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Tonsillitis RecurrentNCT04657549

Tonsil Surgery in Recurrent or Chronic Tonsillitis

A study testing Tonsillectomy and Tonsillotomy in people with Tonsillitis Recurrent and Tonsillitis Chronic, run by Oulu University Hospital at 7 sites in Finland.

Completed

Finished. The study has ended and is not enrolling. Results may be posted on the official record.

Official record
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Trial summary

Tonsil surgery is common in adults with recurrent or chronic tonsillitis. The surgical techniques include either partial or total surgical removal of the palatal tonsils (tonsillotomy, TT, and tonsillectomy, TE, respectively). Read more about this study

Who is it for?
Ages 18 years and older
Conditions the study is for
Tonsillitis Recurrent, Tonsillitis Chronic
What is being tested?
Tonsillectomy and Tonsillotomy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
147 participants
Where
7 sitesFinland
Study dates
8 Dec 2020to 9 Jun 2023
Phase
Interventional
Are there results?
None posted in the registry

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 years and older
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

The inclusion criteria are:

  • Recurrent tonsillitis episodes:
  • At least 4 episodes in the previous 12 months or at least 3 episodes in 6 months
  • Episodes are disabling, prevent normal functioning and are severe enough for the patient to seek medical attention
  • Episodes are thought to involve the palatine tonsils based on signs found during the episodes (e.g. edema, erythema, exudative tonsillitis, anterior cervical lymphadenitis)
  • No throat cultures or antigen/molecular tests to show infection with group A streptococcus are needed
  • Chronic tonsillitis:
  • Recurrent or chronic throat pain for at least 6 months
  • At least one symptom or sign that indicate that symptoms originate from the palatal tonsils (disturbing tonsil stones, halitosis, anterior cervical lymphadenitis, tonsillar exudates, abnormal tonsillar crypts)
  • Symptomatic treatment has not been effective

The exclusion criteria are:

  • Age less than 18 years
  • Pregnancy
  • History of peritonsillar abscess
  • Previous illness that make prompt same-day surgery unfeasible
  • No electronic identity verification tools

Trial locations and contacts

7 sites in 1 country.

7 sites in 1 country

Finland7 sites
  • Länsi-Pohja Central Hospital

    Kemi, FIN-94100

  • Keski-Pohjanmaa Central Hospital

    Kokkola, FIN-67200

  • Oulu University Hospital

    Oulu, FIN-90029

  • Lapland Central Hospital

    Rovaniemi, Lapland, FIN-96400

  • Seinäjoki Central Hospital

    Seinäjoki, FIN-60220

  • Turun yliopistollinen keskussairaala

    Turku

  • Vaasan keskussairaala

    Vaasa

Other trials in Finland

About this study

Official title: Partial or Total Surgical Removal of Palatal Tonsils to Change Quality of Life for Adults With Chronic or Recurrent Tonsillitis: Randomized Controlled Trial.

Tonsil surgery is common in adults with recurrent or chronic tonsillitis. The surgical techniques include either partial or total surgical removal of the palatal tonsils (tonsillotomy, TT, and tonsillectomy, TE, respectively). The aim of this study is to find out, whether tonsil surgery improves the quality of life in these patients and whether the lighter TT is as effective as TE. Our main outcome is the disease-specific Tonsillectomy Outcome Inventory-14 (TOI-14) quality of life questionnaire score at 6 months follow-up.

Read the detailed description

Rationale

Surgical removal of palatal tonsils is among the most common ear, nose and throat operations in adults in Finland. The vast majority of these operations are done for recurrent and chronic tonsillitis. Internationally accepted guidelines for the treatment of these diseases are lacking and the indications for tonsil surgery are practice-based rather than evidence-based. The choice of the surgical technique further confuses the picture. The traditional surgical technique has been the total removal of tonsils (tonsillectomy, TE). The relatively recent introduction of partial resection of tonsils, namely tonsillotomy (TT), is suggested to have the benefits of less postoperative pain and smaller risk of post-operative hemorrhage as compared to TE. The relative efficacy of these two techniques to alleviate infective tonsillar diseases is still unclear.

Objectives

The main aim of this study is to obtain reliable evidence on, whether tonsil surgery improves the quality of life in adult patients suffering from recurrent or chronic tonsillitis, and whether the lighter TT would be as effective as TE. We will also compare the scores of a generic quality of life questionnaire as well as several other subjective and objective beneficial and harmful outcomes between the groups.

