Carbon Dioxide Laser Tonsillotomy Offers Effective, Cost-Efficient Relief for Tonsil Issues: JAMA

The findings were published online in JAMA Network Open on April 29, 2025.

Tonsillectomy, the standard treatment for adult tonsil disease, involves complete removal of the tonsils and is effective, though often associated with significant postoperative pain, extended recovery, and higher costs. In contrast, carbon dioxide (CO₂) laser tonsillotomy, which entails partial removal of tonsillar tissue, offers a less invasive alternative that may lead to a smoother recovery.

Recognizing these differences, Justin Emile Raoul Edouard Wong Chung, Department of Ophthalmology, Maasziekenhuis Pantein, Boxmeer, the Netherlands, and colleagues conducted a secondary analysis of a randomized clinical trial to compare the 1- and 2-year efficacy and cost-effectiveness of TO versus TE.

The researchers conducted a secondary analysis of a randomized clinical trial conducted across five Dutch hospitals and compared tonsillectomy under general anesthesia with CO₂ laser tonsillotomy under local anesthesia in adults with persistent tonsil-related symptoms. The study assessed outcomes at 1 and 2 years, including symptom presence, severity, patient satisfaction, quality-adjusted life-years (QALYs), and cost-effectiveness. Data were analyzed from January to April 2025 to evaluate their long-term benefits and cost-effectiveness.

The key findings were as follows:

• Ninety-eight patients were assigned to TO and 101 to TE, with 98 analyzed per group.
• Both groups were similar in terms of gender (70% female in TO vs 68% in TE) and mean age (29 years in TO vs 30 years in TE).
• The most common symptom was sore throat with fever (34% in both groups), with similar baseline severity scores (57 mm in TO vs 59 mm in TE).
• At 1 year, 51.8% of TO patients had persistent symptoms, compared to 25.2% of TE patients. At 2 years, 45.2% of TO patients vs 19.7% of TE patients had persistent symptoms.
• Symptom severity decreased significantly in both groups, but TE had a lower severity at 1 year (14.8 mm vs 23.0 mm) and 2 years (10.8 mm vs 19.6 mm).
• Patient satisfaction was similar for both groups at 1 year (VAS scores of 79.0 mm for TE vs 69.3 mm for TO) and 2 years (64.1 mm for TE vs 64.4 mm for TO).
• Similar proportions of participants would recommend the procedure at 1 year (79% TE vs 76% TO) and 2 years (71% for both).
• Both groups showed high cumulative QALYs at 2 years, with no significant difference (EuroQol 5 Dimension and Visual Analogue Scale scores).
• Tonsillotomy had lower overall costs ($869 versus $2363 for TE), with societal cost savings of $1925 and a 71% probability of cost-effectiveness at $25,907 per QALY.

This trial highlights that tonsillectomy and CO₂ laser tonsillotomy effectively reduce long-term tonsil-related symptoms, with TE offering slightly greater symptom relief. However, the authors note that CO₂ laser TO stands out as a safe, less invasive, and cost-effective alternative, offering shorter recovery, lower healthcare costs, and comparable patient satisfaction.

While TE may be preferable for those seeking complete symptom resolution and aiming to avoid a potential secondary procedure, the authors suggest that TO is better suited for patients prioritizing quicker recovery, minimal disruption to daily life, or those unfit for general anesthesia. With proper patient selection and counseling, they concluded, that CO₂ laser TO remains a valuable option in managing adult tonsil disease.

Reference:

Wong Chung JERE, van den Hout WB, van Helmond N, van Benthem PPG, Blom HM. Long-Term Efficacy and Cost-Effectiveness of Laser Tonsillotomy vs Tonsillectomy: A Secondary Analysis of a Randomized Clinical Trial. JAMA Netw Open. 2025;8(4):e254858. doi:10.1001/jamanetworkopen.2025.4858