Open Access Open Badges Research article

Effects of guidelines on adeno-tonsillar surgery on the clinical behaviour of otorhinolaryngologists in Italy

Giovanni Motta1, Sergio Motta2, Pasquale Cassano3, Salvatore Conticello4, Massimo Ferretti5, Bruno Galletti6, Aldo Garozzo7, Gennaro Larotonda8, Nicola Mansi9, Emilio Mevio10, Gaetano Motta11, Giuseppe Quaremba12, Agostino Serra13, Vincenzo Tarantino14, Paolo Tavormina15, Claudio Vicini16, Maurizio Giovanni Vigili17 and Domenico Testa11*

Author Affiliations

1 Institute of Otorhinolaryngology, University “Federico II”, Naples, Italy

2 Institute of Otorhinolaryngology, Department of Preventive Medical Sciences, University “Federico II”, Naples, Italy

3 Institute of Otorhinolaryngology, University of Foggia, Foggia, Italy

4 Institute of Otorhinolaryngology, University of Torino, Torino, Italy

5 Unit of Pediatric Otorhinolaryngology P.O.SS. Annunziata, Naples, Italy

6 Institute of Otorhinolaryngology, University of Messina, Messina, Italy

7 Institute of Otorhinolaryngology, University “Magna Graecia”, Catanzaro, Italy

8 Unit of Otorhinolaryngology, Hospital “Madonna delle Grazie”, Matera, Italy

9 S.C. of Otorhinolaryngology, Azienda Ospedaliera di Rilievo Nazionale Santobono-Pausillipon, Naples, Italy

10 Unit of Otorhinolaryngology, Hospital “Fornaroli”, Magenta (Mi), Italy

11 Institute of Otorhinolaryngology, II University of Naples, Naples, Italy

12 Department of Forensic Medicine, University “Federico II”, Naples, Italy

13 Institute of Otorhinolaryngology, University of Catania, Catania, Italy

14 S.C. of Otorhinolaryngology “Giannina Gaslini”, Genoa, Italy

15 Unit of Otorhinolaryngology, Pediatric Hospital “Regina Margherita S. Anna”, Torino, Italy

16 Unit of Otorhinolaryngology, A.U.S.L. of Forlì, Forlì, Italy

17 Unit of Otorhinolaryngology, Hospital “San Carlo - IDI”, Rome, Italy

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BMC Ear, Nose and Throat Disorders 2013, 13:1  doi:10.1186/1472-6815-13-1

Published: 7 January 2013



Several guidelines on adeno-tonsillar disease have been proposed in recent years and some discrepancies in relation both to clinical manifestations and indications for surgical treatment have emerged. The aim of the study was to verify what influence (adeno)-tonsillectomy guidelines have had on the clinical behaviour of ENT specialists in Italy. Our study is a retrospective and multi-centre case series with chart review.


The survey involved 14,770 children, aged between the ages of 2 and 11, who had undergone adeno-tonsillar surgery between 2002 and 2008 in fourteen Italian tertiary and secondary referral centres. Anova test was used for the statistical analysis, assuming p < 0.05 as the minimum statistical significance value.


The frequency of adeno-tonsillar surgeries did not change significantly (p>0.05) during the study period and following the Italian policy document publication. Overall, adeno-tonsillectomy was the most frequent intervention (64.1%), followed by adenoidectomy (31.1%) and tonsillectomy (4.8%). The indications for surgery did not change significantly for each of the operations (p>0.05), with the exception of adeno-tonsillectomy in case of feverish episodes due to acute recurrent tonsillitis ≥ 5 without nasal obstruction (decreased p= 0.010) , even when the feverish episodes due to acute recurrent tonsillitis were < 5 over the last year. Nasal obstruction was associated with feverish episodes due to acute recurrent tonsillitis in 65.2% of operated cases, while otitis media had been diagnosed in 43.3% of the patients studied.


The recommendations first developed in Italy in a 2003 policy document and then resumed in guidelines in 2008, were not implemented by ENT units involved in the survey. The study highlights the fact that the indications for adeno-tonsillar operations are based on the overall clinical presentation (comorbidity) rather than on a single symptom. Guidelines are necessary to give coherent recommendations based on both the findings obtained through randomized controlled trials and the data collected from observational studies.

Tonsillectomy; Adeno-tonsillectomy; Otitis media; Guidelines