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Tonsillectomy for sore throats


Tonsillectomy is a common operation, with over 70,000 being carried out every year. The main reason for doing it is to prevent recurrent throat infection - either tonsillitis or pharyngitis. How well does tonsillectomy work?

Review

A systematic review [1] searched widely and obtained some unpublished information. The entry criteria were participants suffering from recurrent throat infections, the operation was tonsillectomy or adeno-tonsillectomy, and studies needed to be randomised.

Results

Five studies were found, two of which had strict entry criteria related to frequency of throat infections and defining features of a throat infection. The other three had less explicit criteria. No trial included children over 15 years.

The main outcome was that of incidence of throat infection during two years of follow up. For all throat infections the results for years 1 and 2 are seen in the Figure. Over the two years, tonsillectomy meant avoiding 2.3 to 3.6 throat infections. Of these infections, perhaps 10-30% would be likely to be moderate or severe. More infections occurred in control groups in the first than in the second year. One study had a three year follow up, by which time the benefits of tonsillectomy had been lost. There was no statistical significance in school days lost between treated children and controls.

Comment

Four of these trials were conducted over 10 years ago, and three about 30 years ago, though that need not diminish their value. Tonsillectomy is itself not without adverse effects. These include post-operative bleeding (though new laser techniques may avoid that), as well vomiting and fever.

Any decision on tonsillectomy should not be taken lightly, and must be a balance between possible benefits and harms. Maybe there is work being done to define the benefits and harms more clearly than in the past. We'd love to see it.


Reference:

  1. T Marshall. A review of tonsillectomy for recurrent throat infection. British Journal of General Practice 1998 48: 1331-5.



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