More than 85 percent of children who have had their tonsils removed, ostensibly due to tonsillitis, may not have needed the surgery and are unlikely to benefit from it, according to a recent study. Researchers analyzed 12 years of medical records for 1.6 million children in the UK, and found that each year, upwards of 32,000 children undergo needless tonsillectomies. Even more surprising, a large number of children who likely needed the surgery were overlooked.
“Most children who had their tonsils removed weren’t severely enough affected to justify treatment,” said study co-author Tom Marshall of the University of Birmingham, in a statement. “While on the other hand, most children who were severely enough affected with frequent sore throats did not have their tonsils removed. The pattern changed little over the 12 year period.”
Tonsillitis is one of the most common conditions diagnosed in children, and tonsillectomies are one of the most commonly performed childhood surgical procedures. But tonsillectomies have been in sharp decline over the past fifty years. In 1965, one million children under the age of 15 had their tonsils removed. By 2006, five hundred thousand. By 2010, a quarter million. The main reason tonsillectomies fell out of vogue is that, although the procedure is not terrible risky, minor to moderate complications (bleeding, breathing difficulty) occur in 1 in 5 children. With rates that high, doctors have become somewhat more conservative in recommending tonsillectomies.
Conservative, but not conservative enough. Marshall and colleagues found that only 11.7 percent of children in the UK had tonsillectomies with “evidence-based implications” (meaning that they had a sufficient number of sore throats, fevers, or other symptoms to clinically justify surgery). About half of the children who had their tonsils removed had reported fewer than five sore throats in one year—far beneath the clinical threshold for surgery.
Meanwhile, the study also suggests that most children who met the clinical criteria for surgery never had their tonsils removed—and they turned out fine. To Marshall, this suggests that perhaps even children who have their tonsils removed do not necessarily need to have it done.
“Children may be more harmed than helped by a tonsillectomy,” he says. “We found that even among severely affected children, only a tiny minority of ever have their tonsils out. It makes you wonder if tonsillectomy ever really essential in any child.”