Recurrent Acute Tonsillitis: Re-evaluating Surgical Indications Through Long-Term Outcome Assessment

Objectives: To investigate whether current tonsillectomy (TE) guidelines for adults with recurrent acute tonsillitis (RT) are too restrictive, potentially excluding patients who would benefit from surgery, and to explore predictive factors of improved postoperative Throat-Related Quality of Life (TR-QoL). Methods: In this prospective cohort study, patients undergoing TE were stratified into 3 groups based on increasingly stringent criteria: G1 (not meeting the Danish National Guidelines (DNG) or the Scottish Intercollegiate Guidelines Network SIGN/Paradise criteria), G2 (meeting only DNG), and G3 (meeting both DNG and SIGN/Paradise criteria). The effects of TE were assessed using the Tonsillectomy Outcome Inventory 14 (TOI-14) and the Glasgow Benefit Inventory (GBI). TOI-14 scores, GBI scores, patient satisfaction and postoperative sore throat episodes were evaluated after 12, 24 and 36 months. Predictive factors of improved TR-QOL were identified using multiple linear regression. Results: At baseline, 65 patients (G1: n = 21, G2: n = 33, G3: n = 11) were analyzed. Response rates ranged from 65% to 86% at follow-ups. All groups demonstrated significant, sustained improvements in TOI-14 and GBI scores. TOI-14 total scores improved from 45.0 at baseline to 8.1-10.2 at follow-ups, GBI total scores ranged from 34.9-40.1, satisfaction rates were high (96%-98%), and sore throat episodes were infrequent postoperatively. Group differences were minimal. The preoperative TOI-14 score was the strongest predictor of improved TR-QOL (adjusted R 2 = 0.723). Conclusions: TE provided sustained benefits and significantly improved TR-QoL across a broad range of RT patients, including those who did not meet current guideline criteria, suggesting that guidelines may be too restrictive. The preoperative TOI-14 score was the strongest predictor of TR-QoL improvement. Integrating such a patient-centered tool to select patients for TE may enhance RT patient management.