Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

This article compares recent paediatric and adolescent (adeno)tonsillectomy (T +/- Ads) rates in several countries of the European Union, the US, Canada and Australia. Trends in paediatric and adolescent surgical rates in the Netherlands and UK from 1974 to 1998 are studied as well. In 1998, the paediatric T +/- Ads rate varied from 19 per 10000 children in Canada to 118 per 10000 in Northern Ireland, while the adolescent rate varied from 19 per 10000 adolescents in Canada to 76 per 10000 in Finland. In the Netherlands, the paediatric T +/- Ads rate decreased rapidly between 1974 and 1985 and remained similar since. Ten years later, between 1985 and 1998, the adolescent T +/- Ads rate increased. In the UK, on the other hand, an increase in T +/- Ads was observed both in children and in adolescents. This study shows that paediatric and adolescent T +/- Ads rates still vary considerably between countries. There is no definitive evidence that decreasing rates of T +/- Ads in childhood are associated with tonsil-related disease, necessitating surgery, in later life.

Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution. Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was 21.2 episodes per person-year (95% CI 21.3 to 21.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was 22.8 days per person-year (95% CI 23.9 to 21.6). For upper respiratory infections 1596 personyears were available. The pooled risk difference was 20.5 episodes per person-year (95% CI 20.7 to 20.3). Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting

The prevalence of potential respiratory pathogens on the tonsillar surface of children with moderate symptoms of recurrent tonsillopharyngitis and/or tonsillar hypertrophy differs only slightly from that in children without symptoms of adenotonsillar disease. Variations in the microbial flora do not seem to play an essential role in the predisposition of these children to tonsillar disease.

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