How Does the Morbidity of Sore Throat in Recurrent Tonsillitis Correlate With the Tonsillitis Outcome Inventory‐14 ( TOI ‐14)?

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.