and indications for tonsillectomy. National Clinical Guideline No 34. Scottish Intercollegiate Guidelines Network, Royal College of Physicians, 9 Queen St., Edinburgh EH2 1JQ.
2. Paradise JL, Bluestone CD, Bachman RZ, et al. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. N Engl J Med 1984;310:674-83.
3. Paradise JL, Bluestone CD, Rogers KD, et al. Comparative efficacy of tonsillectomy for recurrent throat infection in more versus less severely affected children [abstract]. Pediatric Res 1992;31:126A.

This is one in a series of chapters excerpted from Clinical Evidence, published by the BMJ Publishing Group, Tavistock Square, London, United Kingdom. Clinical Evidence is published in print twice a year and is updated monthly online. Each topic is revised every eight months, and users should view the most up-to-date version at www.clinicalevidence.com. This series is part of the AFP's CME. See "Clinical Quiz" on page 1603.