Conflicting Study Results
With their retrospective survey following tonsillectomy, the authors' aim was to evaluate the health benefit of this surgical procedure and they reached the conclusion, after time intervals of 14 months and 7 years, that tonsillectomy “was associated with a long-lasting improvement of health and quality of life, and with lower utilization of medical resources” (1). However, why were unoperated patients with the same symptoms not also surveyed? A control group is a basic requirement when evaluating treatment, particularly if the remission rate under conservative treatment is high. Even proponents of surgery report that tonsillectomy is no longer indicated in up to 27% of cases after a waiting period of 9 months (2).
A Cochrane meta-analysis on tonsillectomy compared with conservative treatment in chronic recurrent tonsillitis was not cited (3). Despite a reduction in the number of episodes of sore throat following tonsillectomy, they concluded that: “The size of the effect is modest [...]. It is clear that some children get better without any surgery, and that whilst removing the tonsils will always prevent ‘tonsillitis', the impact of the procedure on ‘sore throats' due to pharyngitis is much less predictable” (3). A randomized controlled study, cited by the authors as confirmation, also arrives at a no more favorable conclusion: “The modest benefit conferred by tonsillectomy or adenotonsillectomy in children moderately affected with recurrent throat infection seems not to justify the inherent risks, morbidity, and cost of the operations” (4). The authors neither discuss these conflicting statements, nor do they attenuate the validity of their survey with the drop-out-rate of almost 40%, which represents a strong bias.
Dr. med. Gerd Reuther
|1.||Senska G, Atay H, Pütter C, Dost P: Long-term results from tonsillectomy in adults. Dtsch Arztebl Int 2015; 112: 849–55 VOLLTEXT|
|2.||Woolford TJ, Ahmed A, Willatt DJ, et al.: Spontaneous resolution of tonsillitis in children on the waiting list for tonsillectomy. Clin Otolaryngol Allied Sci. 2000; 25: 428–30 CrossRef MEDLINE|
|3.||Burton MJ, Glasziou PP: Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 2009; (1): CD001802 CrossRef CrossRef|
|4.||Paradise JL, Bluestone CD, Colborn DK, et al.: Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics 2002; 110: 7–15 CrossRef MEDLINE|