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Are tonsillectomy guidelines too strict? HealthDay’s too-sharp angle goes beyond what studies found

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3 Star

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Should More Kids Have Their Tonsils Out?

Our Review Summary

This story is based on two papers published in the journal Pediatrics (here and here) which were meta-analyses of studies in the medical literature about the success of tonsillectomies in reducing throat infections and in improving obstructed breathing while asleep.

The story includes a very good snapshot of how frequently tonsillectomies are performed today, and how that compares with 30 years ago. The article also includes prospective from an outside source on the implications of the new studies.

But the story characterizes the study results as promoting a change in tonsillectomy guidelines, rather than simply reporting on the findings of the analyses. One of the studies suggests that any improvement in throat infections is limited to only the first year following surgery, and that short-term benefit is noted in the article.

The story doesn’t mention costs and only briefly mentions the risks associated with this procedure. And while the studies are extremely careful in characterizing their findings, this story isn’t and generalizes the conclusions to the detriment of the readers.

 

Why This Matters

While tonsillectomies are common, they are still surgeries done under general anesthesia and carry substantive risks, something this story seems to skate over. The question raised by these studies is whether it is wise for parents to subject their child to the procedure or to take an approach of watchful waiting. The studies are clear in saying that the medical literature is weak on a definitive answer that applies to all kids and that the proper approach depends on the individual.  Given a parent’s fundamental concern and fear for his/her child considering surgery, this is no small issue.

Criteria

Does the story adequately discuss the costs of the intervention?

Not Satisfactory

Nowhere in this HealthDay story is the subject of costs mentioned. While tonsillectomy is considered a common treatment, it is still surgery, and therefore somewhat expensive.  One source online, insurer Blue Cross Blue Shield, quotes the average cost of the procedure as $5,442, although some or all of that may be covered by insurance. Even considering the cost of multiple doctors’ visits and prescribed medication for throat infections over a year or two, the surgical cost still is higher, and that point should have been made in this story.

Does the story adequately quantify the benefits of the treatment/test/product/procedure?

Not Satisfactory

There is little quantification of the benefits claimed in this story. It summarizes the findings: “Children experienced nearly half as many sore throats when they underwent a tonsillectomy, even if they didn’t meet the guidelines.”  But half of three infections occurring during a 1 to 3 year time period is 1 infection in a year. This is hardly life-changing.

It does say that in terms of throat infections, that kids receiving tonsillectomies showed fewer infections in the year following the procedure than did kids not undergoing the surgery, but that advantage disappeared after the first year or so.

The story rightfully points out that kids experiencing obstructive sleep-disordered breathing (OSDB) appeared to benefit from the surgery compared to those in the watchful waiting group. But regardless, nowhere in the story is there any quantification to get readers a clear picture of the extent of improvement following surgery.

Does the story adequately explain/quantify the harms of the intervention?

Satisfactory

We’ll give the story a satisfactory rating for including the following statements:

“About 3 percent of kids who undergo the procedure experience bleeding during the two-week recovery period, Hackett said. “Though a tonsillectomy is low-risk, it is not risk-free, and those risks need to be weighed against the benefits for each individual child,” Chinnadurai said.

The story would have been stronger if it had named the risk of infection following surgery and that general anesthesia carries its own important risks.

Does the story seem to grasp the quality of the evidence?

Not Satisfactory

The two studies on which the article is based include one that compared the occurrence of sore throats in tonsillectomy patients versus those who did not undergo the surgery, and another study compared the use of surgery with watchful waiting among kids experiencing obstructive sleep-disordered breathing (OSDB).

Both studies carefully point out their study limitations, including multiple study designs, different study populations, and that the studies sought different objectives; the authors were frank in expressing the strength of evidence of their conclusions.

The story, however, sums this up by saying, “An evaluation of current medical evidence suggests . . .” without offering any of the caveats and cautions contained in the two papers.

Additionally, the story suggests that current guidelines on whether tonsillectomies are needed are too restrictive — “Because of stringent tonsillectomy guidelines, some kids who could benefit from tonsil removal surgery aren’t getting it, two new reviews suggest.”  Nowhere in the two papers is this suggestion ever mentioned, nor was it an objective of the studies. The statement, “An evaluation of current medical evidence suggests more kids would receive significant short-term improvement in their daily life if the guidelines were relaxed,” is an oversimplification of the precise conclusions that the paper’s authors stated.

Does the story commit disease-mongering?

Satisfactory

The story doesn’t engage in disease mongering and, as noted above, provides very thorough context on how many tonsillectomies are performed on children each year.

The article might waver toward “treatment-mongering,” however, with its emphasis on why the current guidelines might be relaxed.

Does the story use independent sources and identify conflicts of interest?

Satisfactory

The story includes a quote from a clinician not affiliated with the study, which adds some useful context. It does not mention any possible conflict of interest but none are expected from a large Agency for Healthcare Research and Quality (AHRQ)-commissioned evidence review, which this was.

Does the story compare the new approach with existing alternatives?

Satisfactory

The story is about a comparison between tonsillectomies and watchful waiting, the primary two alternatives in dealing with either recurrent sore throats and obstructive breathing.

The published studies note that watchful waiting includes antibiotic therapy. 

Does the story establish the availability of the treatment/test/product/procedure?

Satisfactory

The story notes that “Tonsillectomy is the third most common surgery performed on U.S. children.”  We know tonsillectomies are readily available through the health care system, if needed.

Does the story establish the true novelty of the approach?

Not Satisfactory

The story puts an odd spin on a report of two fairly cautious research studies and if that spin was accurate, it would surely be novel enough. But the approach of the story is not rooted in the actual content of either study. Readers were not well-served by its publication.

Does the story appear to rely solely or largely on a news release?

Satisfactory

The story does not appear to be based on a news release.

Total Score: 6 of 10 Satisfactory

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