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 Over time, however, the benefits of surgery for chronic
streptococcal throat infections appear to go away. Three years after
tonsillectomies, children who had these procedures had roughly the
same number of throat infections as kids who didn't get their
tonsils taken out, one of the studies in Pediatrics found.
"Tonsillectomy, while very common and generally safe, is not
completely without risk," said Dr. Sivakumar Chinnadurai, senior
author of the strep throat study and a researcher at Vanderbilt
University Medical Center in Nashville, Tennessee.
"The recognition of risks, and the knowledge that some patients'
infection rate improves over time has led to (strep) infection being
a much less common indication for tonsillectomy than it was in the
past," Chinnadurai added by email. "While tonsillectomy remains one
of the most common surgeries performed in the United States, the
main indication for children has switched to obstructed breathing."
To assess the potential for tonsillectomies to help kids with
chronic strep infections, Chinnadurai and colleagues examined data
from seven previously published studies of children who had
experienced at least three strep infections in the previous one to
three years.
Four of the studies in the analysis randomly selected kids with
chronic strep infections to get tonsillectomies or no surgery, and a
fifth study followed children who got one of these options but not
as part of a trial.
Overall, kids who got tonsillectomies for chronic sore throats or
strep had fewer infections and doctor visits and missed less school
in the first year after surgery than children who didn't get
operations.
But most of the studies in the analysis included kids with a history
of mild to moderate infections and found the limited benefits of
surgery diminished with time. That may be at least in part because
some children get fewer infections as they get older.
One limitation of the analysis is that much of the included research
lacked data on the severity of symptoms, making it hard to determine
if a subset of children with particularly serious cases of strep
might get more benefit from surgery, the authors note.
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With chronic obstructive sleep-disordered breathing, or sleep apnea,
the benefits of tonsillectomies seemed clearer in a second study in
Pediatrics. But limited long-term follow-up made it hard to rule out
the possibility that the benefits would subside with time.
For the sleep apnea study, researchers examined data from 11
previously published studies that generally followed kids for up to
one year.
Compared to kids who didn't get surgery, children who had
tonsillectomies had greater improvements in sleep-related quality of
life and in negative behaviors that are worsened by apnea such as
anxiety or mood swings, the analysis found.
"These effects are most significant in children with mild to
moderate sleep apnea, where the average improvement could represent
a complete cure of the problem," said Dr. David Francis, senior
author of the sleep apnea study and also a researcher at Vanderbilt
University.
"While a significant improvement was seen with more severe cases, it
was not large enough to suggest a total cure in all patients,"
Francis added by email. "In those more severely affected, there is a
significant benefit from tonsillectomy, but families and health care
providers should work together to understand what other factors may
be at play."
SOURCE: http://bit.ly/2iDWcBR and http://bit.ly/2iL5zmx Pediatrics,
online January 17, 2017.
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