Volume 8, Issue 6, June 2023 International Journal of Innovative Science and Research Technology

ISSN No:-2456-2165

Analysing the Role of Tonsillectomy in Recurrent

Tonsillitis: A Combined Study
Sanjay Kumar1* Kashiroygoud Biradar2*
1* 2*
Associate Prof, Resident,
Department of ENT-HNS, Department of ENT-HNS,
Command Hospital Airforce, Bangalore, India Command Hospital Airforce, Bangalore, India

*Corresponding author: Dr. Sanjay Kumar

Associate professor, Department of ENT,
Command Hospital Airforce,
Bangalore, India

Abstract:-
Objective: The aim of this study was to examine the
effects of tonsillectomy on the frequency of episodes,
pain scores, and quality of life in individuals who
suffered from recurrent tonsillitis. Additionally, this
research sought to explore the potential influence of
patient characteristics on the aforementioned outcomes.
Methods: Over a period of three years, a combined
retrospective &prospective study was carried out on a
cohort of 200 patients aged between 5 and 50 years who
had undergone tonsillectomy due to recurrent tonsillitis.
The frequency of tonsillitis episodes, pain scores, and
quality of life were assessed pre- and post-operatively.
The study investigated postoperative complications and
their correlation with patient characteristics in
determining outcomes.
Results: Following a tonsillectomy procedure, a
noteworthy reduction was noted in the frequency of
tonsillitis occurrences, with an average decrease from 8
to 1 per annum. Additionally, pain scores decreased
significantly from 7.5 to 1.5 out of 10, and there was a
marked improvement in quality-of-life scores, with an
increase from 48 to 88 out of 100. The influence of age on
outcomes was found to be significant, with younger
patients exhibiting superior results. A small proportion
of patients experienced postoperative complications.
Conclusion: The surgical procedure of tonsillectomy has
been observed to have a substantial impact on the
reduction of the frequency of tonsillitis episodes, as well
as the alleviation of pain scores and enhancement of the
quality of life in patients who experience recurrent
tonsillitis. The results of this study provide evidence for
the efficacy of tonsillectomy as a means of managing
recurrent tonsillitis. This may have implications for
clinical decision-making and health policy. Additional
investigation is required to examine prolonged
consequences and supplementary determinants.
Keywords:- Tonsillectomy, Recurrent Tonsillitis, Pain
Scores, Quality of Life, Postoperative Complications, Age
Factors.
I. INTRODUCTION
Tonsillitis is a frequently encountered condition that is
characterised by inflammation of the tonsils resulting from
viral or bacterial infection [1]. Generally self-limiting, the
condition presents significant challenges when recurrent or
chronic, impacting the quality of life and demanding
aggressive treatment strategies [2]. The clinical definition of
recurrent tonsillitis may exhibit variability; however, it is
commonly characterised by multiple occurrences of acute
tonsillitis within a year, resulting in significant morbidity,
absenteeism from school or work, frequent medical visits,
and repeated administration of antibiotics [3]. Beyond the
physical discomfort, recurrent tonsillitis often inflicts
emotional distress and a diminished overall quality of life
[4].
Tonsillectomy, a surgical procedure that involves the
removal of the tonsils, is considered a primary treatment
option for the management of recurrent or chronic tonsillitis.
The decision to undergo this procedure is based on a careful
evaluation of the potential risks and benefits, with the
understanding that the benefits must outweigh the risks [2].
Continuous research is necessary to determine the precise
role and efficacy of tonsillectomy in the treatment of
recurrent tonsillitis, despite its frequent use as a surgical
intervention in otolaryngology.
Numerous research endeavours have examined the
effectiveness of tonsillectomy, yielding diverse findings.
Paradise et al. (1984) [5] conducted a study that showed a
slight reduction in the occurrence of throat infections during
the initial year after surgery. However, this advantage
seemed to diminish over time. In contrast, Van Staaij et al.
(2004) [6] reported insignificant variances in the occurrence
of fever episodes, throat infections, or upper respiratory tract
infections among children who underwent tonsillectomy and
those who were subjected to watchful waiting for a period of
two years. According to various systematic reviews and
studies, tonsillectomy has been found to considerably
decrease the incidence of throat infections and duration of
throat pain, particularly during the initial year after the
surgery. Additionally, it has the potential to enhance health-
related quality of life. (Mitchell et al., 2014 [7];
Koskenkorva et al., 2013 [8]).

