By JASON HIDALGO
Gannett News Service

Tonsil and adenoid removal has long been used to treat children with a history of recurrent throat infections. Removal may not be justified, however, if those infections don’t meet strict standards for frequency and severity, according to a recent study.

The study, funded largely through a grant from the National Institutes of Health, involved more than 300 children and was performed at the Children’s Hospital of Pittsburgh. The results appear in the July issue of the journal Pediatrics.

“The modest benefit conferred by tonsillectomy and adenotonsillectomy in children moderately affected by throat infections does not seem to justify the risks and cost of having the operations,” says Dr. Jack Paradise, professor of pediatrics at the University of Pittsburgh School of Medicine.

The study is a follow-up to an earlier study done at the children’s hospital at 1971, which lasted more than a decade and was published in the New England Journal of Medicine in 1984. In that study, researchers found that children who met strict standards had significant benefits from tonsillectomy.

The first study, however, left two key questions unanswered, Paradise said. Although it showed that children who met strict standards benefited from tonsillectomy, it didn’t show whether children who met less strict standards would have the same benefits, as well. It also didn’t answer the question of whether removing the adenoids — in addition to the tonsils — in children who had no specific indications for adenoid removal also would pose a significant benefit.

For the second study, standards for tonsillectomy were reduced regarding either the required frequency of recurrent episodes of throat infection or their severity or degree of documentation. For example, one requirement was reduced from at least seven to at least five episodes of throat infections within the preceding year or at least four episodes for younger children. Parallel two-way and three-way trials also were designed to account for various combinations of children having tonsil removal, tonsil and adenoid removal, or no surgery.

The biggest difference between the two studies was seen in children in the third year. In the second study, children in both the two-way and three-way trials averaged one-third of a moderate or severe episode per child in each of the three follow-up years. There also was no significant difference in results between children who had their tonsils removed and those who had both their tonsils and adenoids removed.

SIGNS OF POSSIBLE TONSILLITIS

• Red and swollen tonsils
• Yellow coating over the tonsils
• A “throaty” voice
• Sore throat
• Uncomfortable or painful swallowing
• Swollen lymph nodes (glands) in the neck
• Fever
• Signs of adenoid enlargement
• Breathing through the mouth instead of the throat most of the time
• Nose sounds “blocked” when child talks
• Noisy breathing during the day
• Snoring at night

Source: American Academy of Pediatrics