Most Child Tonsillectomies Unnecessary, Study Finds

Nov. 9, 2018 -- Seven out of 8 children in the United Kingdom who have their tonsils removed are unlikely to benefit from the surgery, a study found.

But many children who could benefit from a tonsillectomy are not having the surgery, say researchers from the University of Birmingham.

Recurrent or chronic sore throat is the most common reason for getting a tonsillectomy. Evidence shows that the surgery results in modest, short-term reductions in recurring, severe sore throats in children aged 3 to 15, but not in those with milder symptoms.

U.K. guidelines say a child should have a tonsillectomy if he or she has had seven or more sore throats in a year, five or more in each of the previous 2 years, or three or more in each of the last 3 years.

Plus, the children with sore throats should also have swollen lymph nodes, an abscess behind the tonsil, fevers, or strep throat.

The NHS performed about 37,000 tonsillectomies on children from April 2016 to March 2017, at a cost of £42 million (about $54.5 million).

Study of U.K. Medical Records

The researchers studied more than 1.6 million electronic medical records of children up to 15 years old who were registered with 739 U.K. doctors' offices.

Out of 18,281 children who had their tonsils removed between 2005 and 2016, only 2,144 (11.7%) had evidence-based reasons for the surgery.

Of those who had the surgery without a reason based on evidence, 12.4% had only five to six sore throats in a year; 44.7% reported two to four sore throats in a year; and 9.9% had one sore throat in a year. Other reasons for surgery were problems breathing while sleeping (12.3%) or obstructive sleep apnea (3.9%).

The findings of the study suggest that 32,500 children underwent needless tonsillectomies.

Children Who Might Benefit 'Missing Out'

The data also suggest that many children who might benefit from tonsillectomy were not having the procedure. The researchers found that out of 15,760 children who had records showing symptoms, only 2,144 (13.6%) went on to have a tonsillectomy.

Reaction to the Study

Commenting on the research, UK ENT says surgeons use evidence from a number of sources including the referral letter from the child’s doctor and a careful history obtained from the child’s parents when making a decision whether a child should be offered surgery.

It said the procedure carried a significant risk of bleeding that could require emergency surgery, while pain control could lead to another hospital stay.