Seven in eight children's tonsillectomies are unnecessary, study reveals

A new study by the University of Birmingham has found that seven in every eight children who have their tonsils removed are unlikely to benefit from the operation.

Researchers, supported by the National Institute for Health Research, analysed the electronic medical records of over 1.6 million children from more than 700 UK general practices dating between 2005 and 2016. They found that out of 18,271 children who had their tonsils removed during this time, only 2,144 (11.7 per cent) had enough sore throats to justify surgery.

The researchers at the University of Birmingham’s Institute of Applied Health Research concluded that their evidence, published today (Nov 6th) in British Journal of General Practice, showed that annually 32,500 children undergo needless tonsillectomies at a cost to the NHS of £36.9 million.

What’s more, they found that many children who might benefit from having their tonsils removed are not having the surgical procedure. They found that of 15,764 children who had records showing sufficient sore throats to undergo a tonsillectomy, just 2,144 (13.6 per cent) actually went on to have one.

Current UK health policy, based on the best scientific evidence, is that to meet the criteria to benefit from a tonsillectomy children must suffer from either more than seven documented sore throats in a year; more than five sore throats per year for two successive years; or three sore throats per year for three successive years.

The researchers found that, of those who had undergone a tonsillectomy, 12.4 per cent had reported five to six sore throats in a year; 44.7 per cent had suffered two to four sore throats in a year; and 9.9 per cent had just one sort throat in a year.

Tom Marshall, Professor or Public Health and Primary Care at the University of Birmingham, said: “Research shows that children with frequent sore throats usually suffer fewer sore throats over the next year or two. In those children with enough documented sore throats, the improvement is slightly quicker after tonsillectomy, which means surgery is justified.

“But research suggests children with fewer sore throats don’t benefit enough to justify surgery, because the sore throats tend to go away anyway.

“Our research showed that most children who had their tonsils removed weren’t severely enough affected to justify treatment, while on the other hand, most children who were severely enough affected with frequent sore throats did not have their tonsils removed. The pattern changed little over the 12 year period.

“Children may be more harmed than helped by a tonsillectomy. We found that even among severely affected children only a tiny minority of ever have their tonsils out. It makes you wonder if tonsillectomy ever really essential in any child.”

For more information please contact Emma McKinney, Communications Manager (Health Sciences), University of Birmingham, tel: +44 (0) 121 414 6681, or contact the press office on +44 (0) 7789 921 165.

• The University of Birmingham is ranked amongst the world’s top 100 institutions. Its work brings people from across the world to Birmingham, including researchers, teachers and more than 5,000 international students from over 150 countries.
• Šumilo et al (2018). ‘Incidence of indications for tonsillectomy and frequency of evidence-based surgery: a 12-year retrospective cohort study of primary care electronic records’. British Journal of General Practice. DOI: 10.3399/bjgp18X699833

• Professor Tom Marshall is partly funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM).

• The National Institute for Health Research (NIHR): improving the health and wealth of the nation through research. Established by the Department of Health and Social Care, the NIHR: 
• funds high quality research to improve health
• trains and supports health researchers:
• provides world-class research facilities

• works with the life sciences industry and charities to benefit allinvolves patients and the public at every step.

Professor Tom Marshall is partly funded by the National Institute for Health Research (NIHR) through the Collaborations for Leadership in Applied Health Research and Care for West Midlands (CLAHRC-WM).

works with the life sciences industry and charities to benefit allinvolves patients and the public at every step.