Tonsillectomy improved throat infections in short-term, review finds

Children who had their tonsils taken out had fewer throat infections and missed fewer school days than those who didn't have the surgery for recurrent sore throats, according to new review of research.

Tonsillectomy in children is mainly done for recurrent inflammation of the tonsils and obstructive sleep apnea — short pauses in breathing during sleep that can lead to snoring and restless sleep.

Tonsillectomy was one of the top 10 most common inpatient surgeries in some provinces and territories in 2013-2014, according to the Canadian Institute for Health Information.   About 14,000 of the surgeries are performed in Ontario alone every year. 

Now researchers in the U.S. have done a systematic review on tonsillectomy versus watchful waiting.

In Tuesday's issue of the journal Pediatrics, Dr. Siva Chinnadurai of Vanderbilt University Medical Center  in Nashville, Tenn., and his team focused on studies that involved children with a three or more throat infections in the previous one to three years.

Overall, they found children who had tonsillectomy showed fewer clinician visits and fewer missed days of work or school in the year after surgery compared with children who did not receive surgery.

"Tonsillectomy can produce short-term reduction in throat infections compared with no surgery in children with three or more throat infections in the previous one to three years," the reviewers concluded.

But definitions of severity are somewhat arbitrary, the researchers said. Until the natural history of throat infections in childhood is better understood, it may be difficult to find consistency.

Guidelines say a tonsillectomy to treat throat infections is justified if a child had seven or more sore throats during the previous year; five or more sore throats two consecutive years, or three or more sore throats for three years in a row. 

Chinnadurai said the researchers decided to review whether the throat infection guidelines were too strict. 

Quality-of-life benefits

The long-term effects on growth, development of quality-of-life aren't clear in the literature, the reviewers said.

In a companion study, the same researchers looked at whether children with obstructive sleep-disordered breathing improved after tonsillectomy.  They did find better sleep outcomes among those who had surgery.

The latest review lends support to considering the surgery for more individuals, said Dr. Alyssa Hackett, an otolaryngologist with the Icahn School of Medicine at Mount Sinai in New York City. Hackett was not involved in the research.

"If you need your appendix out, you need your appendix out," Hackett said. "But for the tonsils and adenoids, there are great quality-of-life benefits that are evident for the surgery, but no child has ever died because they haven't gone through the surgery." (Adenoids, glands at the roof of the mouth, are often removed along with tonsils.)

No procedure is risk-free. About 3 per cent of kids who have the procedure experience bleeding during the two-week recovery period, Hackett said.

A 2014 Cochrane Review also concluded that tonsillectomies lead to a reduction in sore throats in children in the first year after surgery, but the size of the effect was modest.

The project was funded by the Agency for Healthcare Research and Quality and the U.S. National Institutes of Health.