We studied the efficacy of tonsillectomy, or tonsillectomy with adenoidectomy, in 187 children severely affected with recurrent throat infection. Ninety-one of the children were assigned randomly to either surgical or nonsurgical treatment groups, and 96 were assigned according to parental preference. In both the randomized and nonrandomized trials, the effects of tonsillectomy and of tonsillectomy with adenoidectomy were similar. By various measures, the incidence of throat infection during the first two years of follow-up was significantly lower (P less than or equal to 0.05) in the surgical groups than in the corresponding nonsurgical groups. Third-year differences, although in most cases not significant, also consistently favored the surgical groups. On the other hand, in each follow-up year many subjects in the nonsurgical groups had fewer than three episodes of infection, and most episodes among subjects in the nonsurgical groups were mild. Of the 95 subjects treated with surgery, 13 (14 per cent) had surgery-related complications, all of which were readily managed or self-limited. These results warrant the election of tonsillectomy for children meeting the trials' stringent eligibility criteria, but also provide support for nonsurgical management. Treatment for such children must therefore be individualized.

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Adenoidectomy is well established as a procedure for treating children with recurrent or persistent otitis media. Many physicians also believe that when adenoidectomy is undertaken for otitis media, tonsillectomy also should be done routinely. Thus otitis media serves as the justification for a substantial proportion of the tonsil and adenoid operations carried out on children. Nonetheless, evidence supporting the efficacy of adenoidectomy, or tonsillectomy and adenoidectomy (T&A), for otitis media is scant and inconclusive. Only six prospective studies have been reported, and in all but two of them, the combination of adenoidectomy with tonsillectomy, rather than adenoidectomy alone, was tested. The results were contradictory, perhaps because all of the studies contained flaws in design or methodology or both. Whether adenoidectomy or T&A are efficacious remains entirely uncertain. We are attempting to address the question currently in a prospective study in which children considered at high risk for otitis media are entered into a randomized, controlled clinical trial of adenoidectomy. The trial is complicated by the need to take adequate account of subject variables such as age, sex, adenoid size, and the presence or absence of allergy, and of the important treatment variable of concomitant myringotomy with tympanostomy tube insertion. Outcome measurements employed in the trial include the number of episodes per year of acute otitis media, the persistence of middle ear effusion, and the frequency of subsequent myringotomy. Data thus far collected in the study are not sufficient to reach a conclusion for or against the efficacy of adenoidectomy for otitis media, but it is apparent that adenoidectomy by no means eliminates the problem.