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, and behavior.
"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]."
"This study ... finds many significant [quality of life factors] worsened by this disease," Charles Gross, MD, tells WebMD. "However, the study is limited by the size of the group and by grouping together children aged 2-16 years." Gross, a professor of otolaryngology at the University of Virginia School of Medicine in Charlottesville, was not involved in the study.
"Although tonsil and adenoid problems are often considered trivial, some children have had dramatic changes in lifestyle," David Tunkel, MD, the director of pediatric otolaryngology at Johns Hopkins Medical Institutions in Baltimore, tells WebMD in an independent interview. "However, because these patients were [from] otolaryngology clinics [clinics that specialize in diseases that affect the ears, nose, and throat], it would be helpful to study children with tonsil and adenoid disease in pediatric practices."
- Children with chronically infected tonsils and enlarged adenoids suffer from lower general health and have a poorer quality of life than healthy children.
- The authors say the study should compel doctors to refocus more attention on children's quality of life when they have these common illnesses.
- Parents should also be compelled to seek proper treatment for their children who suffer from chronically infected tonsils and enlarged adenoids.