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Alho et al conclude: “Tonsillectomy is an effective alternative for adults with a documented history of recurrent episodes of pharyngitis,”1 but this assertion is unsupported by the evidence presented.
For those who had the early operation, the combined time with a sore throat including the operation was four days greater than for those whose operation was deferred.
People who were offered early tonsillectomy had fewer swabs taken than people given late tonsillectomy (5/36 v 20/34, P<0.0001). Yet, in the people who took swabs, there was little difference between positivity rates for group A streptococcal infection (1/5 samples (intervention) v 8/20 (control), P>>0.1). This comparison is still biased, albeit differently from the one reported in the paper.
The authors also say: “A substantial improvement over time in the rate of episodes of pharyngitis occurred in the control group during the follow-up, probably because of the natural course of the disease.”1 Isn't this the point? Recurrent tonsillitis tends to get better over time.
What this paper also shows is that a proper surgical control is required to test established surgical techniques. The absence of surgery, or delayed surgery, just does not pass scientific muster. But would people consent to a sham technique?
The NHS continues to do around 40000 tonsillectomies in adults and children each year. Current research evidence of benefit is weak. Until the position is clearer, isn't there an argument to stop offering this intervention routinely on the NHS for recurrent tonsillitis outside of a properly conducted clinical study?
Competing interests: None declared.