Research Finds Vast Majority of Tonsillectomies Are Unnecessary

Researchers at the University of Birmingham (UB; United Kingdom) conducted a retrospective cohort study of the electronic medical records of 1,630,807 children (0–15 years of age) in order determine indications for tonsillectomy and the proportion of those meeting evidence-based criteria. These included sore throats of sufficient frequency and severity, periodic fever, aphthous stomatitis, pharyngitis, cervical adenitis syndrome (PFAPA) or tonsillar tumor; other indications were considered non-evidence-based. The number of children subsequently undergoing tonsillectomy was then identified.

The results revealed that only 11.7% of children in the United Kingdom had evidence-based indications, and that the proportion of evidence-based tonsillectomies was unchanged over a 12 year period. Most childhood tonsillectomies followed non-evidence-based indications, including five to six sore throats during one year (12.4%), two to four sore throats during one year (44.6%), sleep disordered breathing (12.3%), or obstructive sleep apnea (3.9%). Of the 15,764 children who had sufficient sore throats to undergo a tonsillectomy, only 13.6% actually had one. The study was published on November 5, 2018, in the British Journal of General Practice.

“Our research showed that most children who had their tonsils removed weren't severely enough affected to justify treatment, while on the other hand, most children who were severely enough affected with frequent sore throats did not have their tonsils removed,” said senior author Professor Tom Marshall, MSc, PhD. “Children may be more harmed than helped by a tonsillectomy. We found that even among severely affected children only a minority ever have their tonsils out. It makes you wonder if tonsillectomy ever really essential in any child.”

Tonsillectomy is a 3,000-year-old surgical procedure in which the tonsils are removed from either side of the throat. The procedure is performed in response to cases of repeated occurrence of acute tonsillitis or adenoiditis, obstructive sleep apnea (OSA), nasal airway obstruction, snoring, or peritonsillar abscess. Tonsillectomy is often performed together with adenoidectomy, the surgical removal of the adenoids; this may be done for several reasons, including impaired breathing and chronic infections or earaches.

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