To the Editor.—The commentary, "Indications for Adenotonsillectomy," by Gates and Folbre1 is, indeed, a step backward. It is most reassuring that the number of tonsillectomies and adenoidectomies has substantially decreased over the years. However, if the "indications" by these authors are really acceptable, without any question the number of these procedures would increase. The authors have no evidence whatsoever that four or more documented episodes of tonsillopharyngitis per year are, indeed, an indication for tonsillectomy. "A positive culture for group A β-hemolytic streptococci" is, of course, no indication, because if there are no symptoms, the patient may well be an asymptomatic carrier.
As I pointed out in a recent commentary,2 there has been no critical study to delineate the indications for tonsillectomy and adenoidectomy for patients who have "chronic upper airway obstruction." No definition exists of what really is meant by the term obstructive apnea. The patients
STICKLER GB. Adenotonsillectomy. Arch Otolaryngol Head Neck Surg. 1986;112(12):1300–1301. doi:10.1001/archotol.1986.03780120064015