December 2004

Removing tonsils has little benefit, researchers find

Surgical removal of the tonsils and adenoids (adenotonsillectomy) in children with mild symptoms of throat infections or enlarged tonsils and adenoids has no major benefits over watchful waiting, finds a new study published by the British Medical Journal).

Adenotonsillectomy is a common procedure in children in western countries, yet evidence of its benefits in children with milder symptoms is lacking. Researchers in the Netherlands monitored 300 children aged 2‑8 years with recurrent throat infections or enlarged tonsils and adenoids. Half were allocated to surgery and half to watchful waiting. All children were monitored over two years.

During the first six months, surgery marginally reduced the number of episodes of fever, throat infections, and upper respiratory tract infections. But from six to 24 months, there was no difference between the groups.

The authors conclude that adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or enlarged tonsils and adenoids.

According to the Department of Otolaryngology of University of Texas Medical Branch (UTMB), as of 1996, approximately 200,000‑300,000 adenotonsillectomies were performed each year. Because many are performed as outpatient surgery, however, it is difficult to know the exact number of surgeries being performed. At that time, the UTMB researchers estimated that annual expenditures for tonsil and adenoid surgery in the United States probably exceeded half a billion dollars.

SOURCE: "Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial," British Medical Journal, September 10, 2004.