Watchful waiting is useful for children with recurrent throat infections

Van Staaij et al's study is a welcome addition to a controversial subject.1 It shows that for children with moderately frequent throat infections (on average three in the previous year) a "wait and see" approach results in acceptable control of symptoms and avoids postoperative pain and complications (1% requiring operative surgery for haemorrhage, and 2.6% having severe nausea or dehydration). The major limitation of the study is the large number of children from the watchful waiting group who had tonsillectomy (34%). Since a per protocol analysis was not done—that is, comparing those who had tonsillectomy with those who did not, controlling for severity indices—it cannot be concluded that tonsillectomy in itself is ineffective but simply that immediate tonsillectomy is not effective. The data from this trial, however, match data from a similar trial, which reported little symptomatic benefit and a significant rate of complications (7%) among children who had tonsillectomy for more severe symptoms.