Letters Paediatric ENT surgery

BAPO response to Des Spence

BMJ 2010; 341 doi: https://doi.org/10.1136/bmj.c7292 (Published 20 December 2010) Cite this as: BMJ 2010;341:c7292
  1. Michael Rothera, consultant paediatric ENT surgeon and president of British Association for Paediatric Otorhinolaryngology (BAPO)1
  1. 1Royal Manchester Children’s Hospital, Manchester M13 9WL, UK
  1. mprothera{at}aol.com

As paediatric ear, nose, and throat (ENT) surgeons, we are as keen as Spence to ensure that surgery is considered for children with persistent secretory otitis media or recurrent tonsillitis only when it is in their best interests.1 Hospital episode statistics data show a 52% reduction in the number of paediatric tonsillectomies in the past 15 years (because surgeons have refined the criteria so that surgery is offered only to those most likely to benefit). UK randomised controlled trials on both conditions have recently been completed.2 3

GPs have an important role in deciding which patients to refer. Fortunately there are nationally agreed and referenced guidelines to prevent inappropriate surgery,4 5 which all referrers should use. ENT UK published position papers on both of these topics in 2009.6 7

Whatever Spence’s personal view of paediatric ENT surgery might be, we prefer a more collaborative partnership with our patients and their parents, based on individual analysis of the problem (often with good objective tests), discussion of the course of the illness, and options for treatment, with risks and benefits explained. Our default position is to be conservative, but in certain well recognised circumstances, intervention is in the child’s best long term health interests.


Cite this as: BMJ 2010;341:c7292


  • Competing interests: None declared.


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