Recurrent Throat Infections in Children: Surgery or Watchful Waiting?

Summary and Comment |
January 17, 2017

Recurrent Throat Infections in Children: Surgery or Watchful Waiting?

  1. Deborah Lehman, MD

A systematic review finds that tonsillectomy provides some short-term benefits over watchful waiting for children with mild to moderate throat infections, but it's not clear if the benefits persist.

  1. Deborah Lehman, MD

Recurrent tonsillitis is an indication for tonsillectomy, but the effectiveness of surgery compared with more-conservative watchful waiting is not clear. Many studies examining the benefits of tonsillectomy are challenged by strict definitions of tonsillitis and lack of long-term follow-up data.

These authors conducted a systematic review of studies published over the past 4 decades comparing tonsillectomy with watchful waiting for children with recurrent throat infections. Watchful waiting could include an intervention, such as antibiotics. Seven articles met inclusion criteria for comparative study design, appropriate interventions, and measurement of outcomes. The studies varied in reported outcomes and definition of throat infection. Most children enrolled in the studies had mild or moderate pharyngeal symptoms.

Overall, the four randomized controlled trials demonstrated that children who underwent tonsillectomy had fewer visits for sore throat during the first postoperative year compared with children in the watchful waiting group. Based on assessment of the strength of the evidence for each study, the authors conclude that tonsillectomy provides some short-term benefits over watchful waiting — fewer episodes of sore throat and fewer streptococcal infections —and that there is insufficient evidence to determine whether these benefits persist.

Comment

Parents should be advised that although tonsillectomy may provide some benefit from recurrent sore throats in the first year after surgery, longer-term benefits are less clear. Further studies are needed to identify which children (those with recurrent streptococcal pharyngitis, perhaps?) are likely to benefit most from tonsillectomy.

Editor Disclosures at Time of Publication

  • Disclosures for Deborah Lehman, MD at time of publication Leadership positions in professional societies AAP PREP The Course (Member, Planning Committee)

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