Letter: Keep your tonsils if you can

Sir: Your article about tonsillectomy ("When pain is hard to swallow", 3 June) might benefit from an overview of the research evidence.

For an operation that has been carried out for over 2,500 years there is pitifully little decent evidence that it is effective. There have been no studies which show that tonsillectomy reduces throat infection in children over 15 or in adults. Your article correctly identifies the one reasonably well-designed study which showed that children who had their tonsils out had fewer throat infections in the next two years.

However, on average, the children had two fewer "moderate or severe" throat infections in the next two years. They did not take less time off school and children on average take one or two weeks off to recover from the operation. To even be considered for tonsillectomy in this trial, children had to have suffered from seven fairly severe throat infections in one year, or five a year for two successive years or three a year for three successive years. So if you have had this many throat infections it might be worth having your tonsils out - if you can afford the time off school and you think that the operation is not as bad as two throat infections.

Given the lack of evidence to support the enthusiasm with which ENT surgeons advocate this operation, it is difficult to agree with the suggestion that "the pendulum has swung too far".

TOM MARSHALL

Specialist Registrar in Public Health Medicine

Northamptonshire Health Authority