NEW YORK (Reuters Health) Jul 08 - Many children moderately affected by recurrent throat infections will improve on their own and don't necessarily require tonsillectomy, researchers in Pittsburgh have found. According to their report in the July issue of Pediatrics, the criterion for surgery in official guidelines should be more stringent.

Dr. Jack L. Paradise, of the University of Pittsburgh School of Medicine, and associates evaluated children whose indications for tonsillectomy were "comparable to those in general use." These indications were more stringent than those in the current guidelines of the American Academy of Otolaryngology-Head and Neck Surgery, which list as criteria for surgery "three or more infections of tonsils and/or adenoids per year despite adequate medical therapy."

A total of 177 children were randomized to undergo tonsillectomy, adenotonsillectomy, or no surgery. A further 151 patients were randomly assigned to adenotonsillectomy or a control group.

During followup, children in the surgical groups had a small but significant decrease in throat-infection episodes in each of three followup years compared with control children. "Even among control children, mean rates of moderate or severe episodes were low, ranging from 0.16 to 0.43 per year," the investigators write.

"Sore-throat days" totalled on average 19 to 23 days during the first followup year among children who underwent surgery, versus 24 to 25 days among those in the control groups.

"There are substantial complications [associated with tonsillectomy]," Dr. Paradise told Reuters Health. Of the 203 children in this report who underwent surgery, 16 experienced complications, including three intraoperative hemorrhages and seven postoperative hemorrhages and one case of possible incipient malignant hyperthermia.

The investigators suggest that the degree of benefit does not justify the risks, morbidity and cost of surgery. They suggest that more stringent criteria be used before recommending tonsillectomy, including at least seven episodes in the previous year or at least five episodes in each of the past 2 years. Even then, they write, individualized decision-making is required.

"We tell families that, even if nothing is done, many if not most of these children improve with time," Dr. Paradise told Reuters Health. He added that individual considerations would include the parents' tolerance of illness versus their tolerance for the risks associated with surgery, the child's wishes, and outpatient health insurance that would cover continued medical treatment.

Pediatrics 2002;110:7-15.