Tonsillectomy Versus Watchful Waiting for Recurrent Throat Infection: A Systematic Review

Pediatrics. 2017 Feb;139(2):e20163490. doi: 10.1542/peds.2016-3490. Epub 2017 Jan 17.


Context: The effectiveness of tonsillectomy or adenotonsillectomy ("tonsillectomy") for recurrent throat infection compared with watchful waiting is uncertain.

Objective: To compare sleep, cognitive, behavioral, and health outcomes of tonsillectomy versus watchful waiting in children with recurrent throat infections.

Data sources: MEDLINE, Embase, and the Cochrane Library.

Study selection: Two investigators independently screened studies against predetermined criteria.

Data extraction: One investigator extracted data with review by a second. Investigators independently assessed risk of bias and strength of evidence (SOE) and confidence in the estimate of effects.

Results: Seven studies including children with ≥3 infections in the previous 1 to 3 years addressed this question. In studies reporting baseline data, number of infections/sore throats decreased from baseline in both groups, with greater decreases in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in tonsillectomized children in the short term (<12 months). Quality of life was not markedly different between groups at any time point.

Limitations: Few studies fully categorized infection/sore throat severity; attrition was high.

Conclusions: Throat infections, utilization, and school absences improved in the first postsurgical year in tonsillectomized children versus children not receiving surgery. Benefits did not persist over time; longer-term outcomes are limited. SOE is moderate for reduction in short-term throat infections and insufficient for longer-term reduction. SOE is low for no difference in longer-term streptococcal infection reduction. SOE is low for utilization and missed school reduction in the short term, low for no difference in longer-term missed school, and low for no differences in quality of life.

Publication types

  • Comparative Study
  • Review
  • Systematic Review

MeSH terms

  • Absenteeism
  • Adenoidectomy*
  • Child
  • Follow-Up Studies
  • Humans
  • Pharyngitis / surgery*
  • Randomized Controlled Trials as Topic
  • Streptococcal Infections / surgery*
  • Streptococcus pyogenes
  • Tonsillectomy*
  • Tonsillitis / surgery*
  • Watchful Waiting*