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Tonsillectomies ‘better than drugs’

By Lilian Anekwe

Tonsillectomies have clear clinical benefits over medical management of tonsillitis that persist for at least two years, according to an NHS-funded evaluation.

The randomised controlled trial, conducted as part of a Health Technology Assessment, found children achieve better clinical outcomes if they have their tonsils removed, and the researchers encouraged GPs to consider tonsillectomies, particularly in children or parents who have a strong preference for surgery.

The number of tonsillectomies carried out has dropped sharply since a Government review in 1999 concluded up to a quarter of the procedures were performed needlessly.

Since then the number of tonsillectomies performed has fallen by 12% from 66,000 in 1999-2000 to 58,000 in 2008-2009, and are likely to become even more restricted.

Researchers randomised 729 children aged 4 to 15 years with recurrent sore throats to either surgical management or conventional non-surgical management by a GP.

Tonsillectomy reduced the likelihood of children having an episode of sore throat by 30% in the first year and 46% in the second year, and also reduced the mean number of sore throats by 33% in the first year and 73% in the second year, compared to medical management.

The mean number of GP consultation for sore throats was also lower in children who opted for surgical management (see box).

The researchers also estimated that £261 could be saved per episode of sore throat avoided through surgery – and said their evidence called into question the NHS’ policy of limiting tonsillectomies on cost grounds.

Dr Catherine Lock, lecturer in public health at Newcastle University led the study and told Pulse her research should prompt a rethink of Government policy.

‘Patients still have a very strong preference for surgery. This adds to the evidence that there is some benefit from tonsillectomies and contributes to the debate that cutting costs by preventing tonsillectomies may not be the best thing to do. Certainly my specialist ENT colleagues still see it is a worthwhile thing to do.’

Dr Rakesh Chopra, a GPSI in ENT in St Helen’s, Merseyside, said GPs were often confused about who to refer for tonsillectomies.

‘A GP will refer if they are children are coming to see them frequently or if parents are pushy. There is only very loose guidance for GPs to use and not all of them are familiar with referral criteria.’

Tonsillectomies ‘better than drugs’, say researchers