Family Practice Vol. 19, No. 6, 707-708
© Oxford University Press 2002
Effectiveness of tonsillectomy? A reply to Howel et al.
Department of Public Health and Epidemiology University of Birmingham Edgbaston Birmingham B15 2TT
Howel et al. refer to my systematic review as evidence for the effectiveness of tonsillectomy in patients meeting criteria for surgery.1 It may help to restate the criteria used in the only controlled trial demonstrating effectiveness. Children had suffered at least seven clinically documented sore throats in the previous year, or five yearly in the two previous years or three yearly in the three previous years. Each documented throat infection should be characterized by at least one of the following clinical features: oral temperature >38.3°C; cervical lymphadenopathy >2 cm; pus seen on the tonsils; a throat culture positive for Streptococcus. It is important that throat infections are documented, because undocumented histories do not predict future throat infection.2 In an unpublished trial, children just failing to meet these criteria showed insufficient benefit to justify surgery.3 Few tonsillectomy patients meet these criteria: only 25% in one survey.4
Perhaps the simplest solution to this problem is to tell patients the truth. A child who meets these strict criteria will probably suffer from 6 throat infections in the next two years. A child who has surgery now will probably suffer from 3 throat infections. In two years there will probably be no difference. Children take one to two weeks to recover from surgery. We do not know if surgery delayed by waiting 3 to 6 months is effective (as is routine in the NHS).
References
1 Howel D, Webster S, Hayes J, Barton A, Donaldson L. The impact of recurrent throat infection on children and their families. Fam Pract 2002; 19: 242–246.
2 Paradise JL, Bluestone CD, Bachman RZ et al. History of recurrent sore throat as an indication for tonsillectomy: Predictive limitations of histories that are undocumented. Nw Engl J Med 1978; 298: 409–413.
3 Marshall T. A review of tonsillectomy for recurrent throat infection. Br J Gen Pract 1998; 48: 1331–1335.[Medline]
4 Marshall T, Anantharachagan A, Chan VGKW, Soo Hoo S, Yeo JCL. How many tonsillectomies are evidence-based? Journal of Clinical Excellence May 2001; 3: 23–25.
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