Tonsillectomy Versus Conservative Care for Recurrent or Chronic Tonsillitis in Adults: A Systematic Review and...

BackgroundRecurrent and chronic tonsillitis significantly impairs adult quality of life through frequent pain and functional disruption. While tonsillectomy offers definitive symptomatic relief, its associated postoperative morbidity has sparked an ongoing debate favoring conservative care.MethodsA comprehensive search of PubMed, CENTRAL, Embase, Scopus, Google Scholar, and Web of Science was conducted up to May 2026 to identify randomized controlled trials (RCTs) and non-randomized comparative studies. The primary outcome the recurrence rate, defined as the incidence of any recurrent episode of sore throat, tonsillitis, or pharyngitis during follow-up. Risk ratios (RR) and mean differences (MD) were pooled using a random-effects model.ResultsEight studies (four RCTs, four observational) involving 3,111 adult patients were included. Tonsillectomy was associated with a significantly reduced risk of symptomatic recurrence compared with conservative care (RR: 0.28, 95% CI [0.13, 0.59]; p < 0.001). Additionally, surgical intervention significantly decreased the overall number of sore throat episodes (MD: -4.31, 95% CI [-7.17, -1.46]; p = 0.003), symptomatic days (MD: -15.20, 95% CI [-28.81, -1.60]; p = 0.03), and days absent from work or school (MD: -6.94, 95% CI [-13.33, -0.55]; p = 0.03). However, there was no significant reduction in healthcare visits (p = 0.20), and 13% of conservatively managed patients eventually required surgery.ConclusionTonsillectomy can be effective in reducing the disease burden of recurrent throat infections in adults, significantly decreasing recurrence, symptomatic days, and functional absenteeism. However, the benefit must be balanced against postoperative pain and bleeding, and the certainty of the effect size is limited by current clinical heterogeneity and the risk of bias in observational evidence.