Skip to main content

Featured post

Earbuds vs Over-Ears: Which One Is Silently Damaging Your Hearing?

Headphones are no longer an occasional accessory—they’re part of daily life. From early-morning podcasts to late-night playlists, our ears are spending more time under acoustic load than ever before. But a question keeps coming up in clinics, classrooms, and conversations around ear health: Are earbuds worse for your hearing than over-ear headphones? Let’s move beyond opinion and aesthetics. By looking at sound pressure levels , hygiene , and long-term listening behaviour , we can reach a clear, evidence-informed conclusion. 1. Sound Pressure Levels: Distance Matters More Than You Think The single most important factor in headphone-related hearing risk is the amount of sound energy that  reaches the inner ear . Earbuds (In-Ear Headphones) Sit millimetres from the eardrum Deliver sound directly into the ear canal Require lower absolute power , but often result in higher sound pressure at the cochlea Users tend to increase volume in noisy environments (commuting, g...

Clinical Trials on Tonsillitis


 Tonsillitis, characterized by inflammation of the tonsils, has been a subject of medical interest for decades. After a long hiatus without significant trials, the field has seen renewed attention with several pivotal studies. These trials aim to refine surgical treatments and improve patient outcomes, marking a significant step forward in managing recurrent and chronic tonsillitis.

 

Key Research Questions

Tonsillotomy vs. Tonsillectomy: Is tonsillotomy as effective as tonsillectomy in reducing sore throat days over 24 months?

Surgical Techniques for Tonsillectomy: How does the recovery time compare among extracapsular monopolar tonsillectomy, intracapsular microdebrider tonsillectomy, and intracapsular coblation tonsillectomy?

Watchful Waiting vs. Surgical Intervention: What is the impact of tonsillectomy, tonsillotomy, and watchful waiting on the quality of life for adults with recurrent or chronic tonsillitis over six months?

 

 

The NATTINA Trial

The NATTINA trial (National Trial of Tonsillectomy in Adults) initiated a series of studies exploring the efficacy and outcomes of various tonsil surgery techniques. While this trial's results are still unfolding, it has laid the groundwork for subsequent research.

 

The German TOTO Trial

The TOTO trial in Germany is a landmark study investigating the non-inferiority of tonsillotomy compared to tonsillectomy. In this multicenter, randomized, non-blinded trial, patients aged three and above are allocated to tonsillotomy or tonsillectomy. The primary outcome measure is the number of sore throat days experienced over a 24-month follow-up period. This trial aims to determine if the less invasive tonsillotomy can provide benefits similar to those of a more traditional tonsillectomy.

 

The Finnish FINITE Trial

The FINITE trial in Finland examines whether intracapsular tonsillectomy can reduce recovery time from tonsil surgery in adults. This randomized, controlled, three-arm clinical trial compares:

 

Extracapsular monopolar tonsillectomy

Intracapsular microdebrider tonsillectomy

Intracapsular coblation tonsillectomy

The primary endpoint is the recovery time from postoperative pain. By comparing these techniques, the trial seeks to identify the method that offers the quickest and least painful recovery.

 

Finnish Multicentre Trial

Another critical trial in Finland compares tonsillectomy, tonsillotomy, and watchful waiting in adults with recurrent or chronic tonsillitis. The primary outcome is tonsillitis-specific quality of life at six months. This study will provide valuable insights into whether surgical intervention or conservative management offers better quality-of-life improvements.

 

Clinical Registers and Quality Control

In addition to these trials, clinical registers in the Nordic countries serve as essential tools for ongoing investigation and quality control. For instance:

 

Sweden: The National Tonsil Surgery Register has been in use since 1997.

Norway and Denmark: Similar registers have been established since 2016.

 

These registers allow continuous monitoring of indications, surgical methods, and complications, helping to enhance patient care. In the United States, the Pediatric Health Information System analyzed a cohort of 96,415 children undergoing tonsillectomy between 2016 and 2021. This large-scale analysis identified key variables associated with postoperative bleeding and developed a probability model for future quality initiatives.

 

Key Findings and Implications

Effectiveness of Less Invasive Techniques: The German TOTO trial will provide evidence on whether tonsillotomy is a viable alternative to tonsillectomy.

Reduced Recovery Time: The Finnish FINITE trial aims to identify surgical techniques that minimize recovery time and postoperative pain.

Quality of Life Improvements: The Finnish multicentre trial will illuminate the impacts of different treatment approaches on long-term quality of life.

Enhanced Patient Care: Data from clinical registers in the Nordic countries and the US highlight the importance of quality control and continuous improvement in surgical practices.

These trials and registers are crucial in advancing our understanding of tonsillitis treatment, offering hope for more effective and patient-friendly approaches in the future. As research progresses, these studies will provide the evidence to guide clinical decisions and improve patient outcomes.


