Removing the tonsils of children with mild or moderate
is more expensive and has fewer health benefits than simply
watching and waiting, Dutch researchers said.
In a study involving 300 children aged 2 to 8 advised
to have their tonsils out, those who avoided surgery had
fewer annual visits to doctors and lower resulting medical
costs due to fevers and throat infections.
Tonsils are masses of tissue at the back of the throat
that trap bacteria and viruses a person may breathe in.
"Surgery resulted in a significant increase in costs
without realizing relevant clinical benefit," Erik
Buskens, an epidemiologist and colleagues at the University
Medical Centre Utrecht in the Netherlands,
wrote in the Archives of Otolaryngology - Head and Neck
Tonsillectomy is one of the most frequently performed
surgical procedures for children. Young patients have
traditionally had their tonsils removed to relieve repeated
throat infections and related fevers.
While doctors today carry out far fewer tonsil operations
than in the past, the Dutch study provides evidence that
many children who do have the procedure see little, if
In their study conducted between 2002 and 2003, the team
excluded children with frequent throat infections or those
who had their tonsils removed because of sleep apnea.
The researchers asked parents to track their children's
respiratory track symptoms, measure their temperatures
daily and record any costs related to their care.
They found that annual costs among the group which did
not have surgery was about 551 euro per year, about 46
percent less than the 803 euros for children who had their
tonsils removed. The children who avoided surgery also
had fewer fevers, throat
infections and respiratory illnesses.
The researchers did not take into account costs borne
by parents in the form of missed days from work or other
expenses related to their children's illnesses.
And because the surgery is cheaper in the Netherland
than in many other countries, the gap between costs and
benefits in other Western nations is likely greater, they
"Compared with other Western countries, our cost
estimates may be low," the researchers wrote. "In
other settings, the cost-effectiveness would be further
offset by more costly procedures."