Children experience no long-term advantages with tonsillectomy
Although throat infection, utilization and school absences improved in children who received tonsillectomy compared with those who did not, the benefits did not persist longer than the first postsurgical year, according to findings published in Pediatrics.
“Most diagnoses of ‘tonsillitis’ are made without supportive documentation of bacterial testing,” Anna Morad, MD, from the department of pediatrics at Vanderbilt University Medical Center, and colleagues wrote. “Heterogeneity in diagnostic accuracy, establishment of severity, and frequency of infections complicates treatment decisions regarding tonsillectomy and the performance of comparative effectiveness of its treatments.”
To compare the effectiveness of tonsillectomy with watchful waiting in children with recurrent throat infection, two researchers separately screened prior studies against predetermined sleep, cognitive, behavioral and health outcomes data. They used MEDLINE, Embase and the Cochrane Library from January 1980 to June 2016 to assess risk of bias, strength of evidence (SOE) and confidence in the estimate of effects.
Morad and colleagues found that seven studies included children with three or more infections recorded in the previous 1 to 3 years. Number of infections/sore throats lessened from baseline in both children who received tonsillectomy and those who did not.
In these studies, researchers observed greater decreases within 12 months after surgery in sore throat days, clinician contacts, diagnosed group A streptococcal infections and school absences in children who received tonsillectomy. They found these outcomes insufficient for longer term reduction. Regardless of surgery, the investigators saw no difference in quality of life.
“Benefits did not persist over time, and data on longer term results are lacking,” Morad and colleagues wrote. “Additional research to assess longer term benefits of tonsillectomy compared with no surgery, as well as subgroups of children who may experience greater benefit, is needed to inform decision-making for caregivers and clinicians.” – by Savannah Demko
Disclosures: Morad reports no relevant financial disclosures.