09 Nov Tonsillectomy Often Done When Not Indicated (and vice versa!)
A pair of tonsils after surgical removalWikipedia image[/caption] Tom Marshall, MSc, PhD, MRCGP, FFPH Professor of public health and primary care Institute of Applied Health Research University of Birmingham, Birmingham, UK MedicalResearch.com: What is the background for this study? Response: Tonsillectomy is one of the most common childhood surgical procedures. There are two main indications: recurrent sore throat and sleep-related breathing problems (including obstructive sleep apnoea). Jack Paradise’s 1984 study made clear tonsillectomy is modestly effective in children with frequent, severe sore throats: seven in one year, or five yearly in two successive years, or three yearly in three successive years. Sore throats must have symptoms: fever, pus seen on tonsils, lymphadenopathy or confirmed Streptococcal infection. With surgery, children average two sore throats in the next year, without surgery, three. Two years later there is no difference. Further research shows the benefits are too tiny to justify surgery in children with less frequent, less severe or undocumented sore throats. Subsequent randomised controlled trials have not changed the evidence. There isn’t enough good evidence to support surgery in children with obstructive sleep apnoea or sleep related breathing problems. Tonsillectomy is not a trivial procedure, about 2% are readmitted with haemorrhage and about 1 in 40,000 dies. Childhood tonsillectomy is linked to risk of adult autoimmune diseases. It is important to be sure tonsillectomy is only undertaken in children where there are evidence-based indications.














Dr. Staud[/caption]
Roland Staud, M.D.
Professor of Medicine
University of Florida
Gainesville, FL
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Fatigue after exertion or sleep loss is normal. However, fatigue at rest is not. Resting fatigue is reported by cancer, heart disease, RA, SLE patients and patients with chronic fatigue syndrome (CFS). CFS has been mostly associated with chronic infections but findings are inconsistent. We hypothesized that chronic fatigue is signaled by sensitized tissue receptors to the CNS where minute amounts of muscle metabolites can activate these receptors (metabo-receptors). Why the receptors are sensitized is unclear. To test our hypothesis we injected CFS patients with lidocaine or normal saline into muscles once. We saw a statistical improvement of overall fatigue (27%) with lidocaine compared to saline.
Conclusion: Chronic fatigue syndrome patients are using metabo-receptors for inappropriately signaling fatigue to the CNS.