Volume 360, Number 9338, 28 September 2002
Science and medicine
Adenotonsillar disease has a detrimental effect on children’s quality of life
The effect of adenotonsillar disease is significantly greater than previously believed, involving most aspects of a child’s life, according to research presented at the Annual Meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (San Diego, CA, USA, Sept 22-25).
“It is well understood that in children with sleep apnoea, adenotonsillectomy is almost always indicated”, senior researcher Christos Georgalas (Royal National Throat and Ear Hospital, London, UK) told The Lancet. “But for the vast majority of children who present with recurrent tonsillitis, the usefulness of adenotonsillectomy is being questioned. Essentially the argument is that recurrent tonsillitis is part of normal development and is not associated with significant morbidity.”
However, Georgalas points out that parents generally do not share this view. “They feel that the quality of their children’s life is significantly impaired as a result of their condition.”
Georgalas and colleagues studied overall quality of life of 43 children with symptoms of recurrent tonsillitis and/or adenotonsillar hypertrophy who were referred to a paediatric specialty clinic. The child’s primary carer completed the Child Health Questionnaire PF 28, a generic tool measuring 14 different aspects of a child’s wellbeing. Scores were compared with those of healthy children and children with rheumatoid arthritis.
Compared with healthy children, 11 measures of quality of life–including global health, general health perception, and bodily pain and discomfort–were depressed in the study cohort.
“When we looked at children with rheumatoid arthritis”, says Georgalas, “we found that children in our group were equivalent in most areas, although they scored worse in overall perception of health as well as the total physical score”.
Commenting on these findings, David Tunkel (Johns Hopkins Medical Institutions, Baltimore, MD, USA) points out that doctors have become more careful about who actually needs surgery and who will benefit most from it. “Our criteria has become much more strict, but none of the published guidelines actually take into account quality-of-life issues.”
“Validated instruments and ways of measuring changes in quality of life, and recognition from studies which show that adenotonsillar disease causes a severe problem”, he adds, “will certainly play a role in who will have their tonsils and adenoids out in the future”.