Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2021 Jul 22;22(1):479.
doi: 10.1186/s13063-021-05434-y.

Tonsillectomy versus tonsillotomy for recurrent acute tonsillitis in children and adults (TOTO): study protocol for a randomized non-inferiority trial

Orlando Guntinas-Lichius  1   2 , Katharina Geißler  3 , Thomas Asendorf  4 , Ralf Tostmann  5   6 , Jan Löhler  5   7
Affiliations

Tonsillectomy versus tonsillotomy for recurrent acute tonsillitis in children and adults (TOTO): study protocol for a randomized non-inferiority trial

Orlando Guntinas-Lichius et al. Trials. .

Abstract

Background: Tonsillectomy is one of the most frequently performed surgeries in children and young adults worldwide. For decades, tonsillectomy was the surgical treatment of choice for recurrent acute tonsillitis. Tonsillotomy was used in some countries as an alternative to tonsillectomy only for the treatment of obstructive sleep apnea in young children. In recent years, an increase of tonsillotomy also to treat recurrent acute tonsillitis can be observed. Therefore, the German Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G-BA) to investigate whether tonsillotomy offers advantages compared to tonsillectomy. The meta-analysis of the IQWiG including studies until 2016 revealed that the long-term benefits and harms of tonsillotomy compared to tonsillectomy are unclear. Consequently, the G-BA performed a European call for a clinical trial. A consortium of the German Professional Association of ENT-surgeons (BVHNO), the German Society of Oto-Rhino-Laryngology, Head and Neck Surgery (DGHNO-KHC), and the Jena University Hospital were finally selected to perform the TOTO study.

Methods: TOTO is a multicenter, 1:1 two-arm, randomized non-blinded non-inferiority trial. Four hundred fifty-four patients ≥ 3 years of age will be randomly allocated to undergo either tonsillotomy or tonsillectomy as surgical treatment of recurrent acute tonsillitis. All participants will be followed up for a total of 24 months. The primary outcome is the number of sore throat days experienced over the 24-month follow-up.

Discussion: TOTO is designed to evaluate the effectiveness and efficiency of tonsillectomy versus tonsillectomy for the management of patients with recurrent acute tonsillitis. Tonsil disease and surgery have a major impact on preschool and school children as well as on economically active young adults, with individual and societal costs through loss of school visits, earnings, and productivity. If tonsillotomy is at least as effective as tonsillectomy but with reduced morbidity, this would reduce costs to the healthcare system and society.

Trial registration: German Clinical Trials Register DRKS00020823 . Registered on 04 September 2020.

Keywords: Randomized controlled trial; Sore throat; Surgery; Tonsillectomy; Tonsillitis; Tonsillotomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow chart of the trial process from allocation to follow-up. ITT, intention to treat; PP, per protocol
See this image and copyright information in PMC

References

    1. Windfuhr JP, Alizoti P, Hendricks C. Regional variability of hemorrhage following tonsil surgery in 1,520,234 cases. Eur Arch Otorhinolaryngol. 2020. 10.1007/s00405-020-06080-x Online ahead of print. - PubMed
    1. Nolting HD, Zich K, Deceknbach B. Faktencheck Gesundheit. Entfernung der Gaumenmandeln bei Kindern und Jugendlichen. Gütersloh: Bertelsmann Stiftung; 2013.
    1. Sarny S, Habermann W, Ossimitz G, Stammberger H. What lessons can be learned from the Austrian events? ORL J Otorhinolaryngol Relat Spec. 2013;75(3):175–181. doi: 10.1159/000342319. - DOI - PubMed
    1. AWMF Leitlinie . Therapie entzündlicher Erkrankungen der Gaumenmandeln - Tonsillitis. 2016. - PubMed
    1. Rubie I, Haighton C, O'Hara J, Rousseau N, Steen N, Stocken DD, et al. The NAtional randomised controlled Trial of Tonsillectomy IN Adults (NATTINA): a clinical and cost-effectiveness study: study protocol for a randomised control trial. Trials. 2015;16(1):263. doi: 10.1186/s13063-015-0768-0. - DOI - PMC - PubMed

Publication types