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Letters to the Editor
June 1, 2008

Indications for Tonsillectomy: Setting the Bar High Enough

Arch Otolaryngol Head Neck Surg. 2008;134(6):673. doi:10.1001/archotol.134.6.673-a

In their clinical trial of adenotonsillectomy in children with “mild to moderate symptoms of throat infection,” Buskens et al1 found that children in the adenotonsillectomy group, compared with children in the watchful-waiting group, experienced 0.21 fewer episodes of throat infection per person-year during a median follow-up period of 22 months. The authors concluded, with good reason, that this degree of benefit was inconsequential. Notably, however, the criteria for entry in their trial consisted of either a history obtained from parents (but without mention, by the authors, of documentation) of 3 or more episodes of throat infection in the preceding year or “other indications such as symptoms of obstruction or recurrent upper respiratory tract infections.” Approximately one-half of the children in the trial were enrolled on the basis of these “other indications,” and in these children, a history of throat infection, if any, was not described. It seems axiomatic that children with indications other than a history of throat infection could not anticipate substantial benefit from adenotonsillectomy regarding subsequent episodes of throat infection.

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