Abstract
Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.
Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.
Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was –1.2 episodes per person-year (95% CI –1.3 to –1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was –2.8 days per person-year (95% CI –3.9 to –1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was –0.5 episodes per person-year (95% CI –0.7 to –0.3).
Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting
Full Text
The Full Text of this article is available as a PDF (137.3 KB).
Selected References
These references are in PubMed. This may not be the complete list of references from this article.
- Blair R. L., McKerrow W. S., Carter N. W., Fenton A. The Scottish tonsillectomy audit. Audit Sub-Committee of the Scottish Otolaryngological Society. J Laryngol Otol. 1996 Aug;110 (Suppl 20):1–25. [PubMed] [Google Scholar]
- Burton M. J., Towler B., Glasziou P. Tonsillectomy versus non-surgical treatment for chronic / recurrent acute tonsillitis. Cochrane Database Syst Rev. 2000;(2):CD001802–CD001802. doi: 10.1002/14651858.CD001802. [DOI] [PubMed] [Google Scholar]
- Capper R., Canter R. J. Is there agreement among general practitioners, paediatricians and otolaryngologists about the management of children with recurrent tonsillitis? Clin Otolaryngol Allied Sci. 2001 Oct;26(5):371–378. doi: 10.1046/j.1365-2273.2001.00485.x. [DOI] [PubMed] [Google Scholar]
- Donnelly M. J., Quraishi M. S., McShane D. P. Indications for paediatric tonsillectomy GP versus Consultant perspective. J Laryngol Otol. 1994 Feb;108(2):131–134. doi: 10.1017/s0022215100126088. [DOI] [PubMed] [Google Scholar]
- Grobbee D. E., Hoes A. W. Confounding and indication for treatment in evaluation of drug treatment for hypertension. BMJ. 1997 Nov 1;315(7116):1151–1154. doi: 10.1136/bmj.315.7116.1151. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Henteleff P. D., Roos L. L., Jr, Roos N. P. Indications for tonsillectomy: a 4-yr follow-up evaluation. Clin Invest Med. 1981;4(2):123–128. [PubMed] [Google Scholar]
- MCKEE W. J. THE PART PLAYED BY ADENOIDECTOMY IN THE COMBINED OPERATION OF TONSILLECTOMY WITH ADENOIDECTOMY. SECOND PART OF A CONTROLLED STUDY IN CHILDREN. Br J Prev Soc Med. 1963 Jul;17:133–140. doi: 10.1136/jech.17.3.133. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Marshall T. A review of tonsillectomy for recurrent throat infection. Br J Gen Pract. 1998 Jun;48(431):1331–1335. [PMC free article] [PubMed] [Google Scholar]
- Mawson S. R., Adlington P., Evans M. A controlled study evaluation of adeno-tonsillectomy in children. J Laryngol Otol. 1967 Jul;81(7):777–790. doi: 10.1017/s0022215100067694. [DOI] [PubMed] [Google Scholar]
- Mawson S. R., Adlington P., Evans M. A controlled study evaluation of adeno-tonsillectomy in children. J Laryngol Otol. 1968 Nov;82(11):963–979. doi: 10.1017/s0022215100069747. [DOI] [PubMed] [Google Scholar]
- McLeod R. S. Issues in surgical randomized controlled trials. World J Surg. 1999 Dec;23(12):1210–1214. doi: 10.1007/s002689900649. [DOI] [PubMed] [Google Scholar]
