Tonsillectomy
with or without adenoidectomy, is a common operation, but the indications for
surgery are controversial. A Cochrane updated review by Burtton et al. of randomized
controlled trials assessed the effectiveness of tonsillectomy (with and without
adenoidectomy) in children and adults with chronic/recurrent acute tonsillitis
in reducing the number and severity of episodes of tonsillitis or sore throat.
The
review includes seven trials; five in children (987 participants) and two in
adults (156 participants). The
authors concluded that adeno-/tonsillectomy leads to a reduction in the number
of episodes of sore throat and days with sore throat in children (5.1 fewer
days) in the first year after surgery compared to non-surgical treatment.
Children who were more severely affected were more likely to benefit as they
had a small reduction in moderate/severe sore throat episodes.
In
adults there were 3.6 fewer episodes (95% CI 7.9 fewer) in the group receiving
surgery within six months post-surgery. The pooled mean difference for number
of days with sore throat in a follow-up period of about six months was 10.6
days fewer in favor of the group receiving surgery (95% CI). Given the short
duration of follow-up and the differences between studies, the authors considered
the analysis found the evidence for adults to be of low quality. They concluded
that insufficient information is available on the effectiveness of
adeno-/tonsillectomy versus non-surgical treatment in adults to draw a firm
conclusion.
The authors concluded that potential 'benefit' of surgery must be weighed against the risks
of the procedure as adeno-/tonsillectomy is associated with a small but
significant degree of morbidity in the form of primary and secondary
haemorrhage and, even with good analgesia, and is particularly uncomfortable
for adults.
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