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Lookup NU author(s): Dr Pavithran Maniam, Tony FouweatherORCiD, Emerita Professor Dawn Teare, Emerita Professor Janet WilsonORCiD, James O'HaraORCiD
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© 2026 John Wiley & Sons Ltd. Introduction: The National Trial of Tonsillectomy in Adults (NATTINA) demonstrated that tonsillectomy is clinically and cost-effective; however, the generalizability of the results to a real-world population remains uncertain. The number of episodes of tonsillitis is used to assess candidacy for tonsillectomy. An alternative approach could be to utilise a patient-reported outcome measure such as the Tonsillectomy Outcome Inventory-14 (TOI-14). Aim: To compare the TOI-14 scores in a real-world clinical cohort with the NATTINA cohort. To assess the relationship between the TOI-14 and the number of sore throat days. To assess the role of socioeconomic status in recurrent tonsillitis. Methods: Baseline TOI-14 scores, the relationship between the number of sore throat days and TOI-14 scores, and socioeconomic deprivation were compared between a real-world clinical cohort and the NATTINA population. Results: Individuals declining entry into NATTINA (n = 609) had the highest TOI-14 score (48.3 (SD 9.9)), followed by the clinical cohort (n = 422) (43.9 (SD 13.3)) and then the randomised NATTINA population (n = 452) (43.1 (SD 12.0), p < 0.001). The correlation between the number of sore throat days and baseline TOI-14 score in all participants was very weak, 0.114, p = 0.001. Approximately 50% of participants with recurrent tonsilitis reside in areas ranked from deciles 1 to 3 on the Scottish/English Index of Multiple Deprivation. Conclusion: The findings from NATTINA can be applied to general clinical practice. The use of a patient-reported outcome measurement instead of sore throat episodes as a criterion for tonsillectomy candidacy requires further research and should consider the impact of socioeconomic status on tonsillitis.
Author(s): Maniam P, Douglas CM, Fouweather T, Teare MD, Wilson J, O'Hara J
Publication type: Article
Publication status: Published
Journal: Clinical Otolaryngology
Year: 2026
Pages: Epub ahead of print
Online publication date: 11/05/2026
Acceptance date: 04/05/2026
ISSN (print): 1749-4478
ISSN (electronic): 1749-4486
Publisher: John Wiley and Sons Inc.
URL: https://doi.org/10.1111/coa.70116
DOI: 10.1111/coa.70116
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