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Tonsillectomy not the best option always

The removal of tonsils of children with recurrent throat infections may not be as effective as thought earlier.

Tonsillectomy not the best option always

The removal of tonsils of children with recurrent throat infections may not be as effective as thought earlier. Tonsillectomy is one of the most common surgical procedures to remove round masses of lymphoid tissue at the back of the throat, performed on children to relieve repeated throat infections and related fevers. Many people believe that the procedure is expensive and not worth the ordeal when compared to the few benefits it provides. At times, the cost incurred on performing the surgery outweighs the health benefits of the surgery. The absolute indications for tonsillectomy include:
  • Enlarged tonsils that cause upper airway obstruction, severe difficulty in swallowing, sleep disorders (like sleep apnoea), or heart / lung complications
  • Peritonsillar abscess unresponsive to medical management and surgical drainage, unless surgery is performed during acute stage
  • Tonsillitis resulting in febrile convulsions
  • and Tonsils requiring a biopsy to define tissue pathology.
The relative indications for tonsillectomy include the following:
  • Three or more tonsil infections per year despite adequate medical therapy
  • Persistent foul taste or breath due to chronic tonsillitis that is not responsive to medical therapy
  • Chronic or recurrent tonsillitis in a streptococcal carrier not responding to beta-lactamase-resistant antibiotics
  • and Tonsil hypertrophy on one side that is presumed to be cancerous.
To evaluate the benefits of tonsillectomy, researchers at the University Medical Centre, Utrecht, in the Netherlands, conducted a study involving 300 children aged 2 to 8 years, who had been advised to have their tonsils removed. The parents of these children were asked to track their children's symptoms, measure their temperatures daily and record any costs related to their care. Out of these, children who had frequent throat infections and those with suspected obstructive sleep apnea were excluded. The results showed that surgery to remove the tonsils resulted in a significant increase in costs without realising relevant clinical benefit. Out of the study participants, those who avoided surgery had fewer annual visits to doctors and lower resulting medical costs due to fevers and throat infections. It was found that the annual costs among the group which did not have surgery was about 46 percent less than for children who had their tonsils removed. The children who avoided surgery also had fewer fevers, throat infections and respiratory illnesses. This study provides evidence that many children who undergo tonsillectomy see little, if any benefit, when compared to the cost incurred on the surgery.
Archives of Otolaryngology – Head and Neck Surgery,
November 2007
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