Diagnosis and Treatment: Tonsils and Adenoids—a Problem Revisited

Anyone who is sure of the indications for removing tonsils and adenoids is surely naive and anyone who attempts to write about it impolitic, for little in medicine elicits more strong or divergent opinions. Living in Rochester, New York, where Dr. Albert Kaiser carried out his courageous community studies1 over 40 years ago may give me some license to write about the problem but should also keep one humble for even here, its hometown, the study is little known. In the early 1920's Kaiser was able to organize a community-wide program which accomplished the incredible job of removing tonsils and adenoids from 10,000 of the then 50,000 children in Rochester in a 5-month period. The major follow-up data2 were on 5,000 of these children who had the operation and were able to be followed for 10 years after operation. Comparison was made between a subsample of 2,200 of these and a like number who had been recommended for tonsillectomy and adenoidectomy but never had had the operation. While there are many defects in this study compared to the ideal controlled trial, it would comfort Dr. Kaiser to know that no other study since has been able to do much better, since clinical trials to determine the effectiveness of an operation can rarely be controlled in the sense of random assignment of patients and practically never double blind (this would require sham operations). It is worth reading Kaiser's works again for, though widely touted as a condemnation of the procedure, they are in fact no such thing.