#49: Tonsils, Tinnitus and Vertigo: An ENT Update

Now, importantly, are we going from top to bottom or bottom to top?

I think we should go from top, top to bottom.

Oh, yeah, top to bottom.

Let's do the high value first.

Okay, high value.

What's the number one reason GPs refer patients to the ear, nose and throat service?

And for a drumroll, please, it's recurrent tonsillitis is the number one bread and butter for ENT surgeons.

Everyone could have guessed that who's listening, I am sure.

What are the take-home messages for people who are wondering whether or not they should be seeing the surgeon about recurrent tonsillitis? What are the tips and tricks for us?

So the tips and tricks, well, the biggest thing is the adult-pediatric divide.

So when we're talking about adults and we're thinking about patients with recurrent tonsillitis, because it's essentially an elective procedure, I will often discuss with patients the impactful nature or how impactful the recurrent tonsillitis is on them.

So for some people, having time off is at a massive premium because they've either got kids who get sick and they have to use their sick leave for that, they run businesses, they're very busy people, and that having one or two bouts of tonsillitis per year, which lays them up for anywhere between between, you know, seven and 14 days, that's just not compatible with their lifestyle.

So versus someone who, yes, they might get the numbers, i.e., you know, five to six episodes in one year, but if they're only sick for one to two days at a time and they recover quite quickly, they don't require antibiotics every time and they're not taking time off, you can have an honest discussion with them saying, is this the best reason to go for So really, when it comes to recurrent tonsillitis in adults, you have to match the impact of the disease process on the patient, both in a sort of physiological sense as well as a social sense.

And I think social reasons are just as valid as any other for people to want to have their

tonsils removed.

When it comes to kids and recurrent tonsillitis, because of course, children aren't consenting to things, I'm actually relatively strict on my numbers.

When it comes to working out if they are a candidate to have surgery, and the papers that look at all this talk about the number of episodes over a period of time, where being that if over time, you know, one year, you need to have six plus six to seven episodes per year for that one year.

If you're looking over a longer time period, so over two years, if you're having four to five episodes per year for two years,

or if

you're having two to three episodes per year for three years running, all of those fall into the category of recurrent tonsillitis.

And then there are also papers in this space that look at the social impact of tonsillitis on families.

And again, that does come into the decision process, but less so than in adults.

So they're the kind of things that I look for when people are sending in recurrent tonsillitis patients.

Because it does sound like a pretty quick and easy procedure, doesn't it? We just whip out the tonsils.

But I don't think people in the community recognise the extent or the potential for complications the way you are always looking for those potential complications, right? It can be quite significant, the fallout, for those few patients who do get a post-op bleed or are unwell in the few days afterwards.