The effect of tonsillectomy on the morbidity from recurrent tonsillitis

Background Tonsillitis is a common condition with an incidence in UK general practice of 37 per 1000 population a year.1 Recurrent tonsillitis results in significant morbidity and impacts on individuals’ quality of life. This study assesses the morbidity and quality of life of adults with recurrent tonsillitis, and the impact of surgical intervention on their health state. Objectives To describe disease-specific and global quality of life for adults with recurrent tonsillitis 6 months after tonsillectomy, using two instruments: the health impact of throat problems (HITP) and EuroQol-visual analogue scale questionnaire. To assess the overall health benefit from tonsillectomy as an intervention using the Glasgow Benefit Inventory (GBI). To assess potential predictors of tonsillectomy benefit. Design A prospective, observational cohort audit of patients who have fulfilled Scottish Intercollegiate Guideline Network (SIGN) criteria for tonsillectomy.2 Setting Secondary care, teaching hospital. Participants Seventy patients (57 female), median age 20 years (range 13-41). Results Median preoperative HITP was 47 (range 15-67), compared to 4 (0-72), (P<.001) 6 months following surgery. Median HITP difference was 39.5 (range −20 to 75). There was no significant change in global Quality of Life. Median overall 6 months GBI was 39 (−3 to 100). Patients had an average of 27 episodes of tonsillitis over a period of seven years before “achieving” tonsillectomy, significantly higher than the SIGN guidelines of three or more episodes over three years. Conclusions Recurrent tonsillitis causes a poor disease-specific quality of life. Patients experienced a median of three episodes per year for seven years before tonsillectomy. Following tonsillectomy, patients had a significant improvement in their disease-specific quality of life. Baseline HITP significantly improved after tonsillectomy. The results imply patients with recurrent acute tonsillitis may be experiencing undue dela

Inequality in the survival of patients with head and neck cancer in Scotland

Background: Socioeconomic inequalities impact on the survival of head and neck cancer patients, but there is limited understanding of the explanations of the inequality, particularly in long-term survival. Methods: Patients were recruited from the Scottish Audit of Head and Neck cancer from 1999 to 2001 and were linked to mortality data as at 30th September 2013. Socioeconomic status was determined using the area-based Carstairs 2001 index. Overall and disease-specific survival were calculated using the Kaplan-Meier method with 95% confidence intervals (CI’s) at one-, five- and 12-years. Cox proportional hazard models with 95% CIs were used to determine the explanations for the inequality in survival by all-cause mortality and disease-specific mortality with 95% CIs. Net survival at one-, five- and 12-years was also computed with 95% CIs. Results: Most patients were from the most deprived group, and were more likely to smoke, drink, have cancer of a higher stage and have a lower WHO Performance Status. A clear gradient across Carstairs fifths for unadjusted overall and disease-specific survival was observed at one-, five- and 12-years for patients with HNC. Multiple patient, tumour and treatment factors play a part in the inequality observed, particularly by five- and 12-years when the inequality could be explained in fully adjusted models. However, the inequality at one-year survival remained. The inequality in 12-year net survival was very small, suggesting that the inequality in the long-term may be partly attributable to background mortality. Conclusion: Explanations for the inequality in the survival of patients with HNC are not straightforward, and this study concludes that many factors play a part including multiple patient, tumour and treatment factors

Determinants of long-term survival in a population-based cohort study of patients with head and neck cancer from Scotland

Background: We investigated long‐term survival from head and neck cancer (HNC) using different survival approaches. Methods: Patients were followed‐up from the Scottish Audit of Head and Neck Cancer. Overall survival and disease‐specific survival were calculated using the Kaplan–Meier method. Net survival was calculated by the Pohar‐Perme method. Mutually adjusted Cox proportional hazards models were used to determine the predictors of survival. Results: A total of 1820 patients were included in the analyses. Overall survival at 12 years was 26.3% (24.3%, 28.3%). Disease‐specific survival at 12 years was 56.9% (54.3%, 59.4%). Net survival at 12 years was 41.4% (37.6%, 45.1%). Conclusion: Determinants associated with long‐term survival included age, stage, treatment modality, WHO performance status, alcohol consumption, smoking behavior, and anatomical site. We recommend that net survival is used for long‐term outcomes for HNC patients—it disentangles other causes of death, which are overestimated in overall survival and underestimated in disease‐specific survival

