Keeping tonsils may be better

Removing the tonsils of children with mild or moderate throat infections is more expensive and has fewer health benefits than simply watching and waiting, Dutch researchers say.

In a study involving 300 children aged two to eight years advised to have their tonsils out, those who avoided surgery had fewer annual visits to doctors and lower resulting medical costs due to fevers and throat infections.

"Surgery to remove the tonsils, round masses of lymph tissue embedded in the back of the throat near the soft palate, resulted in a significant increase in costs without realising relevant clinical benefit," said Erik Buskens, an epidemiologist and colleagues at the University Medical Centre Utrecht in the Netherlands, in the Archives of Otolaryngology - Head and Neck Surgery.

Most common surgery for children
Tonsillectomy is one of the most frequently performed surgical procedures for children. Young patients have traditionally had their tonsils removed to relieve repeated throat infections and related fevers.

While doctors today carry out far fewer tonsil operations than in the past, the Dutch study provides evidence that many children who do have the procedure see little, if any benefit.

In their study conducted between 2002 and 2003, 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.

Lower annual medical cost
They found that annual costs among the group which did not have surgery was about 551 euro (about R5 500) per year, about 46 percent less than the 803 euros (R8 000) for children who had their tonsils removed. The children who avoided surgery also had fewer fevers, throat infections and respiratory illnesses.

The researchers did not take into account costs borne by parents in the form of missed days from work or other expenses related to their children's illnesses.

Because the surgery is cheaper in the Netherlands than in many other countries, the gap between costs and benefits in other Western nations is likely greater, they said.

"Compared with other Western countries, our cost estimates may be low," the researchers wrote. "In other settings, the cost-effectiveness would be further offset by more costly procedures." - (Reuters Health)

Read more:
Most tonsillectomies not worth it

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