Throat-related quality of life in peritonsillar abscess sufferers: application of the adult tonsil outcome inventory

Powell, Jason; Powell, E; Conroy, Katherine; Hopkins, Claire; Moor, James; Wilson, Janet A.

doi:10.1017/s0022215113003071

Cited by 6 publications

(5 citation statements)

References 8 publications

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“…Still, 88% of our surgical patients achieved an improvement of at least 10.0 points, which we found to be the MIC value indicating that, despite lower TOI-14 levels at entry, the vast majority of our patients benefitted from tonsillectomy. We found that the mean TOI-14 score in the normal population (5.0, 3.6-6.4) coincides with the findings of both Skevas et al [1] and Powell et al [3] We utilized a matched cohort design, which guaranteed similar methods and timing of data collection and thus reduced the risk of bias when the surgical and control subjects were compared. The TOI-14 instrument was translated into Finnish and psychometrically validated according to the recommendations of the two distinguished societies (ISO-QOL and COSMIN).…”

Section: Discussionsupporting

confidence: 54%

“…Despite the fact that chronic throat-related diseases are common, disease-specific quality-of-life (QoL) instruments for these illnesses are scarce. For adults with chronic tonsillitis, we have merely the Tonsillitis Outcome Inventory-14 (TOI-14), which was developed and validated in German by Skevas et al [1] In addition to the validation studies reported by Skevas et al, Roplekar et al reported that preoperative TOI-14 scores were high among tonsillectomy candidates and Powell et al showed similarly raised scores among peritonsillar abscess sufferers [2,3]. Still, we need more information particularly on interpretation of the TOI-14 scores.…”

Section: Introductionmentioning

confidence: 99%

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Interpretation of Tonsillectomy Outcome Inventory-14 scores: a prospective matched cohort study

Laajala

Autio

Ohtonen

et al. 2020

Eur Arch Otorhinolaryngol

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Purpose Knowledge of disease-specific instruments enables the evaluation of health-related quality-of-life (QoL) change associated with chronic and recurrent tonsillitis in adults. The main objective was to explore the interpretation of scores according to the throat-related QoL instrument, Tonsillectomy Outcome Inventory-14 (TOI-14), by determining the typical scores in healthy subjects and patients and define the minimum important change (MIC). Methods We performed a prospective matched cohort study in a secondary care area of Oulu University Hospital. The surgical cohort consisted of 42 patients referred to tonsillectomy due to recurrent or chronic tonsillitis. The control cohort consisted of 42 age-and sex-matched healthy controls obtained from the escorts of patients in the same hospital. We translated and validated the Finnish TOI-14 instrument and collected TOI-14 scores at entry and at 6 months and compared results to the anchor question. Results At entry, the mean TOI-14 scores were significantly higher in the surgical cohort than in the control cohort [mean (95% confidence interval)] 33.0 (27.0-39.1) vs. 5.0 (3.6-6.4), respectively. At 6 months follow-up, the mean TOI-14 scores had improved markedly after tonsillectomy to the level of the control cohort. In the healthy population, the score was in most cases under 15.0 points. In patients, a score of about 20.0 indicated mild symptoms, 30.0 moderate symptoms and 40.0 or higher intense symptoms. The MIC value was 10.0 points. Conclusions These results enable the more accurate interpretation of the scores of the only disease-specific QoL instrument for adult throat-related diseases.

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Section: Discussionsupporting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Interpretation of Tonsillectomy Outcome Inventory-14 scores: a prospective matched cohort study

Laajala

Autio

Ohtonen

et al. 2020

Eur Arch Otorhinolaryngol

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“…Changes in HRQoL outcomes after tonsillectomy may considerably vary depending on the study cohort and the questionnaire used. In surveys using the GBI or the Adult Tonsil Outcome Inventory, gender had no effect on HRQoL outcomes [ 28 , 29 ]. On the other hand, Plath et al found that female gender resulted in higher socioeconomic item subscores when using the Tonsillectomy Outcome Inventory 14 [ 30 ].…”

Section: Discussionmentioning

confidence: 99%

Quality of Life Assessment for Tonsillar Infections and Their Treatment

Hackenberg

Büttner²,

Schöndorf

et al. 2022

Medicina

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Background and Objectives: Tonsillar infections are a common reason to see a physician and lead to a reduction in the patients’ health-related quality of life (HRQoL). HRQoL may be an important criterion in decision science and should be taken into account when deciding when to perform tonsillectomy, especially for chronic tonsillitis. The aim of this study was to determine the health utility for different states of tonsillar infections. Materials and Methods: Hospitalized patients with acute tonsillitis or a peritonsillar abscess were asked about their HRQoL with the 15D questionnaire. Patients who had undergone tonsillectomy were reassessed six months postoperatively. Results: In total, 65 patients participated in the study. The health states of acute tonsillitis and peritonsillar abscess had both a utility of 0.72. Six months after tonsillectomy, the mean health utility was 0.95. Conclusions: Our study confirms a substantial reduction in utility due to tonsillar infections. Tonsillectomy significantly improves the utility and therefore HRQoL six months after surgery.