Multimodal optical mesoscopy reveals the quantity and spatial distribution of gram-positive biofilms in ex vivo tonsils

Biofilms are known to be present in tonsils, but little is known about their spatial location and size distribution throughout the tonsil. Studies of the location and distribution of biofilms in tonsil specimens have thus far been limited to either high-magnification methods such as electron microscopy, which enables high resolution imaging but only from a tiny tissue volume, or lower magnification techniques such as light microscopy, which allow imaging of larger specimens but with poor spatial resolution. To overcome these limitations, we report the use of multimodal optical mesoscopy to visualize and quantify the number and spatial distribution of gram-positive biofilms in fresh, excised paediatric tonsils. This methodology supports simultaneous imaging of both the tonsil host and biofilms in whole mounts of tissue up to 5 mm x 5 mm x 3 mm with subcellular resolution throughout. A quantitative assessment of thirty-six tonsil specimens revealed no statistically significant difference between biofilm presence on the tonsil surface and the interior of the tonsil. This new quantitative mesoscale imaging approach may prove useful in understanding the role of biofilms in tonsillar diseases and other infections

Twenty-year observational study of paediatric tonsillitis and tonsillectomy

Introduction: Tonsillectomy is now only indicated in the UK when specific criteria are met, as outlined by the Scottish Intercollegiate Guidelines Network (SIGN) and The National Institute for Health and Care Excellence (NICE). As a result, fewer numbers of tonsillectomy are being performed. Tonsillectomy is the primary treatment for recurrent tonsillitis; therefore, we hypothesise that acute admissions to hospital with tonsillitis and infective complications will have risen since criteria were introduced. Our aim was to assess the rates of acute hospital admissions with tonsillitis in children and the factors associated with this. Methods: Data were provided by Information Service Division for all under 16s in Scotland between 1996/1997 and 2016/2017. Socioeconomic background was determined from the Scottish Index of Multiple Deprivation (SIMD) score. Poisson regression analysis was used to model predictors of surgery and correlation analysis to study the relationship between tonsillitis and other factors. Results: 60 456 tonsillectomies were performed. The number of tonsillectomies dropped significantly following the introduction of SIGN guidelines, and the rates of tonsillitis increased; however, admissions with tonsillitis were already on an upward trajectory. Children from the most deprived areas were 72.0% (95% CI 60% to 85%, p<0.001) more likely to receive tonsillectomy and were also more likely to be admitted with tonsillitis than the least deprived areas. Conclusion: Tonsillectomy and tonsillitis rates are highest in the most deprived; postulated reasons include antibiotic stewardship and difficulty accessing primary care. Current guidelines on tonsillectomy may be disproportionately harmful in children from deprived households

The COVID-19 pandemic has not changed stage at presentation nor treatment patterns of head and neck cancer: a retrospective cohort study

Objectives: To evaluate the impact of the COVID-19 lockdown measures on HNC, by comparing the stage at presentation and treatment of HNC before and after the most severe COVID-19 restrictions. Design: A retrospective cohort study. Setting: A regional cancer network serving a patient population of 2.4 million. Participants: Newly diagnosed patients with HNC between June and October 2019 (pre-pandemic) and June and October 2021 (post-pandemic). Main outcome measures: Symptom duration before diagnosis, stage at diagnosis, patient performance status (PS) and intent of treatment delivered (palliative vs. curative). Results: Five hundred forty-five patients were evaluated—250 in the 2019 and 295 in the 2021 cohort. There were no significant differences in symptom duration between the cohorts (p = .359) or patient PS (p = .821). There were no increased odds of presenting with a late (Stage III or IV) AJCC cancer stage in 2021 compared with 2019 (odds ratio [OR] = 0.90; 95% confidence interval [CI]: 0.76–1.08); nor increased odds of receiving palliative rather than curative treatment in 2021 compared with 2019 (OR = 0.68; 95% CI: 0.45–1.03). Conclusion: The predicted stage shift to more advanced disease at the time of diagnosis of HNC due to the COVID-19 pandemic has not been realised in the longer term. In keeping with this, there was no difference in symptom duration, patient PS, or treatment patterns between the 2019 and 2021 cohorts

