Significant improvements in quality of life following paediatric tonsillectomy: a prospective cohort study.

Abstract

The clinical efficacy of adenotonsillectomy is under debate with falling tonsillectomy rates in the UK and Ireland. In 2010, an NHS commissioned randomised controlled trial recommended medical management, leading to some Primary Care Trusts refusing to commission any tonsillectomies at all. With the HSE cutting Hospital Spending by €200 million euro in 2014, data supporting the benefit of adenotonsillectomy in the Irish population are sorely lacking. We aimed to evaluate the symptomatic benefit reported by parents of children undergoing adenotonsillectomy/tonsillectomy in the Irish population. We utilised the T14 Paediatric Throat disorders Outcome Test, a disease-specific, validated questionnaire which assesses patient reported outcome measures (PROMs). We administered pre and post-operative questionnaires to parents of children ages 3-16years undergoing tonsillectomy. Symptomatic children on our tonsillectomy waiting list were also simultaneously recruited. Eighty-six children were recruited. A total of 55 parents of children undergoing tonsillectomy filled questionnaires. These were well matched in age and gender with 31 children on the waiting list. An independent samples t test was conducted to compare the improvement scores for tonsillectomy and control groups. There was a significant difference in scores for the tonsillectomy group, with pre-operative scores of (M=39.8, SD=9.7) and at post-operative follow-up of (M=1.6, SD=7.3) t (61)=-18, p≤0.0001 (two tailed). This correlated with a significant difference in the mean between the two periods (mean difference=38.3, 95% CI: 42.3-34.1). This study provides clear evidence that tonsillectomy provides significant improvement in PROMs vs. watchful waiting. We consider tonsillectomy to be a procedure of considerable clinical benefit and a worthwhile allocation of HSE expenditure.