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Volume 8, Issue 6, June 2023 International Journal of Innovative Science and Research Technology
The potential advantages of the procedure under
consideration must be weighed against the surgical hazards
that come with it. These risks include postoperative
complications such as haemorrhage, discomfort, and
alterations in vocalisation [9]. Consequently, the
determination to conduct a tonsillectomy frequently remains
highly personalised, emphasising the necessity for more
comprehensive and current research.
In this prospective study, we aim to provide additional
data and perspective on the role and efficacy of
tonsillectomy in managing recurrent tonsillitis. Our
objective is to provide additional information to medical
practitioners, patients, and carers, thereby assisting them in
making well-informed decisions regarding this significant
health condition.
II. METHODOLOGY
The present study was a combined retrospective
&prospective study that spanned over three years,
commencing in January 2019 and concluding in December
2022. The study cohort consisted of 200 patients who had
been diagnosed with recurrent tonsillitis and were being
evaluated for tonsillectomy and later undergone
tonsillectomy. Retrospective group included patients who
undergone tonsillectomy with indication of recurrent
tonsillitis in recent two years. The pre operative evaluation
of these patients included evaluation of medical documents
& post operative assessment was done after 2 years as per
our study format.
A. Study Population:
 The research encompassed a sample of 200 individuals
ranging from 5 to 50 years of age, who visited the
Otolaryngology department of a tertiary care hospital and
were clinically determined to have recurrent tonsillitis
and underwent tonsillectomy.
Fig. 1: Pain scale
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ISSN No:-2456-2165
 Inclusion Criteria:
The study incorporated the subsequent patients:
Patients who had been diagnosed with recurrent
tonsillitis, which was defined as seven or more documented
episodes in the past year, five or more documented episodes
in each of the past two years, or three or more documented
episodes in each of the past three years[SIGN Guidelines
(10)].
 The individuals who were advised to undergo
tonsillectomy by their primary care physician or
otolaryngologist.
 Patients who possessed the capacity to provide informed
consent, or in the case of minors, had legal guardians with
the ability to provide consent.
 Exclusion Criteria:
Exclusion criteria were applied to patients who
exhibited the following characteristics during the study:
 Underlying immune deficiency disorders.
 Previous tonsillectomy.
 Contraindications to surgery.
B. Data Collection:
Data was gathered via patient interviews and medical
records. The data collected encompassed demographic
variables, medical records, the frequency and intensity of
tonsillitis occurrences, administration of antibiotic
treatment, and absenteeism from school or work.
Subsequent to the surgical procedure, we proceeded to
observe and assess these variables throughout a duration of
two years, as part of our follow-up protocol.
C. Outcome Measures:
The principal metric utilised in our study was the
alteration in the frequency of tonsillitis occurrences
subsequent to the surgical procedure. The secondary
outcome measures encompassed pain scores, number of
missed school or work days, and alterations in health-related
quality of life measures, which were evaluated using a
validated pain scale and a validated tool such as the SF-36.
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D. Statistical Analysis
The data was summarised using descriptive statistics.
Paired t-tests were employed to evaluate the differences in
the frequency of tonsillitis episodes, pain scores, and quality
of life scores pre- and post-tonsillectomy. The study
employed multivariable regression models to ascertain the
variables that were correlated with the outcomes. The
statistical analyses were executed utilising a software
package for statistical analysis. A p-value of less than 0.05
was deemed to be statistically significant.
ISSN No:-2456-2165
were conducted utilising a software package for statistical
analysis. A p-value of less than 0.05 was deemed to be
statistically significant.
The length of the study presented a chance to track the
advancement of individuals over time, providing a thorough
assessment of the effects of tonsillectomy on patients who
suffer from repeated bouts of tonsillitis.
III. RESULT

The data was summarised using descriptive statistics.
Paired t-tests were employed to assess the differences in the
frequency of tonsillitis episodes, pain scores, and quality of
life scores pre- and post-tonsillectomy. The study employed
multivariable regression models to ascertain the factors that
are correlated with the outcomes. The statistical analyses
The study comprised a cohort of 200 individuals who
were diagnosed with recurrent tonsillitis and subsequently
underwent tonsillectomy. Among the sample population,
62% were identified as male, with an age range spanning
from 5 to 50 years and a calculated mean age of 22 years.

