When to remove the tonsils and why so many children are operated unnecessarily?
A study conducted in England found that 9 out of 10 type-type operations are unnecessary and signaled that the surgical procedure could be causing more harm than good to children.
Research conducted in England shows that nine out of 10 operations of the type are unnecessary.
Thousands of children undergo surgeries to remove the tonsils without any need. A study in England found that 7 out of 8 operations of the type performed on children in the country would hardly bring any advantage.
The tonsils, located near the base of the tongue, play an important role in the immune system, helping to protect the body from viruses and bacteria entering through the mouth or nose. But they are one of those organs that are not considered indispensable for survival.
According to the study, the surgical procedure may be causing more harm than good to children. Not to mention spending on the English public health system, the NHS – which has already reported that it plans to reduce the number of amygdala withdrawal operations and other “inefficient” treatments, where losses are greater than gains.
Criteria for removal of the tonsils
According to the researchers, removal of the tonsils is indicated only when it meets one of the criteria below:
- More than seven episodes of neck pain or inflammation per year;
- More than five episodes of neck pain or inflammation per year for two consecutive years;
- Three episodes of neck pain or swelling a year for three years in a row.
The England study, published in The British Journal of General Practice, looked at the records of more than 1.6 million English children between 2005 and 2016. Out of every thousand children in the country, two or three children underwent amygdala withdrawal surgery.
However, 88% (about 7 out of 8) did not meet the above criteria. Only 12% of surgeries performed during the period were clinically justified.
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In the group of children who underwent surgery without meeting the criteria, 10% had had only a single episode of a sore throat or inflammation.
Based on these data, the study estimated that 32,500 of the 37,000 child tonsillectomies performed in the UK between 2016 and 2017 were unnecessary, costing £ 36.9 million to the public health system.
Tom Marshall, a professor at the Institute for Applied Health Research at the University of Birmingham in England and one of the study’s authors, says surgery can be justified in the case of more seriously affected patients.
“The research suggests that children with less pain or inflammation of the throat will not benefit enough to justify the surgery because, in any case, the sore throat tends to disappear,” he says.
Removal of tonsils can lead to complications
The specialists also point out that, as in all surgeries, tonsillectomies can lead to complications that, although rare, can be serious.
“When this operation is performed on the right group of children, it can significantly reduce throat infections, improve sleep quality, decrease medical appointments, use antibiotics and, most importantly, improve the child’s quality of life and of the family, “say experts at McGovern Medical School at the University of Texas, USA.
“However, there is morbidity associated with surgery that includes hospitalization, financial cost, the risk of anesthesia, postoperative bleeding and scarring,” they add.
“In fact, up to 4% of the children who are operated on may have to be hospitalized again due to secondary complications, which means that adequate decision-making for this surgery is of paramount importance.”
In addition, some studies suggest that withdrawal of the tonsils in childhood may have long-term gains, such as increased risk of early heart attack and respiratory diseases such as asthma, pneumonia, and influenza in adult life.
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The problem is not unique to the UK. A survey published in 2014 by The Cochrane Review compared studies conducted in several places around the world on the effectiveness of tonsil removal surgery and found that a large number of operations are done without sufficient clinical justification.
The survey does not cite Brazil. Here, the Unified Health System (SUS) performed 33,800 surgeries to remove tonsils in 2017, 31,100 of which were children (more than 90%). The United States is the country with the highest rates of the procedure.
Each year, more than 500 thousand tonsillectomies are performed for children – this is the third most common operation in children in the country. “It’s a silent epidemic of unnecessary medical care,” said David Goodman of Dartmouth Atlas, a health care database at the Dartmouth Institute for “In most cases, (tonsil removal) is performed on patients with symptoms much less recurrent than is necessary to indicate the procedure,” Goodman said.