Mr Gaurav Kumar

Ear Nose Throat Consultant


Call For Appointment
07494914140



Follow on Instagram








Popular Post

Boil in the Ear canal can be very painful...

How do I know I have boil in the ear canal? The ear canal is lined by skin up to the eardrum. Skin in the outer third of the ear canal has hair follicles. Hair follicles can get infected with bacteria and can form boil or furunculosis. It is challenging to look in our own ear canal. You can only feel a bump in the ear canal entrance which is tender to touch. Why is so painful when we have boil in the ear? Ear canal skin is very tightly attached to underlying cartilage. So any swelling in the skin stretches it and makes it very sore to touch. How do we get boil in the ear canal?  Most common causes of boil in the canal is dryness of the skin and trauma. Dry skin leads to cracks and these cracks can get infected. People who use dry earbuds, fingers, towel edges or pens and traumatise ear canal skin, which can get infected with bacteria. How do I release the temptation of using earbuds? Some people can get very dry skin due to sensitivity to soup, shampoo o...
Read more

Coblation Tonsillectomy

Hi Guys, Let us talk about your tonsils and adenoids. Tonsils and adenoids are part of the immune system and help fight germs. Sometimes these tissues become infected and is called tonsillitis. When you have tonsillitis, you can feel sore to eat and drink, have the temperature, and can even have difficulty in breathing. This can be treated by a procedure called Tonsillectomy. Mr Kumar may advise you to have your tonsils removed if you have tonsil stones, if your airway is blocked due to large tonsils making you choke at night ie sleep apnoea or one tonsil is bigger than other. Tonsillectomy can be done by the traditional techniques using cold steel, electrocautery or coblation.  Cold steel and elctrocautery has moderate to severe pain in postoperative period. With new coblation technique, post operative pain is very low leading to quicker recovery.  Coblation is an advanced technology that combines gentle radiofrequency energy with natural saline — to quickly, and safely r...
Read more

Bleeding From Ears

  Why is my Q-tip bleeding from my ear?   It can be alarming if you've ever noticed blood on your Q-tip after cleaning your ears. Here are a few reasons why this might happen:   🚫 Avoid Inserting Q-tips Too Deep: The most common cause of bleeding is inserting Q-tips too far into the ear canal. This can lead to irritation, scratches, or even damage to the delicate ear tissues.   🩹 Ear Injuries or Scratches: Vigorous or improper cleaning can cause small injuries or scratches inside the ear canal. These injuries may result in bleeding when you use a Q-tip.   🩸 Ear Infections: Infections like otitis externa or swimmer's ear can make the ear canal more sensitive. Cleaning during an active infection can cause bleeding.   🔄 Wax Impaction: Excessive earwax can cause blockages, leading to a feeling of fullness and impaired hearing. Attempting to clean it out with a Q-tip may cause bleeding, especially if the wax is impacted.   👂 What to Do...
Read more

Retracted Ear Drum

  What Is a Retracted Eardrum? A retracted eardrum, also known as tympanic membrane retraction, is a condition where the eardrum (tympanic membrane) is pulled inward or drawn backwards from its normal position. The eardrum is a thin, delicate membrane that separates the outer ear from the middle ear. It plays a crucial role in transmitting sound vibrations from the outer ear to the middle ear, where the auditory ossicles (small bones) are located.   Under normal circumstances, the eardrum is slightly concave and positioned at an angle that allows it to respond to changes in air pressure. The Eustachian tube, a tube connecting the middle ear to the back of the throat, helps equalize pressure between the middle ear and the outside environment.   However, in cases of a retracted eardrum, the Eustachian tube might not function correctly or become blocked, leading to an imbalance in pressure. When negative pressure builds up in the middle ear, it causes the eardrum t...
Read more

What are different types of nasal sprays?

Nasal sprays are a popular form of medication for treating nasal allergy symptoms. They are sprayed directly into the nose to target the symptoms without affecting the rest of the body. There are many types of nasal sprays available, both prescription and over-the-counter. Here is a quick guide to the different types: Nasal Steroid Sprays: These are usually one of the first-line allergy therapies. They decrease inflammation within the nasal passages and relieve nasal congestion, sneezing, watery eyes, and runny nose. Many of these sprays are available over the counter. Some common generic and brand names include Budesonide, Ciclesonide, Fluticasone, Flunisolide, Mometasone, Rhinocort, Omnaris, Zetonna, Flonase, Nasonex, Nasacort, Xhance, Beconase, Nasarel, Qnasl, Vancenase, Veramyst, and Zetonna Nasal Decongestant Sprays: These sprays temporarily relieve nasal congestion by constricting the blood vessels in the nose, reducing nasal swelling and congestion. They are available over the...
Read more

"Naseptin: Powerful Defence Against Nasal Bacteria!"

