• tonsillectomy

Tonsillectomy was once fashionable. Regarded as a panacea for upper respiratory tract problems, many children in the late 1950s and 1960s underwent tonsillectomy. In 1967, 120 per 10 000 children (age ≤14 years) had their tonsils removed. But over the years fashions change; by 1985 this was 51 per 10 000, up to 81 in 1990, and down again to 65 in 1998.¹

As an issue, tonsillectomy is back in fashion for two important reasons—the increasing focus on “evidence based medicine”, and the recent débˇcle about disposable surgical instruments and new variant Creutzfeldt-Jakob disease (vCJD).

In a Cochrane systematic review² we found no good evidence for or against tonsillectomy. Evidence from two randomised controlled trials (RCTs) in children^3,4 was inconclusive. There has been some scepticism about the review’s conclusion that a further RCT is required to address this issue. Surely, taking the tonsils out must prevent tonsillitis? It is axiomatic that if a child has recurrent acute tonsillitis and the palatine tonsils are solely and uniquely responsible for that child’s symptoms, removing those tonsils will prevent further similar episodes. In practice two problems arise. What role do the palatine tonsils play in the pathogenesis and natural history of any particular child’s symptom complex? Is the child who has had a lot of “tonsillitis” in the past going to carry on getting “tonsillitis” in the future?

We are not able to answer the first question easily. During the clinical interview it is normal practice to enquire about the frequency and severity of sore throats, the need for, and effectiveness or otherwise of …