Rushing to remove a child's tonsils not such a great idea

The tonsils are masses of tissue at the back of the throat that trap bacteria and viruses a person may breathe in.

Tonsillectomies are one of the most frequently performed surgical procedures for children and it is usually carried out to relieve repeated throat infections and related fevers.

The number of tonsillectomies performed varies widely by country; in 1998, 115 per 10,000 children were performed in the Netherlands, 65 per 10,000 on British children and 50 per 10,000 on American children, which suggests that different indications for surgery are used in each country.

In a study conducted by researchers at the University Medical Centre Utrecht in the Netherlands, it was found that children who avoided surgery had fewer annual visits to doctors and lower resulting medical costs due to fevers and throat infections.

The study involved a group of 151 children randomly assigned to have surgery within six weeks, while another 149 were assigned to watchful waiting, which involved close monitoring and additional interventions as necessary.

Epidemiologist Dr. Erik Buskens, says the surgery resulted in a significant increase in costs without any relevant clinical benefit being realised.

Today far fewer tonsil operations are carried than in the past, and the Dutch team say the study provides evidence that many children who do have the procedure see little, if any benefit.

The study was conducted between 2002 and 2003, and the team excluded children with frequent throat infections or those who had their tonsils removed because of sleep apnoea.

The researchers asked parents to track their children's respiratory track symptoms, measure their temperatures daily and record any costs related to their care.

They found that the annual costs among the group that did not have surgery were about 46% less than for children who had their tonsils removed.

It was also found that the children who avoided surgery had fewer fevers, throat infections and respiratory illnesses.

Additional costs borne by parents such as time off work or other expenses related to their children's illnesses were not included and the research team says, as surgery is cheaper in the Netherlands than in many other countries, the gap between costs and benefits in other Western nations is likely to be greater.

The researchers say that in other countries the cost-effectiveness would be further offset by more costly procedures.

The study is published in the Archives of Otolaryngology - Head and Neck Surgery.