Tonsillectomy for recurrent tonsillitis: the NATTINA trial

We read with great interest the Article by Janet A Wilson and colleagues.1Wilson JA O'Hara J Fouweather T et al.Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial.Lancet. 2023; 401: 2051-2059Summary Full Text Full Text PDF PubMed Google Scholar The authors concluded that immediate tonsillectomy is more effective and cost-effective than conservative management in adults with recurrent acute tonsillitis. The authors reported that "191 adverse events in 90 (39%) of 231 participants were deemed related to tonsillectomy. The most common adverse event was bleeding (54 events in 44 [19%] participants)."1Wilson JA O'Hara J Fouweather T et al.Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial.Lancet. 2023; 401: 2051-2059Summary Full Text Full Text PDF PubMed Google Scholar Is immediate tonsillectomy too radical for adults with recurrent acute tonsillitis? In adult patients, acute tonsillitis is often self-limiting and of short duration.2Powell J O'Hara J Carrie S Wilson JA Is tonsillectomy recommended in adults with recurrent tonsillitis?.BMJ. 2017; 357j1450 Google Scholar Clinically, tonsillectomy provides a definitive treatment for recurrent tonsillitis, but the timing of tonsillectomy should be addressed. Based on the data of 5968 adult patients (82·9% had chronic tonsillitis or adenoiditis), Chen and colleagues reported that the complication rate was 1·2% and the reoperation rate was 3·2%.3Chen MM Roman SA Sosa JA Judson BL Safety of adult tonsillectomy: a population-level analysis of 5968 patients.JAMA Otolaryngol Head Neck Surg. 2014; 140: 197-202Crossref Scopus (28) Google Scholar Thus, interval tonsillectomy might be a better choice for recurrent acute tonsillitis. As clinicians, we believe that immediate tonsillectomy could be more suitable for adults who did not respond to conservative management. To explore reasons for the high complication rate, related information (tonsillectomy technique, BMI, the severity of obstructive sleep apnoea hyponoea syndrome, etc) should be provided by the authors. For example, tonsillectomy technique (coblation, cold steel, etc) is one of the crucial risk factors for postoperative haemorrhage.4Lowe D van der Meulen J Tonsillectomy technique as a risk factor for postoperative haemorrhage.Lancet. 2004; 364: 697-702Summary Full Text Full Text PDF PubMed Scopus (214) Google Scholar For the treatment in adults with recurrent acute tonsillitis, appropriate patient selection, selection of surgical timing, and selection of tonsillectomy technique might be key factors to enhance the effective rate, improve quality of life, and decrease the complication rate. We declare no competing interests. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trialCompared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. Full-Text PDF Open AccessTonsillectomy for recurrent tonsillitis: the NATTINA trial – Authors' replyWe welcome the enthusiasm of fellow researchers to explore other aspects of recurrent tonsil disease in adults and comment on our Article.1 Christopher R Jones and colleagues highlight the putative association between tonsillectomy rates, tonsillitis admission, and invasive group A streptococcus incidence in children.2 It is impossible for us to suggest how improved and timely access to tonsillectomy could affect societal levels of invasive group A streptococcus but the trends in tonsillectomy rates are clear. Full-Text PDF