- Monroe J. D., Volk V. K. Study of the Effects of 736 Tonsillectomies and of 741 Controls. Am J Public Health Nations Health. 1930 May;20(5):495–502. doi: 10.2105/ajph.20.5.495. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Nieminen P., Tolonen U., Löppönen H. Snoring and obstructive sleep apnea in children: a 6-month follow-up study. Arch Otolaryngol Head Neck Surg. 2000 Apr;126(4):481–486. doi: 10.1001/archotol.126.4.481. [DOI] [PubMed] [Google Scholar]
- Paradise J. L., Bluestone C. D., Bachman R. Z., Colborn D. K., Bernard B. S., Taylor F. H., Rogers K. D., Schwarzbach R. H., Stool S. E., Friday G. A. Efficacy of tonsillectomy for recurrent throat infection in severely affected children. Results of parallel randomized and nonrandomized clinical trials. N Engl J Med. 1984 Mar 15;310(11):674–683. doi: 10.1056/NEJM198403153101102. [DOI] [PubMed] [Google Scholar]
- Paradise Jack L., Bluestone Charles D., Colborn D. Kathleen, Bernard Beverly S., Rockette Howard E., Kurs-Lasky Marcia. Tonsillectomy and adenotonsillectomy for recurrent throat infection in moderately affected children. Pediatrics. 2002 Jul;110(1 Pt 1):7–15. doi: 10.1542/peds.110.1.7. [DOI] [PubMed] [Google Scholar]
- Roos L. L., Jr Alternative designs to study outcomes: the tonsillectomy case. Med Care. 1979 Nov;17(11):1069–1087. doi: 10.1097/00005650-197911000-00001. [DOI] [PubMed] [Google Scholar]
- Roos L. L., Jr, Roos N. P., Henteleff P. D. Assessing the impact of tonsillectomies. Med Care. 1978 Jun;16(6):502–518. doi: 10.1097/00005650-197806000-00007. [DOI] [PubMed] [Google Scholar]
- Roydhouse N. A controlled study of adenotonsillectomy. Arch Otolaryngol. 1970 Dec;92(6):611–616. doi: 10.1001/archotol.1970.04310060083015. [DOI] [PubMed] [Google Scholar]
- Shintani T., Asakura K., Kataura A. The effect of adenotonsillectomy in children with OSA. Int J Pediatr Otorhinolaryngol. 1998 Jun 1;44(1):51–58. doi: 10.1016/s0165-5876(98)00047-0. [DOI] [PubMed] [Google Scholar]
- Van Den Akker E. H., Hoes A. W., Burton M. J., Schilder A. G. M. Large international differences in (adeno)tonsillectomy rates. Clin Otolaryngol Allied Sci. 2004 Apr;29(2):161–164. doi: 10.1111/j.0307-7772.2004.00771.x. [DOI] [PubMed] [Google Scholar]
- de Serres L. M., Derkay C., Astley S., Deyo R. A., Rosenfeld R. M., Gates G. A. Measuring quality of life in children with obstructive sleep disorders. Arch Otolaryngol Head Neck Surg. 2000 Dec;126(12):1423–1429. doi: 10.1001/archotol.126.12.1423. [DOI] [PubMed] [Google Scholar]
- van Staaij Birgit K., Rovers Maroeska M., Schilder Anne G., Hoes Arno W. Accuracy and feasibility of daily infrared tympanic membrane temperature measurements in the identification of fever in children. Int J Pediatr Otorhinolaryngol. 2003 Oct;67(10):1091–1097. doi: 10.1016/s0165-5876(03)00198-8. [DOI] [PubMed] [Google Scholar]
- van Tulder M. W., Assendelft W. J., Koes B. W., Bouter L. M. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine (Phila Pa 1976) 1997 Oct 15;22(20):2323–2330. doi: 10.1097/00007632-199710150-00001. [DOI] [PubMed] [Google Scholar]
- van den Akker E. H., Schilder A. G. M., Kemps Y. J. M., van Balen F. A. M., Hordijk G. J., Hoes A. W. Current indications for (adeno)tonsillectomy in children: a survey in The Netherlands. Int J Pediatr Otorhinolaryngol. 2003 Jun;67(6):603–607. doi: 10.1016/s0165-5876(03)00063-6. [DOI] [PubMed] [Google Scholar]
- van der Graaf Y. Clinical trials: study design and analysis. Eur J Radiol. 1998 May;27(2):108–115. doi: 10.1016/s0720-048x(97)00159-9. [DOI] [PubMed] [Google Scholar]