Tonsillectomy for Chronic or Recurrent Tonsillitis

A Cochrane review [Abstract] 1 included 7 studies, 5 undertaken in children (n=987) and 2 in adults (n=156). Good information about the effectiveness of adeno-/tonsillectomy is only available for the first year following surgery in children and for a shorter period (5 to 6 months) in adults.

• Data on children: those who had an adeno-/tonsillectomy had an average of 3 episodes of sore throats (of any severity) in the first postoperative year, compared to 3.6 episodes in the control group; a difference of 0.6 episodes (95% CI -1 to -0.1). When only episodes of moderate/severe sore throat were analysed, children who had been more severely affected and had adeno-/tonsillectomy had on average 1.1 episodes of sore throat in the first postoperative year, compared with 1.2 episodes in the control group. Less severely affected children had more episodes of moderate/severe sore throat after surgery (1.2 episodes) than in the control group (0.4 episodes: difference 0.8, 95% CI 0.7 to 0.9). In the first year after surgery children undergoing surgery had an average of 18 days of sore throat, compared with 23 days in the control group (difference 5.1 days, 95% CI 2.2 to 8.1).
• Data on adults: there were 3.6 fewer episodes (95% CI 7.9 fewer to 0.70 more) in the group receiving surgery within 6 months post-surgery. The pooled mean difference for number of days with sore throat in a follow-up period of about 6 months was 10.6 days fewer in favour of the group receiving surgery (95% CI 5.8 fewer to 15.8 fewer).
• Limited data are available from the included studies to quantify the important risks of primary and secondary haemorrhage.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in results in different populations) and by indirectness (differences in the studied patients, short follow-up for adults).

References

• Burton MJ, Glasziou PP, Chong LY et al. Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis. Cochrane Database Syst Rev 2014;11():CD001802. [PubMed].