Tonsillectomy May Benefit Children with Recurrent Tonsillitis

According to a recent study published online in the journal Pediatrics, for children who suffer mild to moderate, recurrent throat infections, tonsillectomy may provide more short-term benefits than watchful waiting does. However, it remains unclear as to whether these benefits persist over time.

“Overall, children undergoing tonsillectomy to improve number of sore throats/throat infections, associated health care utilization (clinician visits), and days of work/school missed had improvements in these outcomes in the first postsurgical year compared with children not receiving surgery,” write Anna Morad, MD, from Vanderbilt University, Nashville, Tennessee, and colleagues.

Although recurrent tonsillitis in children is a primary indication for tonsillectomy, the effectiveness of this procedure compared with watchful waiting is uncertain. Clinicians are challenged to assess the effectiveness of these treatments because of factors such as variability in diagnostic accuracy of tonsillitis and establishment of its severity, both of which may be used to determine tonsillectomy eligibility.

Therefore, Dr. Morad and colleagues conducted a systematic review of studies that were published over the past 4 decades, to examine sleep, cognitive, behavioral, and health outcomes in children with recurrent throat infections who underwent tonsillectomy, and to compare them with outcomes in children who were treated by watchful waiting (which could include treatment such as antibiotics).

Their systematic review of the medical literature found seven articles that met the criteria for this comparative study. According to the authors, most children included in these studies had a history of mild to moderate throat infection (at least three episodes of sore throat in the previous 1 to 3 years before surgery).

Four of the publications reported data from randomized controlled trials, showing that children who underwent tonsillectomy had fewer medical visits due to sore throat during the first year after surgery than children in the watchful waiting group had.

In three studies, the authors also found that tonsillectomy was more beneficial than watchful waiting in improving the number of episodes of sore throat and group A streptococcal throat infections, associated health care utilization, days of work or school missed, and quality of life in the first year after surgery.

However, although the results showed effectiveness of tonsillectomy over watchful waiting in the short-term, Dr. Morad and colleagues acknowledge that these benefits did not persist over time. They emphasize that “the literature is largely silent on the natural history of throat infections that would provide a basis for the need for tonsillectomy in the long term.”

They stress that long-term data are needed to improve treatment decision making. Parents need to weigh the benefits as well as the risks of surgery against the benefits and drawbacks of managing their child’s tonsillitis episodes over time to see if the child will outgrow the tonsillar problem with age, and therefore, avoid surgery.

“Additional research to assess longer-term benefits of tonsillectomy compared with no surgery, as well as subgroups of children who may experience greater benefit, is needed to inform decision-making for caregivers and clinicians,”

Noting that the literature lacks a consistent, consensus definition of tonsillar infection, they also conclude that defining this term consistently is critical for promoting synthesis of research in the area.

Dr. Parry graduated from the University of Liverpool, England in 1997 and is a board-certified veterinary pathologist. After 13 years working in academia, she founded Midwest Veterinary Pathology, LLC where she now works as a private consultant. She is passionate about veterinary education and serves on the Indiana Veterinary Medical Association’s Continuing Education Committee. She regularly writes continuing education articles for veterinary organizations and journals, and has also served on the American College of Veterinary Pathologists’ Examination Committee and Education Committee.