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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...

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


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07494914140



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