Methods

In this pragmatic multi-center randomized controlled trial, adult patients suffering from recurrent or chronic tonsillitis will be randomly allocated to three groups: tonsillotomy group (TT), tonsillectomy group (TE) and control group with watchful waiting (WW) in ratio 2:2:1. The patients in the surgical groups are blinded to the operation type (TT or TE). Our hypothesis is that both surgical treatments are more effective than watchful waiting in enhancing quality of life without significant risks (superiority assumption) and that TT is non-inferior to TE when the surgical groups are compared (non-inferiority assumption). Our principal outcome is disease-specific quality of life questionnaire score (Tonsillectomy Outcome Inventory (TOI)-14) at 6 months follow-up. We have validated this questionnaire in Finnish and explored the interpretation of the scores. Secondary outcomes have been listed in the Outcomes section.

Separate random allocation lists for the main research center (Oulu University Hospital) and for the four other centers collectively as well as for recurrent and for chronic tonsillitis will be used. Random permuted blocks is used with block size varying between 5 and 10. Based on our earlier study, the principal outcome, TOI-14 score, will most probably be left-truncated at zero and right-skewed. Therefore, both tobit-analysis and covariate analysis is used with log (1+y) transformation. The primary analysis has two phases. Firstly, the TOI-14 score in the combined surgical group (TT+TE) is compared to that in the WW group. Secondly, the score in the TT group is compared to that in the TE group. Effects will be estimated by adjusted mean differences in the log-transformed scores with 95% confidence intervals. Based on our earlier observational studies on the subject, the following covariates are included in the multivariable adjusted model: gender and baseline TOI-14 score together with stratification factors: enrolling center (Oulu vs. others) and main complaint (recurrent vs. chronic tonsillitis). In case there is missing data on the primary outcome, a multiple imputation method will be used. The analyses will be performed on an intention to treat basis. Per protocol analysis will be performed as sensitivity analysis and results from comparisons on secondary outcomes and subgroup analysis (main complaint) are used to generate hypothesis for future trials.

Being tested
Tonsillectomy, Tonsillotomy
Keywords
tonsillitis, tonsillectomy, tonsillotomy, tonsil surgery
Medical subject headings
Tonsillitis

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • TonsillectomyProcedure or surgery

    Also called Extracapsular tonsillectomy, ECTE

    Tonsillectomy is done by monopolar electrocautery, bipolar scissors or cold instruments. First the mucosa of the anterior palatinal arch is incised and tonsillar capsule identified, then tonsillar tissue is removed along the capsule. Any bleeding is coagulated either with monopolar or bipolar electrocautery.

  • TonsillotomyProcedure or surgery

    Also called Intracapsular tonsillectomy, ICTE. Subtotal/intracapsular/partial tonsillectomy, SIPT.

    Tonsillotomy is done using monopolar electrosurgery, bipolar scissors or coblator device. Most of the tonsillar tissue is removed, exceeding the removal behind the line between anterior and posterior palatinal arch so that only thin layer of tonsil tissue is left over the tonsillar capsule.

Study groups in NCT04657549
Study groupRoleWhat they receive
TonsillectomyActive comparatorPatients will undergo tonsillectomy under general anesthesia within three weeks after enrollment.
Receives: Procedure: Tonsillectomy
TonsillotomyActive comparatorPatients will undergo tonsillotomy under general anesthesia within three weeks after enrollment.
Receives: Procedure: Tonsillotomy
Watchful waitingNo interventionPatients will be closely monitored for the 5-6 months monitoring period.

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Tonsillectomy Outcome Inventory -14 (TOI-14) follow-up score

    TOI-14 is a disease-specific quality of life questionnaire for throat related symptoms in adults. TOI-14 summary scores vary between 0 and 100 with higher values indicating poorer quality of life. Analysis is described in the Detailed Description section.

    Measured: At the end of five to six months follow-up

Secondary outcomes (20)
  1. 36-Item short Form Survey (SF-36, RAND-36) follow-up score

    Difference in RAND-36 domains scores between groups. RAND-36 instrument produces eight individual values between 0 and 100 (one for each domain), with higher scores indicating better quality of life

    Measured: At the end of five to six months follow-up

  2. Proportion benefiting

    Difference in proportions of patients benefiting clinically significantly from the intervention between the groups (minimum important change in TOI-14 score)

    Measured: At the end of five to six months follow-up

  3. Days with throat pain

    Difference in the number of days patients have throat pain (severity scaled 0-10) between the groups

    Measured: At the end of five to six months follow-up

  4. Days with halitosis

    Difference in the number of days patients have bad breath (severity scaled 0-10) between the groups

    Measured: At the end of five to six months follow-up

  5. Days with bleeding

    Difference in the number of days patients have bleeding from the throat (severity scaled 0-10) between the groups

    Measured: At the end of five to six months follow-up

  6. Days with tonsil stones

    Difference in the number of days patients have bothering tonsil stones (severity scaled 0-10) between the groups

