Tonsil Removal Has Little Benefit

Unless Kids Are Very Sick, It May Be Best to Watch and Wait

Sept. 9, 2004 -- Kids getting frequent mild throat infections or earaches? Wait before leaping into tonsil removal. It may be unnecessary, a new study shows.

It's standard practice to remove tonsils and adenoids when kids have frequent sore throats or sleep apnea. But for kids with mild symptoms, what's the best route -- nip the problem with tonsil removal? Or is "watchful waiting" the better option to see if things get worse?

In her study, tonsil removal -- tonsillectomy -- had little benefit over watchful waiting, writes researcher Birgit K. van Staaij, MD, with the University Medical Center in Utrecht, the Netherlands. Her study appears in this month's BMJ.

Not Sick Enough for Surgery

Van Staaij's study involved 300 children between ages 2 and 8, all being treated in hospitals and clinics throughout in the Netherlands. Each child had mild problems with sore throats and upper respiratory infections -- about three a year. The children were treated with either a tonsillectomy within six weeks, or doctors took a "wait and see" approach.

For the next two years, parents of all children kept a diary of sore throats, painful swallowing, cough, runny nose, earache, and ear infections. They also took the child's temperature daily. Kids were given antibiotics when they needed them.

The researchers also took into account the child's absences from day care or school due to sore throats. They looked at sleep patterns -- whether the child snored or had trouble breathing at night, and at whether the child had trouble eating solid food. They then compared the child's overall symptoms with the previous year.

For the first six months of the follow up, the kids who underwent tonsillectomy procedures were sick less often. Fevers occurred significantly less during this time but occurred with similar frequency in both groups from six months to two years of follow up.

But every month thereafter, there were no differences between the groups: Kids in the surgery group didn't sleep any better and had no fewer sore throats. In fact, 6% had complications such as bleeding and nausea after the surgery.

However, it's likely the short-term improvement that pleases parents and doctors after tonsil removal, van Staaij notes.

The authors write that surgery marginally reduced the number of episodes of fevers, throat infection, and upper respiratory infections per child per year.

Sicker children in the study -- those with three to six throat infections a year -- got the most benefit from tonsil removal; 50 "watchful waiting" children were allowed to have surgery because of persistent problems, she reports.

No Surprise

"This has been a controversial subject in the U.S. for about 30 years," Glenn Isaacson, MD, chair of otolaryngology at Temple University School of Medicine in Philadelphia, tells WebMD.

Tonsillectomies date back to the days before antibiotics were developed. The surgery made some very sick children "remarkably better," says Isaacson. Tonsil removal actually saved the lives of children with rheumatic fever. But in the 1940s, antibiotics proved to be a less-painful and just-as-effective treatment -- yet many pediatricians still believed in the tonsil removal.

He's not surprised with Staaij's results. Other studies have investigated the benefits of tonsillectomy. In one study of very sick kids, those who got tonsil removal were healthier for two years, compared with those who got antibiotics instead. However, beyond two years, there was no difference between the two groups.

"If a child is not horribly sick from sore throat, it's not worth having [their tonsils] out," Isaacson says. "If tonsils are big, but the child is not sick, can breathe fine at night, and gets a good night's rest, [tonsil removal] is not worth it."

Show Sources

SOURCES: van Staaij, B. BMJ Online First; vol 329. Glenn Isaacson, MD, chair, otolaryngology, Temple University School of Medicine, Philadelphia.
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