Marine mammals and sonar : dose-response studies, the risk-disturbance hypothesis and the role of exposure context

This manuscript was written following the Behavioral Response Research Evaluation Workshop (BRREW), jointly sponsored by the US Office of Naval Research, US Navy Living Marine Resources, and US National Oceanic and Atmospheric Administration - National Marine Fisheries Service. PLT acknowledges funding from the MASTS pooling initiative (The Marine Alliance for Science and Technology for Scotland). MASTS is funded by the Scottish Funding Council (grant reference HR09011) and contributing institutions.1. Marine mammals may be negatively affected by anthropogenic noise. Behavioural response studies (BRSs) aim to establish a relationship between the exposure dose of a stressor and associated behavioural responses of animals. A recent series of BRSs have focused on the effects of naval sonar on cetaceans. Here we review the current state of understanding of the impact of sonar on marine mammals and highlight knowledge gaps and future research priorities. 2. Many marine mammal species exhibit responses to naval sonar. However, responses are highly variable between and within individuals, species and populations, highlighting the importance of context in modulating dose-response relationships. 3. There is increasing support for the risk-disturbance hypothesis as an underlying response mechanism. This hypothesis proposes that sonar sounds may be perceived by animals as a threat, evoking an evolved anti-predator response. An understanding of responses within both the dose-response and risk-disturbance frameworks may enhance our ability to predict responsiveness for unstudied species and populations. 4. Many observed behavioural responses are energetically costly, but the way in which these responses may lead to long-term individual and population level impacts is poorly understood. Synthesis and Applications Behavioural response studies have greatly enhanced our understanding of the potential effects of navy sonar on marine mammals. Despite data gaps, we believe a dose-response approach within a risk-disturbance framework will enhance our ability to predict responsiveness for unstudied species and populations. We advocate for (1) regulatory frameworks to utilise recent peer-reviewed research findings when making predictions of impact (where feasible within assessment cycles), (2) regulatory frameworks to account for the inherent uncertainty in predictions of impact, and (3) investment in monitoring programmes that are both directed by recent research and offer opportunities for validation of predictions at the individual and population level.Publisher PDFPeer reviewe

Understanding the role of biofilms in acute recurrent tonsillitis through 3D bioprinting of a novel gelatin-PEGDA hydrogel

Acute recurrent tonsillitis is a chronic, biofilm-related infection that is a significant burden to patients and healthcare systems. It is often treated with repeated courses of antibiotics, which contributes to antimicrobial resistance. Studying biofilms is key to understanding this disease. In vitro modelling using 3D bioprinted hydrogels is a promising approach to achieve this. A novel gelatin-PEGDA pseudomonas fluorescens-laden bioink was developed and bioprinted in a 3D hydrogel construct fabricated using computer-aided design to mimic the tonsillar biofilm environment. The bioprinted constructs were cultured at 37 °C in lysogeny broth for 12 days. Bacterial growth was assessed by spectrophotometry. Cellular viability analysis was conducted using optical fluorescence microscopy (FDA/PI staining). A biocompatible 3D-printed bacteria-laden hydrogel construct was successfully fabricated. Bacterial growth was observed using optical fluorescence microscopy. A live/dead cellular-staining protocol demonstrated bacterial viability. Results obtained after the 12-day culture period showed higher bacterial growth in the 1% gelatin concentration construct compared to the 0% control. This study demonstrates the first use of a bacteria-laden gelatin-PEGDA hydrogel for biofabrication of a 3D-printed construct designed to model acute recurrent tonsillitis. Initiating a study with clinically relevant ex vivo tonsil bacteria will be an important next step in improving treatment of this impactful but understudied disease