BMJ  2004;329 (18 September), doi:10.1136/bmj.329.7467.0-a

Immediate adenotonsillectomy is not always needed

Children with mild symptoms of throat infection or adenotonsillar hypertrophy may not require immediate adenotonsillectomy. Van Staaij and colleagues (p 651) randomised 300 children aged 2-8 years with these symptoms to adenotonsillectomy or watchful waiting and found that immediate surgery did not reduce episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life. Adenotonsillectomy was more effective in children who had three to six throat infections than in those who had up to two. Twelve children had complications after surgery. In a commentary (p 654) Little points out that a third of children initially treated medically required surgery. This study shows that immediate surgery is not effective, not that tonsillectomy in itself is ineffective, but more data are needed to optimise treatment.

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