Tonsillectomy versus Watchful Waiting for Recurrent Throat Infection in Children


  • The authors of this systematic review compared tonsillectomy and watchful waiting for the management of recurrent throat infection in children. Compared with children managed with watchful waiting, children who underwent surgery had fewer throat infections, healthcare utilizations, and school absences in the year following surgery.
  • However, the benefits were not persistent, and quality of life was not different between the two groups at any point in time. In studies reporting baseline data, both groups showed a reduction in number of infections and sore throats from baseline. The surgical group had a greater decline in sore throat days, clinician contacts, diagnosed group A streptococcal infections, and school absences in the short-term than the watchful waiting group.
  • The benefits of tonsillectomy over watchful waiting for recurrent throat infections in children are limited and short-lived.


Despite the frequency of tonsillectomy in decades past, there are only two major reasons for a child to undergo this procedure:

The presence of obstructive sleep apnea or recurrent tonsillitis.

The benefit in the former case is obvious. However, does it really decrease the incidence of infections? Researchers believe it does, but what does the evidence show?

This question is made all the more complicated by the sometimes-loose diagnosis of “tonsillitis” based on nothing more than “red throat” observations, without laboratory confirmation.

This systematic review focuses exclusively on children with 3 or more documented infections over the previous 3 years, looking at 7 studies to focus on outcome differences between tonsillectomy versus watchful waiting.

Of note, “watchful waiting” could also include treatment with antibiotics or intranasal steroids.


The results were interesting. Both groups had a decrease in sore throat incidence. However, the tonsillectomy group had a greater decrease in the number of days with sore throat, visits to healthcare providers, diagnosed group A streptococcal infections, and school absences. However, the quality-of-life scores were not markedly different between the two groups.


So, based on this, should busy clinicians recommend tonsillectomy to their patients?

Not so fast—it turned out that the benefits listed above did not persist longer than a year after surgery.

So, should we not bother, given the risks of anesthesia and surgical complications?

It’s unclear at this time—there just isn’t strong evidence showing longer-term benefits. 

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This is for informational purposes only. You should consult your clinical textbook for advising your patients.