Obama Children Tonsillitis Debate 2009

I came across a health article in the wall street journal online’s opinion section today commentating on US President Obama’s recent remark whether children should be given a tonsillectomy for a sore throat infection (tonsillitis). President Obama made the remark at a press conference¹ “You come in and you’ve got a bad sore throat, or your child has a bad sore throat or has repeated sore throats,” President Obama explained further saying “The doctor may look at the reimbursement system and say to himself, ‘You know what? I make a lot more money if I take this kid’s tonsils out” So the president of the USA has asked the question should your child have their tonsils taken out (tonsillectomy)?

Tonsillitis – Wait & Watch or Operate

Tonsillectomies are usually performed for recurrent sore throats from infection of the palatine tonsils. President Obama asked the question because a tonsillectomy is relatively easy with low serious risk of 1% are doctors performing tonsillectomies cos they gain more money from  them. Doing some quick scholar googling I found two views. It has been suggested² in children that a tonsillectomy be done after 7 throat infections in the year before surgery or 3 each year for 3 years before surgery with each throat infection documented. However, the procedure has a short term effectiveness of possibly reducing 2 moderate to severe tonsillitis episodes per year for two years post surgery in children who meet the criteria.

In adults would seem to be the same except for one article from Finland³ that found  after 6 months adults had less recurrence of streptococcal pharyngitis. However, it would seem van Staaijand company⁴ believe that:

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

So at then end of the day watch and wait is a good policy except if sore throat infections keep reoccurring every year at least 3 times per year. Then maybe you should discuss having a tonsillectomy.

Reading:

1. WSJ Online “Dr. Obama’s Tonsillectomy – Do Americans want a federal board deciding if their kids need surgery?”
2. A review of tonsillectomy for recurrent throat infection. Br J Gen Pract. 1998 June; 48(431): 1331–1335. T Marshall
3. Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial BMJ, May 2007; 334: 939. Olli-Pekka Alho, Petri Koivunen, Tomi Penna, Heikki Teppo, Markku Koskela, and Jukka Luotonen.
4. Adenotonsillectomy for upper respiratory infections: evidence based? Arch. Dis. Child., Jan 2005; 90: 19 – 25. B K van Staaij, E H van den Akker, G J M G van der Heijden, A G Schilder, and A W Hoes.