Table 1: Demographic and Clinical Characteristics of Patients

Characteristics Value
Number of Patients 200
Male (%) 62%
Female (%) 38%
Age Range (years) 5-50
Average Age (years) 22
Preoperative Tonsillitis Episodes per Year 8

The sample population exhibited a male predominance tonsillitis episodes per year prior to surgery was 8 among the
and had a mean age of 22 years. The mean number of patients.

Tonsillitis Episodes per Year

9
8
8

2
1
1

0
Tonsillitis Episodes per Year

Preoperative Postoperative

Fig. 2: Frequency of Tonsillitis Episodes Pre- and Post-Tonsillectomy

The findings indicated a significant decline in the the surgery. This study supports the efficacy of
frequency of tonsillitis occurrences subsequent to tonsillectomy as a viable treatment option for individuals
tonsillectomy, with a mean decrease from 8 episodes with recurrent tonsillitis.
annually prior to the surgery to 1 episode annually following

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Volume 8, Issue 6, June 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165

Pain Score (out of 10)

1.5

7.5

Preoperative Postoperative
Fig. 3: Pain Scores Pre- and Post-Tonsillectomy

The findings indicated a noteworthy decrease in pain to 1.5 subsequent to the surgical procedure. This finding
ratings subsequent to tonsillectomy. The average score suggests that the procedure resulted in enhanced patient
exhibited a decline from 7.5 prior to the surgical procedure comfort and an improved quality of life.

Quality of Life Score (out of 100)

Quality of Life Score (out of 100)

0 20 40 60 80 100

Postoperative Preoperative

Fig. 4: SF-36 Quality of Life Scores Pre- and Post-Tonsillectomy

The findings indicated a significant enhancement in operation to 88 following the operation. This finding
the SF-36 quality of life measurements subsequent to provides evidence for the efficacy of tonsillectomy in
tonsillectomy, with a mean rise from 48 prior to the improving the overall health and quality of life of patients.

Table 2: Factors Associated with Outcomes of Tonsillectomy

Factor Influence on Outcome
Age Significant (Younger age associated with better outcomes)
Sex Not significant
Preoperative Tonsillitis Episodes Not significant
Comorbid Conditions Not significant

The findings indicate that age is a statistically the cohort of younger patients. The outcomes were not
significant variable that correlates with improved significantly impacted by other factors such as sex,
postoperative outcomes. The findings underscored the preoperative tonsillitis episodes, and comorbid conditions.
possibility of increased advantages of tonsillectomy among

