Tonsillectomy for recurrent tonsillitis: the NATTINA trial
Authors: Nin-Chieh Hsu, Chia-Hao Hsu
Journal: The Lancet (2024)

We read the NATTINA study by Janet A Wilson and colleagues,1Wilson JA O'Hara J Fouweather T et al.Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial.Lancet. 2023; 401: 2051-2059Summary Full Text Full Text PDF PubMed Google Scholar which supports the immediate tonsillectomy approach for adults with recurrent acute tonsillitis. Although we acknowledge that Wilson and colleagues have provided a comprehensive explanation of the study's limitations, several concerns remain. First, the study enrolled patients between May, 2015, and April, 2018, with the primary outcome being the number of sore throat days observed over a 24-month period. However, some participants might have experienced the impact of the COVID-19 pandemic during the early months of 2020. This potential influence of the pandemic on the outcomes could be considered as an additional limitation of the study. Second, a previous study reported a lower rate of COVID-19 RT-PCR positivity among adults with a history of tonsillectomy.2Kara A Elden H Okur E et al.Impact of tonsillectomy on COVID-19 pandemic: an observational study of the incidence and prognosis.Acta Otolaryngol. 2021; 141: 857-859Crossref Scopus (2) Google Scholar However, an Italian study found that a history of tonsillectomy was associated with more intense systemic manifestations of COVID-19, including a higher proportion of cases with temperatures exceeding 39°C, chills, and malaise.3Capriotti V Mattioli F Guida F et al.COVID-19 in the tonsillectomised population.Acta Otorhinolaryngol Ital. 2021; 41: 197-205Crossref Scopus (5) Google Scholar Although a final conclusion has not yet been reached, viral infections are the most common cause of sore throat. Group A streptococcus, the most frequent bacterial cause of sore throat, accounts for approximately 15–30% of cases in children but less than 10% of cases in adults.4Bathala S Eccles R A review on the mechanism of sore throat in tonsillitis.J Laryngol Otol. 2013; 127: 227-232Crossref PubMed Scopus (29) Google Scholar Therefore, to address the argument regarding possible immunological dysfunction of the pharyngeal-associated lymphoid tissue resulting from tonsil removal, the NATTINA study should provide information on the severity of sore throat symptoms among its participants. We declare no competing interests. Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trialCompared with conservative management, immediate tonsillectomy is clinically effective and cost-effective in adults with recurrent acute tonsillitis. Full-Text PDF Open AccessTonsillectomy for recurrent tonsillitis: the NATTINA trial – Authors' replyWe welcome the enthusiasm of fellow researchers to explore other aspects of recurrent tonsil disease in adults and comment on our Article.1 Christopher R Jones and colleagues highlight the putative association between tonsillectomy rates, tonsillitis admission, and invasive group A streptococcus incidence in children.2 It is impossible for us to suggest how improved and timely access to tonsillectomy could affect societal levels of invasive group A streptococcus but the trends in tonsillectomy rates are clear. Full-Text PDF