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Tonsillectomy under threat: auditing the indications for performing tonsillectomy

Published online by Cambridge University Press:  30 April 2012

S Silva ,
M Ouda ,
S Mathanakumara ,
E Ridyard  and
P Morar
S Silva*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Blackburn Hospital, UK
M Ouda*
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Blackburn Hospital, UK
S Mathanakumara
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Blackburn Hospital, UK
E Ridyard
Affiliation:
Medical School, Manchester University, UK
P Morar
Affiliation:
Department of Otolaryngology – Head and Neck Surgery, Royal Blackburn Hospital, UK
*
Address for correspondence: Mr Mohamed Ouda, Royal Blackburn Hospital, Haslingden Road, Blackburn BB2 3HH, UK E-mail: [email protected]
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Abstract

Background:

The 2009 McKinsey National Health Service report considered that tonsillectomy was relatively ineffective and often unjustified, and that its frequently could be greatly reduced. ENTUK argued against this, for severe recurrent tonsillitis. This study audited clinical indications for tonsillectomy.

Criteria and standards:

Current guidelines state that patients with recurrent tonsillitis must have disabling sore throat episodes five or more times per year, and symptoms for at least a year, to justify tonsillectomy.

Methods:

Seventeen recurrent tonsillitis patients receiving tonsillectomy were audited prospectively. Indications were poorly documented in the referral letter, so surgeons agreed to list specified tonsillectomy criteria when scheduling patients for tonsillectomy. A pro forma reminder was distributed to all clinics, and the next 100 scheduled tonsillectomy patients were audited.

Results:

In the first audit, all 17 tonsillectomies were justified but only two (11.8 per cent) had documented indications. In the second audit, 85 per cent of patients had all essential criteria, which were documented in the listing letter.

Conclusion:

Tonsillectomy risks being removed from the UK essential otolaryngological surgical register, risking increased patient morbidity and work absence, despite valid supporting evidence of efficacy for recurrent tonsillitis. All UK otolaryngology units should strictly adhere to the ENTUK and Scottish Intercollegiate Guidelines Network recommendations for tonsillectomy, and should document essential criteria in the listing letter, to strengthen the advocacy argument for tonsillectomy as essential, valid treatment for recurrent tonsillitis.

Keywords

TonsillectomyPharyngitisTonsillitisGuideline AdherenceCost SavingsSign GuidelinesMcKinsey Report
Type
Main Articles
Information
The Journal of Laryngology & Otology , Volume 126 , Issue 6 , June 2012 , pp. 609 - 611
Copyright
Copyright © JLO (1984) Limited 2012

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Footnotes

Presented, and awarded first prize, at the Clinical Audit and Practice Advisory Group (APAG) Annual Audit and Evidence-based Medicine Meeting, 10 September 2010, Coventry, UK

References

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2ENTUK. SIGN Guideline No. 34 Management of Sore Throat and Indications for Tonsillectomy 1999. London: ENTUK, 1999Google Scholar
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