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Volume 8, Issue 6, June 2023 International Journal of Innovative Science and Research Technology
Table 3: Postoperative Complications
Complication
Postoperative Bleeding
Transient Changes in Voice
A subset of patients encountered complications, with
2% experiencing bleeding after the surgical procedure and
8% reporting temporary alterations in vocal function. The
aforementioned discovery underscores the significance of
making well-informed decisions and conducting meticulous
postoperative monitoring.
IV. DISCUSSION
The results obtained from our prospective study
highlight the considerable potential of tonsillectomy as a
viable intervention for the management of recurrent
tonsillitis. The study provided convincing evidence for a
decrease in the frequency of tonsillitis episodes, a reduction
in pain scores, and an improvement in quality-of-life scores
following a tonsillectomy.
The present study's findings are consistent with prior
research [11,12,13] and provide further support for the
favourable effects of tonsillectomy in patients with recurrent
tonsillitis. The significant reduction in the occurrence of
tonsillitis episodes following a tonsillectomy has significant
implications for patients afflicted with this ailment. This has
the potential to considerably minimise the interference in
their daily routines, missed days of work or school, and
overall quality of life related to their health [14].
The observed decrease in pain scores subsequent to
tonsillectomy highlights the efficacy of the procedure in
mitigating a substantial manifestation of recurrent tonsillitis,
consequently resulting in enhanced patient comfort and
overall health. The study findings indicate a significant rise
in SF-36 quality of life scores, which suggests that
tonsillectomy has a favourable effect on patients' physical
and emotional well-being, social functioning, and general
life contentment. This is supported by previous research
[14,15].
The recognition of age as a noteworthy determinant
impacting result held crucial implications for clinical
practise. The findings of our study indicate that there may be
a greater efficacy of tonsillectomy in younger patients as
compared to their older counterparts. This observation is
consistent with the results of a previous investigation by
Baumann et al. (2006), which demonstrated that younger
patients assigned a higher level of benefit to tonsillectomy
than older patients [16]. This discovery has the potential to
assist healthcare professionals in their decision-making
procedures by enabling them to customise management
approaches based on the unique characteristics and
circumstances of each patient.
The occurrence of postoperative complications,
including bleeding and temporary alterations in vocal
function [9], among a small subset of patients highlights the
significance of comprehensive preoperative consultation
regarding potential hazards and complications. Additionally,
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ISSN No:-2456-2165
Percentage of Patients
2%
8%
it emphasises the necessity for meticulous postoperative
observation and treatment.
Viewed from a wider lens, the aforementioned
discoveries hold significant ramifications for healthcare
systems. Our study offers compelling evidence to support
the efficacy of tonsillectomy as a means of managing
recurrent tonsillitis. This evidence has the potential to
impact clinical guidelines and policies, leading to greater
adoption of the procedure. As a result, patients may
experience improved outcomes, while healthcare costs
associated with recurrent episodes and complications of
tonsillitis may be reduced. Ultimately, this could lead to
more efficient allocation of healthcare resources.
V. CONCLUSION
In summary, the study provided significant empirical
support for the efficacy of tonsillectomy as a viable
intervention for the treatment of recurrent tonsillitis. The
results indicated a substantial decline in the incidence of
tonsillitis occurrences, a noteworthy decrease in pain
assessments, and a discernible enhancement in quality-of-
life evaluations post-operation.
The study population demonstrated predominantly
positive outcomes of the procedure, despite the
acknowledgement of some postoperative complications. The
recognition of age as a noteworthy factor in the results of the
procedure contributes to our comprehension of the patient
population that is most likely to derive the maximum
advantages from it.
VI. POTENTIAL LIMITATIONS AND BIAS
The present study exhibits a number of plausible
constraints that merit recognition. Initially, the limited scope
of our study being conducted at a single centre may impede
the applicability of our results to a broader population. The
potential for selection bias exists within our study, given that
the sample solely comprised patients who consented to
undergo tonsillectomy and satisfied our predetermined
criteria. In addition, the study did not account for
confounding variables such as coexisting therapies and
personal health practises, which may have a potential
influence on the outcomes.
Furthermore, subjective measures of outcomes such as
pain assessments and quality of life evaluations are
vulnerable to potential biases arising from individual patient
perceptions and reporting tendencies. There exists a
possibility that certain complications that arose after the
surgical procedure were not duly reported, thereby giving
rise to the likelihood of underestimating their incidence.
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 Volume 8, Issue 6, June 2023 International Journal of Innovative Science and Research Technology
ISSN No:-2456-2165
Not with standing these constraints, we hold a strong 10.1016/j.jpeds.2014.01.055. Epub 2014 Mar 14.
conviction that our investigation offers noteworthy PMID: 24631119.
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recurrent tonsillitis. Nonetheless, it is imperative for Kristo A, Alho OP. Short-term outcomes of
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[9.] Derkay CS, Darrow DH, Welch C, Sinacori JT. Post-
 Conflicts of interest - Nil tonsillectomy morbidity and quality of life in
 Research involving human participants and/or animals pediatric patients with obstructive tonsils and
– Nil adenoid: microdebrider vs electrocautery. Otolaryngol
 Informed consent: Informed consent was taken from the Head Neck Surg. 2006 Jan;134(1):114-20. doi:
patient for the case report. 10.1016/j.otohns.2005.10.039. PMID: 16399190.
 No funding was received to assist with the preparation of [10.] Scottish IG. Management of sore throat and
this manuscript. indications for tonsillectomy. A National Clinical
 The authors have no relevant financial or non-financial Guideline 34. 1999.
interests to disclose [11.] Tzelnick S, Hilly O, Vinker S, Bachar G, Mizrachi A.
Long-term outcomes of tonsillectomy for recurrent
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