  Everything You Need to Know About Using Naseptin Nasal Cream   If you've been dealing with nasal issues, you may have come across Naseptin nasal cream as a potential solution. Whether you suffer from recurrent nasal infections (vestibulitis), nose bleeds or simply need some relief from nasal dryness, Naseptin can be a valuable aid. In this blog, we'll cover everything you need to know about using Naseptin nasal cream to ensure you get the best results from this trusted product.   Unlocking the Power of Naseptin Nasal Cream: A Guide to Its Versatile Uses   Naseptin nasal cream, a powerful ally in nasal health, holds the key to treating infections caused by staphylococcal bacteria. This versatile cream offers much more than meets the eye, and we're here to shed light on its incredible benefits! 🌟 👃 Kicking Nose Infections to the Curb: Say goodbye to those troublesome nose infections! Naseptin comes to the rescue, targeting staphylococcal bacteria and...
Read more

Thinking of having sinus surgery.....

ENDOSCOPIC SINUS SURGERY WHY DO I NEED SINUS SURGERY? Sinus surgery is needed if your sinus symptoms do not respond to medical treatment and lifestyle changes. It is important to understand that you may still need medical treatment in the form of irrigation with/ without steroid spray. You should discuss this in detail with your operating surgeon during your preop consultations. WHAT ARE COMPLICATIONS OF SINUS SURGERY? It is very important to discuss possible complications of surgery and how it impacts your quality of life and profession. • Bleeding - Bleeding is a risk of any operation.  It is very common for small amounts of bleeding to come from the nose in the days following the operation.  Major bleeding is extremely uncommon and it is very rare for a transfusion to be required. • Eye problems - The sinuses are very close to the wall of the eye socket.  Sometimes minor bleeding can occur into the eye socket and this is usually noticed as some ...
Read more

Sudden sensorineural hearing loss

Why is it essential to identify Sudden hearing loss? Treatment of sudden hearing loss due to inner ear infection is a medical emergency. Sudden hearing loss could be due to simple cause due to wax in the ear canal or inner ear infection. If the treatment of inner ear infection is delayed by more than 7days, it can lead to permanent hearing loss. 10-20 people every 100,000 per year can get sudden sensorineural hearing loss.   How do I know that it is a sudden sensorineural hearing loss? It is straightforward to test by humming test. If you suspect your hearing is down in one ear. Humming "aa" and "ee" can help. If you hear, sound louder in the ear you feel deaf then the chances are you have conductive hearing loss due to wax or glue ear. If the sound is louder in the better ear, then chances are you have sensorineural hearing loss, and you need to see a doctor urgently. Example, you had flu for a few days, and suddenly you feel that hearing is ...
Read more

Superior Canal Dehiscence Syndrome (SCDS)

🔍 Unlocking the Mystery of Superior Canal Dehiscence Syndrome (SCDS) 🌀✨ It's a rare condition that affects the inner ear, and here's the lowdown:   Cause: SCDS occurs when one of the bony canals in the inner ear, particularly the uppermost semicircular canal, doesn't close or thicken properly during fetal development.   Symptoms:   Hearing Loss: It's a common symptom of SCDS. Sound Distortion: Ever feel like sounds aren't quite right? That could be SCDS at play. Balance Problems: SCDS can throw your balance off, making you feel unsteady. Autophony: Imagine hearing your own heartbeat or breathing louder than usual. That's autophony. World Tumbling Sensation: Loud noises or pressure changes might make you feel like the world is spinning. Diagnosis and Treatment:   CT Scans: A specialist might use these to spot SCDS, but other tests are crucial too. Hearing Tests: Essential for accurate diagnosis. Treatment: Surgery may be necessary for severe symptoms. ...
Read more

Ear cartilage meatoplasty

  Ear cartilage meatoplasty (conchal cartilage reduction) for external ear canal stenosis — an operation to widen the entrance (outer/cartilaginous part) of the ear canal by reshaping/removing the obstructing conchal cartilage and associated soft tissue, so the canal stays open and can ventilate, drain, and be cleaned.  Why is this being recommended? Your ear canal is narrowed because the conchal cartilage (the bowl-shaped cartilage at the ear opening) is bulky or positioned in a way that crowds the canal entrance. This can lead to a cycle of wax trapping, recurrent otitis externa/inflammation, discharge, blocked hearing, difficulty examining the eardrum , and repeated need for microsuction. Meatoplasty aims to restore a stable, self-cleaning canal opening and reduce recurrent problems.  What benefit can you reasonably expect? The intended benefits are: easier ear toilet/cleaning, fewer blockages and infections, improved access for drops and examination, and (i...
Read more