Background/Rationale
The current outbreak of coronavirus (COVID-19) has forced a significant
change in the delivery of services throughout the National Health
Service (NHS) in the United Kingdom (UK). The majority of elective
operations have been deferred to allow increased inpatient capacity for
patients with COVID-19, allow surgeons to support critical care delivery
and to reduce the risk of cross-infection to protect elective patients,
staff and visitors. Postponing elective surgery has led to longer
waiting lists in England with the median waiting time to elective
treatment in April 2020 at 12.2 weeks compared with 7.2 weeks in April
2019(1). This is likely to continue to worsen causing
a decrease in the quality of life (QoL) of our patients and an increase
in the incidence of associated disease sequelae.
Tonsillectomy is the most common elective procedure undertaken in the
field of Ear, Nose and Throat (ENT) surgery within the UK. It makes up
17% of the elective workload and costs £68 million per year. The most
common indications for tonsillectomy or tonsillotomy are recurrent
tonsillitis and Obstructive Sleep Apnoea (OSA).
It has previously been demonstrated that a proportion of the paediatric
population with recurrent tonsillitis will recover whilst on the waiting
list for surgery. Prim et al found that 18.6% of their patients on
their waiting list no longer fulfilled the criteria for tonsillectomy;
the average waiting time was 10.8 months. Woolford et al contacted
patients who had been on their waiting list for longer than 9 months and
found that 27% of their paediatric population no longer required
tonsillectomy . As such it can be deduced that a proportion of children,
with recurrent tonsillitis, will spontaneously resolve over time. It is
not known however how to identify this subset of the waiting list
accurately.
The pathophysiology of recurrent tonsillitis in children has focussed on
the microbiome of the pharynx. Cultivation studies have demonstrated
numerous pathogenic bacteria in the pharynx in asymptomatic children and
in those with recurrent tonsillitis. Similar studies have demonstrated
latent viral reservoirs which also may play a role. It has been shown
the Epstein Barr Virus (EBV) is reactivated in astronauts as a result of
the stressors of spaceflight and it is understood that the virus’ life
cycle is regulated by both cellular and viral factors. There is a lack
of research surrounding the role that viral load, within the patient’s
surroundings and how social distancing may affect the pathophysiology of
recurrent tonsillitis. The recent COVID-19 outbreak, within the UK, has
led to numerous public health measures to reduce human contact. Schools
have been shut to the majority of pupils and the population has been
advised to keep a distance of 2 metres apart unless residing in the same
household .