The TYPHOON Study (Tonsillectomy Postoperative Haemorrhage Outcomes and Observations National Cohort Study) is a national cohort study aimed at understanding the factors that increase the risk of post-tonsillectomy bleeding (PTB) in adults. TYPHOON is an HRA-approved research study and is registered on the NIHR Associate PI Scheme.
TYPHOON for Investigators
Background
With over 27,000 tonsillectomies performed annually in the UK, ensuring the safety of this common procedure is crucial. The 2005 UK National Prospective Tonsillectomy Audit revealed significant variations in complication rates, highlighting a three-fold increased risk of PTB associated with “hot” surgical techniques compared to cold steel methods. However, this data collection concluded over 20 years ago. Recent data suggests that the rate of PTB has increased significantly. Hospital Episode Statistics suggests that 1 in 5 patients are currently readmitted as an emergency and the rate of post-tonsillectomy haemorrhage has increased drastically to 15.6% over 2022-2023. Investigating any patient and treatment-related variables that may contribute to an individual’s risk of bleeding is an essential component of reducing the readmission and bleeding rates. It will allow us to better understand the risk factors associated with PTB and how we can change our practice to reduce this risk for patients.
Strategies
INTEGRATE is now recruiting to this prospective, multi-centre, collaborative cohort study. The overall aim is to provide an in-depth assessment of the risk factors associated with PTB in the first 28 days following tonsillectomy.
Study setting: UK hospitals performing adult tonsillectomy procedures.
Patients will be expected to fill in a questionnaire on how their sore throat is impacting their quality of life (TOI 14 – Tonsillectomy Outcome Inventory). We will collect granular data on patient characteristics, previous episodes of sore throat, surgical and anaesthetic characteristics and post-operative management including analgesia. We will also telephone the patient at 28 days following surgery to determine if they have had any episodes of bleeding and how this was managed.
The detailed Study Protocol can be found here.
Study Flow
1 – Register your intended participation with INTEGRATE (form link here!)
2 – Register the study with your local research authority department. TYPHOON is an HRA approved research study and is registered on the NIHR Associate PI Scheme. Each participating site will require a site agreement in place (OID – Organisation Information Document) before the site opens the project. The study sponsor, Greater Glasgow and Clyde, must sign off on this document. You can find a template OID form in the Site Registration File. Please send the completed document to Shanice White at shanice.white@nhs.scot.
3 – Fill in the Site Survey (We wish to know more about site pathways by which patients are listed for a tonsillectomy, and the process by which patients with a post-tonsillectomy bleed present to the hospital).
4 – Prospectively identify patients for inclusion and send out the Patient Information Summary (editable format available in the Site Registration File).
— Consecutive adult patients undergoing bilateral tonsillectomy in a 2-month period. Detailed inclusion / exclusion criteria can be found in the protocol.
— Patient Information Summary to be sent together to all patients with their surgery appointment letter.
5 – Consent and Patient Survey (TOI-14) to be given to patients at the Preadmission Clinic / in-person encounter before surgery.
6 – Conduct a 28-day post-operation phone call to the patient and record any bleeding and the management. Enter the pseudonymized individual data into our Excel Data Collection Form. Submit the form to our study email typhoonstudy@entintegrate.co.uk upon completion.
Recognition
Consultant Leads, Trainee Site Leads and Local Collaborators will be acknowledged for their involvement in this national cohort study, in any subsequent outputs, including presentations/publications. A maximum of four collaborators (one Consultant Lead, one Trainee Site Lead, and two Local Collaborators) per site will be granted collaborative authorship.
Contact Us
typhoonstudy@entintegrate.co.uk
Important Dates
Study Period: 1st of August 2025 to 31st of July 2026
Registration is now open!
Resources
Site Initiation Visit PowerPoint
Join us at the TYPHOON study!
We believe that with your collaboration, the TYPHOON Study can make a significant impact on the safety and effectiveness of tonsillectomy procedures. Join us in this important research to help improve outcomes for patients across the UK.
TYPHOON for Patients
What is the TYPHOON Study?
The TYPHOON Study is a national research project focused on understanding complications, especially bleeding, after tonsillectomy surgery. We are a team of surgeons committed to improving the care provided to patients like you. By participating, you’ll help us learn more about what causes bleeding after surgery and how we can prevent it.
Why is This Study Important?
Tonsillectomy is a common procedure, especially for those with recurring sore throats. While it’s effective, one of the most important risks is bleeding after surgery. Over the last 10 years, there has been an increase in patients returning to the hospital due to bleeding or severe pain. We want to find out why this is happening and how we can make tonsillectomies safer for everyone.
Who Can Participate?
If your local care team is participating in this study, they will be recruiting suitable patients who are scheduled for a tonsillectomy between the 1st of August 2025 and the 31st of July 2026.
What Will Participation Involve?
– Before Surgery: On the day of your surgery, one of our researchers will meet with you to explain the study and answer any questions. If you decide to participate, you’ll sign a consent form.
– During the Study: You’ll fill out a short questionnaire called the Tonsillectomy Outcome Inventory-14 (TOI-14) to help us understand how your tonsillitis has impacted your life. This will take about 10 minutes.
– After Surgery: We will call you 28 days after your surgery to ask if you’ve had any bleeding, if you need medical help, and about your use of painkillers.
If you wish to know more about the study, you can find more information in the Patient Information Summary here.
