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Most Tonsillectomies Aren't Worth It

Study finds 'watchful waiting' just as effective

FRIDAY, Sept. 10, 2004 (HealthDayNews) -- A tonsillectomy is no better than watchful waiting for children who have mild throat infections or minor breathing problems due to enlarged tonsils and adenoids, a new Dutch study finds.

There was a "marginal" reduction in episodes of fever and infections in 150 children with mild symptoms in the first six months after they had a tonsillectomy, compared to a matched group of 150 children who didn't have the surgery. But there was no difference between the two groups during the next 18 months, the study by doctors at Wilhelmina Children's Hospital in Utrecht found.

The study appears in the Sept. 11 issue of the British Medical Journal.

"This paper validates our practice in the United States of being more conservative about tonsillectomy," said Dr. Scott R. Schoem, director of otolaryngology at Connecticut Children's Medical Center in Hartford and a spokesman for the American Academy of Pediatrics.

The number of tonsillectomies performed in the United States has declined significantly over the past three decades, from more than 1 million a year in the 1970s to about 250,000 a year now, Schoem said.

But "in the Netherlands, doctors and patients have a preference for surgical management of recurrent upper respiratory infections," said study author Dr. Anne G.M. Schilder, an otorhinolaryngologist at the hospital.

She said she preferred to counsel parents that "the natural course of upper respiratory tract infections is generally favorable. Parents should be instructed in giving their child adequate analgesics [painkillers] or inflammatory drugs in case of pain and fever. They also should monitor their children for an irregular course of infection or obstructive symptoms."

There are cases in which surgery is necessary, Schoem said. It can be done for a child with sleep apnea, in which the tonsils and adenoid are so large they interfere with breathing at night, causing heavy snoring and frequent interruptions of sleep.

The frequency and severity of infections can also indicate the need for surgery, Schoem said. His benchmark is six infections in a single year, or three to four a year for at least three years.

"But there are certain cases where I recommend surgery for people who don't meet those numbers," Schoem said. "If the infections get more frequent or severe over time, or there are more symptoms that last longer, I might recommend surgery."

Antibiotics might help stave off surgery, Schilder said, although "research has shown that the effectiveness of antibiotics in children with recurrent sore throat is limited."

Schoem said, "Sometimes I would recommend a month to six weeks of oral antibiotics, then wait to see what happens."

But the attitude toward surgery in the United States clearly has changed from the past, he said, when "if your sister was going in for a tonsillectomy, you would go in, too."

More information

For more on tonsillectomy, visit the National Library of Medicine.

SOURCES: Scott R. Schoem, M.D., director, otolaryngology, Connecticut Children's Medical Center, Hartford; Anne G.M. Schilder, M.D., Ph.D, otorhinolaryngologist, Wilhelmina Children's Hospital, Utrecht, the Netherlands; Sept. 11, 2004, British Medical Journal
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