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dc.contributor.authorWilson, Janet A
dc.contributor.authorO'Hara, James
dc.contributor.authorFouweather, Tony
dc.contributor.authorHomer, Tara
dc.contributor.authorStocken, Deborah D
dc.contributor.authorVale, Luke
dc.contributor.authorHaighton, Catherine
dc.contributor.authorRousseau, Nikki
dc.contributor.authorWilson, Rebecca
dc.contributor.authorMcSweeney, Lorraine
dc.contributor.authorWilkes, Scott
dc.contributor.authorMorrison, Jill
dc.contributor.authorMacKenzie, Kenneth
dc.contributor.authorAh-See, Kim
dc.contributor.authorCarrie, Sean
dc.contributor.authorHopkins, Claire
dc.contributor.authorHowe, Nicola
dc.contributor.authorHussain, Musheer
dc.contributor.authorMehanna, Hisham
dc.contributor.authorRaine, Christopher
dc.contributor.authorSullivan, Frank
dc.contributor.authorvon Wilamowitz-Moellendorff, Alexander
dc.contributor.authorTeare, M Dawn
dc.identifier.citationWilson , J A , O'Hara , J , Fouweather , T , Homer , T , Stocken , D D , Vale , L , Haighton , C , Rousseau , N , Wilson , R , McSweeney , L , Wilkes , S , Morrison , J , MacKenzie , K , Ah-See , K , Carrie , S , Hopkins , C , Howe , N , Hussain , M , Mehanna , H , Raine , C , Sullivan , F , von Wilamowitz-Moellendorff , A & Teare , M D 2023 , ' Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA) : a multicentre, open-label, randomised controlled trial ' , The Lancet , vol. 401 , no. 10393 , pp. 2051-2059 .
dc.identifier.otherRIS: urn:6781E6904C296002005FAA24B8FF246B
dc.identifier.otherORCID: /0000-0002-6623-4964/work/136288935
dc.descriptionThis study was funded by the NIHR Health Technology Assessment programme (12/146/06).en
dc.description.abstractBackground Tonsillectomy is regularly performed in adults with acute tonsillitis, but with scarce evidence. A reduction in tonsillectomies has coincided with an increase in acute adult hospitalisation for tonsillitis complications. We aimed to assess the clinical effectiveness and cost-effectiveness of conservative management versus tonsillectomy in patients with recurrent acute tonsillitis. Methods This pragmatic multicentre, open-label, randomised controlled trial was conducted in 27 hospitals in the UK. Participants were adults aged 16 years or older who were newly referred to secondary care otolaryngology clinics with recurrent acute tonsillitis. Patients were randomly assigned (1:1) to receive tonsillectomy or conservative management using random permuted blocks of variable length. Stratification by recruiting centre and baseline symptom severity was assessed using the Tonsil Outcome Inventory-14 score (categories defined as mild 0–35, moderate 36–48, or severe 49–70). Participants in the tonsillectomy group received elective surgery to dissect the palatine tonsils within 8 weeks after random assignment and those in the conservative management group received standard non-surgical care during 24 months. The primary outcome was the number of sore throat days collected during 24 months after random assignment, reported once per week with a text message. The primary analysis was done in the intention-to-treat (ITT) population. This study is registered with the ISRCTN registry, 55284102. Findings Between May 11, 2015, and April 30, 2018, 4165 participants with recurrent acute tonsillitis were assessed for eligibility and 3712 were excluded. 453 eligible participants were randomly assigned (233 in the immediate tonsillectomy group vs 220 in the conservative management group). 429 (95%) patients were included in the primary ITT analysis (224 vs 205). The median age of participants was 23 years (IQR 19–30), with 355 (78%) females and 97 (21%) males. Most participants were White (407 [90%]). Participants in the immediate tonsillectomy group had fewer days of sore throat during 24 months than those in the conservative management group (median 23 days [IQR 11–46] vs 30 days [14–65]). After adjustment for site and baseline severity, the incident rate ratio of total sore throat days in the immediate tonsillectomy group (n=224) compared with the conservative management group (n=205) was 0·53 (95% CI 0·43 to 0·65;
dc.relation.ispartofThe Lanceten
dc.titleConservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA) : a multicentre, open-label, randomised controlled trialen
dc.typeJournal articleen
dc.contributor.institutionUniversity of St Andrews. School of Medicineen
dc.contributor.institutionUniversity of St Andrews. Sir James Mackenzie Institute for Early Diagnosisen
dc.contributor.institutionUniversity of St Andrews. Population and Behavioural Science Divisionen
dc.description.statusPeer revieweden

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