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“…We have shown the TOI-14 to have discriminant validity in a comparison of recurrent tonsillitis patients with healthy volunteers 68 and in peritonsillar abscess. 69,70 Importantly, tonsillitis is a disease primarily of younger adults, usually with education or workplace activity profiles. Small descriptive series report substantial benefits in reduction in days lost from work or education following tonsillectomy.…”

Section: Assessment Of Baseline Sore Throat Severitymentioning

confidence: 99%

Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation

Wilson,

Fouweather,

Stocken

et al. 2023

Health Technol Assess

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Background The place of tonsillectomy in the management of sore throat in adults remains uncertain. Objectives To establish the clinical effectiveness and cost-effectiveness of tonsillectomy, compared with conservative management, for tonsillitis in adults, and to evaluate the impact of alternative sore throat patient pathways. Design This was a multicentre, randomised controlled trial comparing tonsillectomy with conservative management. The trial included a qualitative process evaluation and an economic evaluation. Setting The study took place at 27 NHS secondary care hospitals in Great Britain. Participants A total of 453 eligible participants with recurrent sore throats were recruited to the main trial. Interventions Patients were randomised on a 1 : 1 basis between tonsil dissection and conservative management (i.e. deferred surgery) using a variable block-stratified design, stratified by (1) centre and (2) severity. Main outcome measures The primary outcome measure was the total number of sore throat days over 24 months following randomisation. The secondary outcome measures were the number of sore throat episodes and five characteristics from Sore Throat Alert Return, describing severity of the sore throat, use of medications, time away from usual activities and the Short Form questionnaire-12 items. Additional secondary outcomes were the Tonsil Outcome Inventory-14 total and subscales and Short Form questionnaire-12 items 6 monthly. Evaluation of the impact of alternative sore throat patient pathways by observation and statistical modelling of outcomes against baseline severity, as assessed by Tonsil Outcome Inventory-14 score at recruitment. The incremental cost per sore throat day avoided, the incremental cost per quality-adjusted life-year gained based on responses to the Short Form questionnaire-12 items and the incremental net benefit based on costs and responses to a contingent valuation exercise. A qualitative process evaluation examined acceptability of trial processes and ramdomised arms. Results There was a median of 27 (interquartile range 12–52) sore throats over the 24-month follow-up. A smaller number of sore throats was reported in the tonsillectomy arm [median 23 (interquartile range 11–46)] than in the conservative management arm [median 30 (interquartile range 14–65)]. On an intention-to-treat basis, there were fewer sore throats in the tonsillectomy arm (incident rate ratio 0.53, 95% confidence interval 0.43 to 0.65). Sensitivity analyses confirmed this, as did the secondary outcomes. There were 52 episodes of post-operative haemorrhage reported in 231 participants undergoing tonsillectomy (22.5%). There were 47 re-admissions following tonsillectomy (20.3%), 35 relating to haemorrhage. On average, tonsillectomy was more costly and more effective in terms of both sore throat days avoided and quality-adjusted life-years gained. Tonsillectomy had a 100% probability of being considered cost-effective if the threshold for an additional quality-adjusted life year was £20,000. Tonsillectomy had a 69% probability of having a higher net benefit than conservative management. Trial processes were deemed to be acceptable. Patients who received surgery were unanimous in reporting to be happy to have received it. Limitations The decliners who provided data tended to have higher Tonsillectomy Outcome Inventory-14 scores than those willing to be randomised implying that patients with a higher burden of tonsillitis symptoms may have declined entry into the trial. Conclusions The tonsillectomy arm had fewer sore throat days over 24 months than the conservative management arm, and had a high probability of being considered cost-effective over the ranges considered. Further work should focus on when tonsillectomy should be offered. National Trial of Tonsillectomy IN Adults has assessed the effectiveness of tonsillectomy when offered for the current UK threshold of disease burden. Further research is required to define the minimum disease burden at which tonsillectomy becomes clinically effective and cost-effective. Trial registration This trial is registered as ISRCTN55284102. Funding This award was funded by the National Institute for Health and Care Research (NIHR) Health Technology Assessment programme (NIHR award ref: 12/146/06) and is published in full in Health Technology Assessment; Vol. 27, No. 31. See the NIHR Funding and Awards website for further award information.

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Throat-related quality of life in peritonsillar abscess sufferers: application of the adult tonsil outcome inventory

Cited by 6 publications

References 8 publications

Interpretation of Tonsillectomy Outcome Inventory-14 scores: a prospective matched cohort study

Interpretation of Tonsillectomy Outcome Inventory-14 scores: a prospective matched cohort study

Quality of Life Assessment for Tonsillar Infections and Their Treatment

Tonsillectomy compared with conservative management in patients over 16 years with recurrent sore throat: the NATTINA RCT and economic evaluation

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