UK 'doing too few tonsil operations'

 
Doctor checking a child's tonsils Doctors are seeing more cases of tonsillitis

There has been a significant fall in the number of people having their tonsils removed in the UK over recent years, partly as a backlash against the procedure's overuse and, more recently, as a cost-saving exercise for the cash-strapped NHS.

But in this week's Scrubbing Up, consultant ENT surgeon Andrew McCombe, honorary secretary of ENT UK, warns the cuts have gone too far and patients are paying the price.

Tonsillectomy - cutting out the two lumps of lymphoid tissue found at either side of the back of the throat - is an operation that was described first over 3,000 years ago.

Its popularity grew throughout the ages and became so favoured in the UK that in the 1950s over 200,000 were performed in any given year.

Certainly, this rate was too high and surgeons set about refining the indications for carrying out this potentially risky operation, reserving it only for those patients most likely to benefit.

However, over the last 15 years the rate of tonsillectomy has continued to fall, so much so that we are now in danger of too few procedures being carried out.

Out of vogue

In 1994-95 some 77,600 tonsillectomies were carried out in the UK. By 2009 this had dropped by 37% to 49,000.

At the same time, we are seeing increasing rates of diseases and conditions that tonsillectomies can prevent or cure, like infections, and even cancer, of the tonsils.

The number of people who develop cancer of the tonsils is still small, but it has certainly jumped significantly.

In 2000-01, there were 30,942 tonsil-related admissions for emergency medical treatment. By 2008-09, the figure had risen to 43,641, an increase of over 41% in 8 years.

The economic impact of tonsillitis is considerable. Overall, 35m days are lost from school or work each year due to sore throats in the UK. GP consultations for sore throat cost around £60m per year.

As tonsillectomy rates fall, it is predictable that hospital admissions for severe tonsillitis and its complications will rise, and this is borne out by the data available.

Admissions for quinsy - an extremely painful complication of acute tonsillitis - is rising. At the start of 2000 there were 6,352 UK hospital admissions for this condition. This increased to 7,683 in 2008-09, a rise of over 20% and equating to 11,865 hospital bed days.

Any further reduction in the rate of tonsillectomy is likely to be associated with a further worsening of this trend.

Tonsillectomy rates are lower in the UK than in any other country in Europe.

In fact the data trends of increasing hospital activity for tonsillar problems seem to suggest that rather than performing too many tonsillectomies in the UK, we are now performing too few.

 

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  • rate this
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    Comment number 72.


    Whenever there is something science has not fully understood the function of yet it is very dangerous to conclude it has no function due to the current limits of knowledge.

    In the past the appendix and parts of the brain have been written off as useless along with large parts of DNA, all of which are now being found to have a significant role in the overall system and design.

  • rate this
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    Comment number 71.


    Tonsils play a roll in defending the body against initial pathogens entering the mouth and nose from getting further into the system. They may also play a role in the immune system and bacteria.

    The appendix once thought to be "vestigial" is now proven to store good bacteria and play a role in the immune system.

    Maybe docs are being given money from companies to harvest them for stem cells.

  • rate this
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    Comment number 70.

    treatment. He demanded that he was to take priority over others in the ward. The surgeon came to see him, and he was given the good news, as far as I was concerned. His health care insurance was nul and void. Because he came from overseas he had the choice, freemarketeers love choice, either pay up for your treatment or leave. We did not hear another word from the pompous oaf. He left next day.

  • rate this
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    Comment number 69.

    64.
    nieuw divil
    3 Hours ago

    These idiots can't get anything right. Private healthcare is infinitely better (and cheaper than NI) and must be the way forward for this country.


    Private health care is great until you use it. I've seen A patient with private health insurance demanding what he thought he was entitled to in an NHS hospital. he was demanding constant attention and prefferential

  • rate this
    0

    Comment number 68.

    So they are doing fewer tonsillectomies, is that to save money or because fewer people need them? Are healthy tonsils to be removed to meet abitrary targets?
    My mother (a nurse) told me that tonsils were a line of defence agsinst infection so I still have mine at the age of 62 without any problems.

 

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