Having your tonsils out? The evidence in unclear

Each year, more than half a million children in the United States undergo tonsillectomies – surgery to remove tonsils from the throat.  Typically, doctors decide to remove a child’s tonsils to treat reoccurring throat infections.

But a systematic review this month concluded the surgery is not always beneficial for children or adults. The review, published by the Cochrane Collaboration in November, included seven separate studies – five involving children and two involving adults.

Researchers found that children generally see a small benefit from the surgery. Combining data from the separate studies, they found children who undergo tonsillectomies had, on average, three episodes of sore throat the year following their surgery, compared with 3.6 episodes of sore throat experienced by those who did not have the surgery. (It’s important to note one of the three sore throats in children who had surgery was caused by the surgery itself.) The data also showed that children with more severe or frequent tonsillitis might benefit more from surgery.

In adults, the reviewers did not find enough evidence to determine whether tonsillectomies are effective for individuals with chronic tonsillitis.

At the end of the review, they conclude: “The impact of surgery, as demonstrated in the included studies, is modest. Many participants in the non-surgical group improve spontaneously. The potential ‘benefit’ of surgery must be weighed against the risks of the procedure.” Those risks include pain and discomfort, bleeding, and – in rare cases – death.

Three years ago, the American Academy of Otolaryngology – Head and Neck Surgery published guidelines on when doctors should consider tonsillectomies.  Among their recommendations, they suggest children should have at least seven episodes of throat infection, such as tonsillitis or strep throat in a year, or at least five episodes each year for two years.

The take-home message: Surgically removing tonsils is not always the best course of action for children or adults with chronic sore throats.