Tonsil and Adenoid Problems in Kids Signal Overall Poorer Health
Feb. 2, 2000 (Minneapolis) -- When children live with chronically infected
tonsils and enlarged adenoids, they have lower general health and a poorer
quality of life (QOL) than do healthy children, according to a recent study. In
some areas, these children scored even lower than those with either asthma or
rheumatoid arthritis, the authors write.
This study, published recently in the journal Archives of Otolaryngolgy,
Head & Neck Surgery, is part of an ongoing debate on whether to treat
tonsil and adenoid disease medically or with surgery. Adenotonsillectomy, a
combination surgery in which both adenoids and tonsils are removed, is a common
pediatric surgery. In the 1960s, this surgery was performed on countless
school-age children for infected tonsils and enlarged adenoids. But with the
emergence of more effective antibiotics, the frequency of adenotonsillectomies
has diminished. Today, leading investigators do not agree on the appropriate
reasons for the surgery.
"Most of the literature ... has focused on changes in objective measures
... (such as number of infections) and not on quality of life ... or overall
health status," write Michael G. Stewart, MD, MPH, and colleagues. "In
addition, most studies have examined only one aspect of tonsil and adenoid
disease and have enrolled only severely affected children." Therefore, the
impact of tonsil and adenoid disease may be underrated, the authors write.
"Parents of children with tonsil and adenoid disease report a
significant impact on QOL," Stewart tells WebMD. "Parents will find it
helpful to know that the impact of this disease on their and their children's
quality of life may be fairly large. They should definitely seek treatment for
their children if they perceive recurrent tonsil and adenoid problems."
Stewart is an associate professor of otolaryngology and assistant dean of
clinical affairs at Baylor College of Medicine in Houston.
"This study ... is first-rate clinical research," George A. Gates,
MD, tells WebMD. "Since the advent of antibiotics, the pendulum has swung
from everybody getting tonsillectomies to nobody getting them. ... When a child
has ongoing tonsil and adenoid disease, parents should trust their judgment and
insist that the child get proper treatment." Gates, a professor of
otolaryngology at the University of Washington in Seattle, provided WebMD with
an objective analysis of the study.
The investigators surveyed the parents of 154 children who were 2-16 years
old. A subset of 55 children had one of several types of ongoing tonsil or
adenoid disease, such as recurrent tonsillitis or chronic snoring. The average
age of the children with tonsil and adenoid disease was approximately 6 years.
The parents of the affected children completed a QOL questionnaire covering
such areas as bodily pain, physical functioning, self esteem, emotional impact,
"The mean scores of children with tonsil and adenoid disease were
significantly lower ... than the mean scores of healthy subjects," the
authors write. "Overall, general health perceptions for children with
tonsil and adenoid disease were similar [to those of] children with asthma and
arthritis. However, for children with tonsil and adenoid disease, some ...
scores were lower ... including [those] related to emotional impact, behavior,
and ... impact of the disease [on the parents]."