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A Journal on Otorhinolaryngology, Head and Neck Surgery,
Plastic Reconstructive Surgery, Otoneurosurgery
Indexed/Abstracted in: EMBASE, Scopus
Otorinolaringologia 2009 December;59(4):229-39
Childhood tonsillitis and tonsillectomy
Robb P. J.
Department of Otolaryngology, Epsom and St. Helier University Hospitals, Epsom, UK
Sore throat and tonsillitis are common reasons to seek medical advice in childhood; the burden on time and cost of antibiotic prescribing is high. For sore throat and viral pharyngitis, antibiotics appear to make little impact on the speed of recovery from symptoms; emerging evidence on biofilm infections indicates that recurrent tonsillitis might be a biofilm infection, explaining why antibiotics are ineffective, but removing the source of infection (i.e., the tonsils) source abolishes bouts of recurrent acute tonsilllitiis. While parents perceive tonsillectomy as an effective remedy for recurrent acute tonsillitis in their children, evidence to support tonsillectomy from randomized, controlled trials neither supports nor refutes the benefit of tonsillectomy. Evidence from high quality research is often difficult to interpret, as subjects with sore throat and tonsillitis are often considered as one subject group and indications for surgery often include both recurrent infection and upper airway obstruction; studies of tonsillectomy often include some children undergoing adenoidectomy as part of the same procedure. Limitations from primary care research include the lack of an objective clinical test to cheaply and quickly differentiate viral pharyngitis and sore throat from acute bacterial tonsillitis. In the UK, the effect of socialised medicine, public health control and limitation on spending has resulted in restrictions being applied to high volume operations such as tonsillectomy. Over the last ten years, issues surrounding variant Creutzfeldt-Jakob disease and possible patient-to-patient transmission by surgical instruments used in tonsillectomy have also had an impact on attitudes to tonsillectomy.