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

Abstract

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.

Conflict of interest statement

Competing interests: None declared.

Figures

Fig 1 Enrolment and allocation of patients in study

Fig 2 Times to first episode of group A streptococcal pharyngitis proved by culture, acute pharyngitis episode with medical consultation, and acute pharyngitis episode of any kind (differences between groups tested with log rank test)