A Systematic Review of the Literature on Evaluative Studies of Tonsillectomy and Adenoidectomy

Although tonsillectomy and adenoidectomy (T and A) is frequently performed (indeed, it is the commonest surgical procedure done in North America1, 2) considerable controversy persists regarding its effectiveness. In 1971, 161, 301 T and A's were performed in Canada at an estimated cost of close to 25. 6 million dollars. 3 In the United States in 1968 more than 1 million T and A's were performed. 4 Assuming the cost per T and A to be similar to the costs in Canada, around 150 million were spent on this procedure in the United States in that year. The purpose of this study is to review the English language literature pertaining to evaluation of T and A with particular emphasis on an assessment of the scientific merit of studies which have attempted to determine the efficacy of this procedure. See Table in the PDF File METHOD Studies evaluating the results of T and A in the English language literature for the past 50 years5-33 were evaluated according to the following parameters: study design, sampling, completeness of description of illness and therapy, and precision of follow-up. Those studies which were most objective were awarded the highest points in each parameter. Conversely, studies which were purely descriptive or poorly documented received the fewest points. The maximum number of points which a randomized, prospective, well-documented study could obtain was 34 points. Table I shows the distribution of maximum scores in the various categories. For the parameter of study design, points were awarded as shown in Table II. The highest score was given to a randomized study and the lowest to a descriptive one.