Tonsil removal may not be solution: study

Children who have mild symptoms of throat infections or enlarged tonsils may be better off keeping their tonsils, a new study finds.

Doctors often remove tonsils and adenoids from kids with frequent sore throats or sleep apnea. In 1998, surgery rates for tonsillectomy varied from 115 per 10,000 children in the Netherlands to 50 per 10,000 in the U.S.

But the new study shows that there is little evidence the procedure benefits those with milder symptoms.

To test the best approach for mild cases, Dutch researchers randomly assigned 300 children between ages two and eight to receive either a tonsillectomy or to simply wait and see what happened.

The children all had frequent sore throat problems with upper respiratory infections.

For two years, their parents kept a diary of measures like sore throats, upper respiratory infections, absence from day care or school because of the infections, and quality of life factors such as sleep patterns.

Dr. Anne Schilder, an ear, nose and throat specialist at Wilhelmina Children's Hospital in Utrecht, and her colleagues mainly tracked daily temperatures.

Knowing that parents in the watchful waiting group may be more likely to report symptoms than those in the surgery group, the researchers used ear thermometers that automatically stored data to avoid "information bias."

The team found for the first six months, children who had their tonsils removed were sick less often with fever. About six per cent had complications such as nausea and bleeding after surgery.

From six to 24 months, there was no difference between the two groups.

"The reduction of problems in the first six months might explain why parents and doctors are usually satisfied with [the surgery]," the study's authors wrote in the Sept. 10 issue of BMJ Online First.

Schilder's team concluded sicker children with three to six throat infections a year benefited from tonsil removal, but it had little clinical benefit for mild symptoms.