Increasingly Hard to Swallow – 18 Years of Changing Tonsillectomy Practice in Northern Ireland.

Letters IncreasIngly Hard to swallow-18 years of cHangIng tonsIllectomy practIce In nortHern Ireland. editor, The clinical and economic value of tonsillectomy has been the subject of debate for decades. The McKinsey Report 1 considered tonsillectomy (along with a number of other procedures) to be a 'relatively ineffective, and often unjustified' procedure, stating that reducing tonsillectomies by 90 percent could save the NHS £45 million each year. Subsequently ENT UK 2 showed an association between a decreasing number of tonsillectomies performed within the UK and an increasing number of hospital admissions for tonsil-related complications. The aim of our study was to determine if there was an association between the number of tonsillectomies performed and the number of admissions for tonsillitis and peri-tonsillar abscesses in Northern Ireland. Using a computer-aided system data was collected and analyzed for all tonsillectomies performed within the Southern Trust from 1994 until 2012, and compared to the admission rate for tonsillitis and peri-tonsillar abscesses during the same time period. From 1994 until 2001 the number of tonsillectomies performed decreased from 1,235 to 497 per year, while the number of admissions for tonsillitis and peri-tonsillar abscesses increased from 226 to 452 per year. The decrease in the number of tonsillectomies performed was largely attributed to financial constraints and waiting-list times within the Trust. From 2001 until 2012 the number of tonsillectomies performed increased from 497 to 973 per year, while the number of admissions for tonsillitis and peri-tonsillar abscesses decreased from 452 to 239 per year. Our results show a general trend between the decreasing number of tonsillectomies performed and an increased number of admissions for tonsillitis and peri-tonsillar abscesses, and vice-versa, over the 18 year period assessed (figure 1). Studies in England and Wales have shown similar results with admissions for tonsillitis increasing over the last decade while the number of tonsillectomies has generally declined. 3,4 With ever increasing pressure on governments to curtail spending in healthcare budgets it is important for both doctors in primary and secondary healthcare practices to be aware of the potential impact on the quality of life of their patients from reducing the number of operations performed that are deemed " ineffective " by government. The impact of tonsillitis and peri-tonsillar abscesses on both the patients' quality of life and the economy is considerable with the debilitating nature of these conditions resulting in an average of 35 million days being lost from …