BMJ  2004;329:1045 (30 October), doi:10.1136/bmj.329.7473.1045-a

Letter

Adenotonsillectomy in children with mild symptoms

Watchful waiting is appropriate

The first 150 words of the full text of this article appear below.

EDITOR—van Staaij et al's large, open, multicentre, randomised controlled trial of the effectiveness of tonsillectomy in children with mild symptoms was carried out in the Netherlands and all the patients randomised were sent and assessed as appropriate according to current medical practice.1 The paper makes no mention of the fact that such practices vary from country to country.

In the United Kingdom most departments for ear, nose, and throat medicine would use the 1999 guidelines of the Scottish Intercollegiate Guidelines Network (SIGN) (www.sign.ac.uk), which acknowledge that there is a paucity of high quality evidence for surgical intervention. Following the SIGN guidelines, however, would mean that many of the children in the randomised group would have been placed on a "watch and wait" policy. This seems to have been confirmed by the 34% in the watchful waiting group who underwent adenotonsillectomy.

Tonsillectomy itself is of benefit in . . . [Full text of this article]

Ram Moorthy, specialist registrar in ear, nose, and throat medicine

ram75@medix-uk.com, Department of Ear, Nose, and Throat Medicine, New Cross Hospital, Wolverhampton WV10

Hassan Khan, senior house officer in ear, nose, and throat medicine

Department of Ear, Nose, and Throat Medicine, New Cross Hospital, Wolverhampton WV10


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Relevant Article

Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial
Birgit K van Staaij, Emma H van den Akker, Maroeska M Rovers, Gerrit Jan Hordijk, Arno W Hoes, and Anne G M Schilder
BMJ 2004 329: 651. [Abstract] [Full Text] [PDF]

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