Tonsillectomy Often Done When Not Indicated (and vice versa!)

MedicalResearch.com Interview with:

A pair of tonsils after surgical removal Wikipedia image

A pair of tonsils after surgical removal
Wikipedia image

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.

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Role of Steroids Post Tonsillectomy Explored

MedicalResearch.com Interview with:
Sayaka Suzuki, MD
Department of Clinical Epidemiology and Health Economics, School of Public Health, Faculty of Medicine, Department of Otolaryngology–Head and Neck Surgery, University of Tokyo, Tokyo, Japan

Medical Research: What are the main findings of the study?

Dr.  Suzuki: We found a slight increase in the risk of severe bleeding requiring surgery for hemostasis in children who were administrated intravenous steroid on the day of tonsillectomy.

Physicians should carefully make a decision to use steroids, taking into account patients’ choice under being well informed on the risks and benefits of steroid use.
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Smaller Kids Gain Weight After Tonsillectomy, But No Increase In Obesity

Kay W. Chang, MD Associate Professor of Otolaryngology and Pediatrics Stanford University Department of Otolaryngology Lucile Packard Children's Hospital at Stanford Division of Pediatric OtolaryngologyMedicalResearch.com Interview with:
Kay W. Chang, MD
Associate Professor of Otolaryngology and Pediatrics
Stanford University
Department of Otolaryngology
Lucile Packard Children’s Hospital at Stanford
Division of Pediatric Otolaryngology

MedicalResearch: What are the main findings of the study?

Dr. Chang: At 18 months after surgery, weight percentiles in the study group increased by a mean of 6.3 percentile points, and body mass index percentiles increased by a mean of 8.0 percentile points. The greatest increases in weight percentiles were observed in children who were between the 1st and 60th percentiles for weight and younger than 4 years at the time of surgery. An increase in weight percentile was not observed in children who preoperatively were already above the 80th percentile in weight.
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Tonsillectomy: Substantial Variability in Pediatric Hospital Care

MedicalResearch.com Interview with:
Dr. Sanjay Mahant, MD, FRCPC Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, CanadaDr. Sanjay Mahant, MD, FRCPC
Division of Pediatric Medicine, Pediatric Outcomes Research Team (PORT), Department of Pediatrics, Institute of Health Policy, Evaluation and Management, University of Toronto, Child Health Evaluative Sciences, Research Institute, Hospital for Sick Children, Toronto, Canada

MedicalResearch.com: What are the main findings of the study?

Dr. Mahant: In a large cohort of children undergoing same-day tonsillectomy at 36 children’s hospitals in the U.S., we observed substantial variability in several areas. These include: processes of care, the use of steroids and antibiotics – for which there are national guidelines that outline the recommended use of these medications – and outcomes of usage, as well as revisits to hospital after surgery for complications within 30 days following surgery.
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