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Topic Name: New study says Tonsillectomy to treat chronic and recurrent tonsillitis significantly improves quality of life

Category: Biomedical

Research persons: David L. Witsell, MD, MHS, Laura J. Orvidas, MD

Location: American Academy of Otolaryngology-Head and Neck Surgery, United States

Details

Tonsillectomies to treat chronic and recurrent tonsillitis substantially improve a patient’s quality of live in both children and adults, according to two new studies published as a supplement to the January 2008 issue of Otolaryngology-Head and Neck Surgery.
In one study involving 72 adults, patients showed improvement in all six subscales of the Tonsil and Adenoid Health Status Instrument (TAHSI), a scale used to measure the quality of life (QOL) of patients pre- and post-procedure. Among the scale-related findings, 98 percent reported fewer infections in the six months following surgery, with 76.9 percent expressing strong satisfaction with the surgery results. Patients also reported substantially fewer cases of persistent bad breath (halitosis), sore throats, and trips to the doctor because of sore throats.
In the study involving children, 92 patients also showed significant improvements when measured with the same TAHSI scale, including airway and breathing, infection, health care utilization, cost of care, eating and swallowing, and behavior. Additionally, the Child Health Questionnaire-PF28 was used on 55 of the subjects in order to measure QOL with regards to general health, physical functioning, behavior, bodily pain, and parental impact. Among the study’s findings were significant decreases in number of sore throats, antibiotic courses, days missed from daycare/school, doctor visits, and persistent halitosis.
Tonsillectomy remains one of the most common procedures performed on children each year, and while the number of incidences in adults is lower, it is still a routine operation. The current clinical guidelines produced by the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), which were developed using consensus of expert opinions, recommend tonsillectomy for children with three or more documented tonsil infections in the span of a year.
The studies’ authors are David L. Witsell, MD, MHS; Laura J. Orvidas, MD; Michael G. Stewart, MD, MPH; Maureen T. Hannley, MD, PhD; Edward M. Weaver, MD, MPH; Bevan Yueh, MD, MPH; Timothy L.. Smith, MD, MPH; and Nira A. Goldstein, MD. Additionally, investigators in New York, North Carolina, Washington, Oregon, Minnesota, and Virginia assisted with information gathering.
About Tonsillectomy
A tonsillectomy is a surgical procedure in which the tonsils are removed. Sometimes the adenoids are removed at the same time.
Tonsillectomy may be performed when the patient:
Experiences frequent bouts of acute tonsillitis. The number requiring tonsillectomy varies with the severity of the episodes. One case, even severe, is generally not enough for most surgeons to decide tonsillectomy is necessary.
Has chronic tonsillitis, consisting of persistent, moderate-to-severe throat pain.
Has multiple bouts of peritonsillar abscess.
Has sleep apnea (stopping or obstructing breathing at night due to enlarged tonsils or adenoids)
Difficulty eating or swallowing due to enlarged tonsils
About Otolaryngology
Otolaryngology is the branch of medicine that specializes in the diagnosis and treatment of ear, nose, throat, and head & neck disorders. The full name of the specialty is otolaryngology-head and neck surgery. Practitioners are called otolaryngologists-head and neck surgeons, or sometimes otorhinolaryngologists (ORL). A commonly used term for this specialty is ENT (ear, nose and throat). The term comes from the Greek ωτολαρυγγολογία (oto = genitive for ear, laryngo = genitive for larynx/throat, logy = study) and it literally means the study of ear and neck. The full term ωτορινολαρυγγολογία (otorhinolaryngology), also includes rhino, which is the genitive of nose.
Otolaryngologists are medical doctors (MD,MBBS,MBChB,etc.) or osteopathic doctors (DO) who complete at least five years of surgical residency training. Currently, this comprises one year in general surgical training and four years in otolaryngology - head and neck surgery; in the past it varied between two and three years of each. Otolaryngology is considered to be one of the most competitive residency fields to match into.
Following residency training, some otolaryngologists elect to complete advanced subspeciality fellowship training which can range from one to three years in duration.
About Chronic disease
In medicine, a chronic disease is a disease that is long-lasting or recurrent. The term chronic describes the course of the disease, or its rate of onset and development. A chronic course is distinguished from a recurrent course; recurrent diseases relapse repeatedly, with periods of remission in between. As an adjective, chronic can refer to a persistent and lasting medical condition. Chronicity is usually applied to a condition that lasts more than three months.
The definition of a disease or causative condition may depend on the disease being chronic, and the term chronic will often, but not always appear in the description:
Chronic osteoarticular diseases: rheumatoid arthritis, osteoarthritis
Chronic respiratory diseases: chronic obstructive pulmonary disease, asthma
Chronic renal failure
Diabetes mellitus
Chronic Hepatitis
Autoimmune diseases, like lupus erythematosus
Cardiovascular diseases: heart failure, ischemic cardiopathy, cerebrovascular disease
Neoplasic diseases not amenable to be cured
About Quality of life
The well-being or quality of life of a population is an important concern in economics and political science. It is measured by many social and economic factors. A large part is standard of living, the amount of money and access to goods and services that a person has; these numbers are fairly easily measured. Others like freedom, happiness, art, environmental health, and innovation are far harder to measure. This has created an inevitable imbalance as programs and policies are created to fit the easily available economic numbers while ignoring the other measures, that are very difficult to plan for or assess.
Debate on quality of life is millennia-old, with Aristotle giving it much thought in his Nicomachean Ethics and eventually settling on the notion of eudaimonia, a Greek term often translated as happiness, as central. The neologism liveability (or livability), from the adjective liv(e)able, is an abstract noun now often applied to the built environment or a town or city, meaning its contribution to the quality of life of inhabitants.
Understanding quality of life is today particularly important in health care, where monetary measures do not readily apply. Decisions on what research or treatments to invest the most in are closely related to their effect on a patient's quality of life.
The measures often used in the study of health care are 'quality-adjusted life years' (QALYs) and the related 'disability-adjusted life years' (DALYs); both equal 1 for each year of full-health life, and less than 1 for various degrees of illness or disability. Thus the cost-effectiveness of a treatment can be assessed by the cost per QALY or DALY it produces; for example, a cancer treatment which costs $1 million and on average gives the patient 2 extra years of full health costs $500,000 per QALY. Assessing treatments in this way avoids the much greater problems associated with putting a monetary value on life, as required in other areas of economics; saying that a treatment costs $5000 per QALY (i.e. per year of life) does not say or assume anything about the monetary value of a year of life or about the real quality of that life.
About the AAO-HNS
The American Academy of Otolaryngology – Head and Neck Surgery (www.entnet.org), one of the oldest medical associations in the nation, represents more than 12,000 physicians and allied health professionals who specialize in the diagnosis and treatment of disorders of the ears, nose, throat, and related structures of the head and neck. The Academy serves its members by facilitating the advancement of the science and art of medicine related to otolaryngology and by representing the specialty in governmental and socioeconomic issues. The organization’s mission: “Working for the Best Ear, Nose, and Throat Care.”