    Measured: At the end of five to six months follow-up

  7. Days with absence from work

    Difference in the number of days patients are absent from work or school due to throat symptoms between the groups

    Measured: At the end of five to six months follow-up

  8. Days with dexketoprofen

    Difference in the number of days patients take deksketoprofen 25 mg pain medication due to throat pain between the groups

    Measured: At the end of five to six months follow-up

  9. Days with acetaminophen

    Difference in the number of days patients take acetaminophen 1 g pain medication due to throat pain between the groups

    Measured: At the end of five to six months follow-up

  10. Days with oxycodone/naloxone

    Difference in the number of days patients take oxycodone/naloxone 5mg/2.5mg pain medication due to throat pain between the groups

    Measured: At the end of five to six months follow-up

  11. Medical visits

    Difference in the number of medical visit for throat symptoms between the groups

    Measured: At the end of five to six months follow-up

  12. Antibiotic courses

    Difference in the number of antibiotic courses for throat symptoms between the groups

    Measured: At the end of five to six months follow-up

  13. Adverse effect-postoperative bleeding

    Frequency of postoperative bleeding in the surgical groups

    Measured: At the end of five to six months follow-up

  14. Adverse effect - postoperative pain

    Frequency of postoperative pain in the surgical groups

    Measured: At the end of five to six months follow-up

  15. Adverse effect - postoperative infection

    Frequency of postoperative infections in the surgical groups

    Measured: At the end of five to six months follow-up

  16. Adverse effect - dental injury

    Frequency of dental injury in the surgical groups

    Measured: At the end of five to six months follow-up

  17. Adverse effect -anesthetic complication

    Frequency of anesthetic complication in the surgical groups

    Measured: At the end of five to six months follow-up

  18. Adverse effect - tightness/globus

    Difference in proportions having feeling of tightness/globus in throat between the groups

    Measured: At the end of five to six months follow-up

  19. Adverse effect - voice problems

    Difference in proportions having voice problems between the groups

    Measured: At the end of five to six months follow-up

  20. Adverse effect - jaw problems

    Difference in proportions having mandibular joint problems between the groups

    Measured: At the end of five to six months follow-up

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted8 Dec 2020
  2. Study start8 Dec 2020
  3. Primary completion9 Jun 2023
  4. Study completion9 Jun 2023

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Randomised
Intervention model
Parallel groups
Masking
Single blind
Who is masked
Participant
Enrolment
147 participants (actual)
IDs, dates and publications
ClinicalTrials.gov ID
NCT04657549
Sponsor's protocol ID
Diary number 113/2020
Status last verified
Jun 2023
First submitted
16 Nov 2020
Last updated
12 Jun 2023
Results posted
No
Data monitoring committee
No
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: Study protocol that includes the Informed Consent Form will be sent to a journal for publication, Statistical analysis Plan will be published later in ClinicalTrials.gov web site. The data generated or analyzed during this study will be available from the corresponding investigator on reasonable request.

Publications

  • Laajala A, Autio TJ, Ohtonen P, Alho OP, Koskenkorva TJ. Interpretation of Tonsillectomy Outcome Inventory-14 scores: a prospective matched cohort study. Eur Arch Otorhinolaryngol. 2020 May;277(5):1499-1505. doi: 10.1007/s00405-020-05832-z. Epub 2020 Feb 14.

    PubMed 32060601
  • Koskenkorva T, Koivunen P, Laara E, Alho OP. Predictive factors for quality of life after tonsillectomy among adults with recurrent pharyngitis: a prospective cohort study. Clin Otolaryngol. 2014 Aug;39(4):216-23. doi: 10.1111/coa.12263.

    PubMed 24863677
  • Laajala A, Tokola P, Autio TJ, Koskenkorva T, Tastula M, Ohtonen P, Laara E, Alho OP. Total or partial tonsillar resection (tonsillectomy or tonsillotomy) to change the quality of life for adults with recurrent or chronic tonsillitis: study protocol for a randomised controlled trial. Trials. 2021 Sep 15;22(1):617. doi: 10.1186/s13063-021-05539-4.

    PubMed 34526073

Questions about this trial

What is this clinical trial studying?

A study testing Tonsillectomy and Tonsillotomy in people with Tonsillitis Recurrent and Tonsillitis Chronic, run by Oulu University Hospital at 7 sites in Finland.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: finished, as of the sponsor's last update on 12 Jun 2023. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 7 sites in Finland. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

The study is completed, but results are not available in the source record. That does not mean the treatment did or did not work.

How can a doctor refer a patient or contact the research team?

The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Tonsillectomy Outcome Inventory -14 (TOI-14) follow-up score (time frame: At the end of five to six months follow-up). It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT04657549, which also lists 3 linked publications.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 12 Jun 2023.

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