Discussion
This study has demonstrated a significant correlation between recurrent
tonsillitis and halitosis. Tonsillitis is a very common clinical
condition, with tonsillectomy being performed when patients suffer from
repeated disabling episodes4. Recurrent tonsillitis
causes significant morbidity for the patient including time of work,
with a major impact on a patient’s quality of life8.
The TIO-14 is a disease specific quality of life tool for assessing sore
throat. In this study the mean TOI-14 score was 48.22, comparable to
Skevas et al and Roplekar et al5,9. Laajala et al
demonstrated that a TOI-14 score of greater than 40 suggests a patient
has severe symptoms of tonsillitis. There was no evidence of correlation
between the TIO-14 and sex, BMI, reflux or smoking status comparable to
the findings by Laajala et al.
Although oropharyngeal pathology is frequently listed as a cause for
halitosis, there is little published literature to support this. The few
papers that discuss halitosis in relation to oropharyngeal pathology
tend to highlight tonsoliths as the cause of halitosis, rather than
provide evidence that tonsillitis is the cause. In this paper only 3
patients had tonsil stones, and this was not significantly related to
the HALT score. The HALT has never been used in patients with recurrent
tonsillitis. Halitosis can significantly impact on a patient’s quality
of life, with it being considered one of the most socially unattractive
aspects of social interactions10. Patients can have
low self-esteem, anxiety, depression and poor self-confidence. The
halitosis can also impact on relatives and friends as they may need to
reassure or counsel the sufferer about their bad breath. There is also a
large economic burden associated with halitosis, with Meninguad et al
reporting that over 2 billion dollars is spent annually on products to
mask halitosis11. Therefore a considerable amount of
psychological, social and economic resources are dedicated to patients
with halitosis, in a similar way to those with recurrent tonsillitis.
The HALT was not associated with smoking, although smoking is commonly
linked to severity of halitosis. Halitosis is not an indicator for
tonsillectomy in the UK, however some countries list it as a relative
indication. This is the first evidence that patients with poor quality
of life due to sore throat also have poor quality of life due to
halitosis.
The significant correlation of the TIO-14 and HALT could be attributed
to the questionnaires asking the same questions, however there is only
one question that is the same in both questionnaires – patients are
asked about sore throat. There is no overlap between the other
questions.
It is well established that tonsillectomy improves the TIO-14 score in
patients. It is currently unknown if the HALT score is modified by
tonsillectomy.