The Tonsillectomy Two-fer: Two Review Articles Addressing Common Clinical Conundrums Regarding This Procedure :

Tonsillectomy is not something we readily recommend anymore but it does have its indications. Yet just when to suggest tonsillectomy may still carry a subjective component as much as an evidence-based approach—at least until this week, when Morad et al, (10.1542/peds.2016-3490) and from the same group Chinnadurai et al. (10.1542/peds.2016-3491) offer two systematic review articles on tonsillectomy and its indications. The first article by Morad et al. focuses on the effectiveness of doing a tonsillectomy or adenotonsillectomy for recurrent throat infections versus just doing watchful waiting.  Seven studies are found that follow the number of infections and sore throats that ensue as a result of both strategies and demonstrate the benefit of tonsillectomy at least for the first year after the procedure was done but interestingly enough without significant differences in quality of  life.  Sadly, longer term outcomes are limited beyond a year and there are some substantive limitations to the 7 studies that met review criteria but at least one can see what the strength of evidence really is for moving forward with this operation. The companion study addressed the question of whether tonsillectomy was effective for obstructive sleep-disordered breathing versus watchful waiting and supportive care. In this case 11 studies met criteria and a meta-analysis could be done in addition to the systematic review.  Again, the follow-up is only a year at best in the articles that met criteria, but tonsillectomy did triumph even more dramatically when used for this predisposing condition.  What can we conclude from both review articles?  In the short term—there may be reasonable evidence for advocating for tonsillectomy certainly for sleep-disordered breathing and possibly for recurrent throat infections and in the longer run, good data is non-existent and probably difficult to swallow. For an up-to date look at the strength of evidence for indications leading to tonsillectomy, read both—you won’t be sore that you did.