[Skip to Content]
[Skip to Content Landing]
Views 382
Citations 0
Comment & Response
January 16, 2020

The “Right Rate” of Tonsillectomy

Author Affiliations
  • 1World Development Group Inc, Bethesda, Maryland
JAMA Otolaryngol Head Neck Surg. Published online January 16, 2020. doi:10.1001/jamaoto.2019.4206

To the Editor Tonsillectomy has been performed for thousands of years. In modern times, the operation went from being needed rarely to becoming almost routine.1 In New York, a random sample of 1000 school children was examined; reported in 1934, 60% were found to have undergone tonsillectomy.2 The remaining children were examined by school physicians; 45% were recommended for tonsillectomy. A second group of physicians examined those who were not; then a third group, the remainder. In each of the 3 successive rounds, 44% to 45% of children examined were recommended for tonsillectomy.2 At the end of the experiment, 94% of the children had either had or were recommend for the operation.2 By the 1980s, tonsillectomy was labeled a dangerous fad.3 In the absence of sound scientific evidence, preferences dominate clinical decision-making. Variation in rates of procedures stems from many factors, chief among them surgeons' attitudes, a well-known factor.4 In her insightful commentary, Dr Chen raises 2 important questions: (1) why is there so much variation despite the proliferation of clinical practice guidelines (CPG); (2) how can unwanted variation in rates be reduced?5

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words
    ×