I came across a health article in the wall street journal online’s opinion section today commentating on US President Obama’s recent remark asking whether children should be given a tonsillectomy for a sore throat infection (a.k.a tonsillitis). Why would Obama says this you may ask?
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?
Tonsillitis: Should You Wait & Watch or Operate?
The surgical procedure of having your tonsils taken out is called a tonsillectomy. This type of throat surgery are usually performed for recurrent sore throats from infection of the palatinetonsils.
President Obama asked the question if your child should have this type of surgery because a tonsillectomy is relatively easy with low serious risk rate of 1%, but, are doctors performing them because they gain more money from performing them?
Doing some quick scholar googling I found two views. It has been suggested² that a tonsillectomy in children be done after 7 throat infections in the year or 3 each year for 3 years before surgical treatment be considered, with each throat infection documented. However, the procedure has a short-term effectiveness of possibly only reducing two moderate to severe tonsillitis infection episodes per year for two years post-surgery in children who meet the criteria.
In adults would seem to be the same criteria for a requiring a tonsillectomy except for one article from Finland³ that found after six 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
The NHS website says that for children with mild sore throats, watchful waiting is recommended rather than a tonsillectomy. However, there are exceptions except if sore throat infections keep reoccurring every year at least 3 times per year. Then maybe you should discuss having a tonsillectomy with your doctor or paediatrician.
- WSJ Online “Dr. Obama’s Tonsillectomy – Do Americans want a federal board deciding if their kids need surgery?”
- A review of tonsillectomy for recurrent throat infection. Br J Gen Pract. 1998 June; 48(431): 1331–1335. T Marshall
- 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.
- 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.