T and A — Nature of the controversy and steps toward its resolution

Abstract

It is ironic that while tonsillectomy and adenoidectomy continue to be the major operations most commonly carried out on children, at the same time these procedures are held in low esteem, or at best viewed with suspicion, by a large number of present-generation pediatricians. The reasons for this are several. First, excessive tonsil and adenoid surgery has long been recognized as a pediatric health care problem of some importance [ 111. Secondly, in many academic pediatric training programs, the prevailing attitude toward tonsil and adenoid surgery has been derogatory. And thirdly, the collective thrust of a number of critical reviews over the past 30 years has been to emphasize the lack of convincing evidence that tonsil and adenoid surgery is efficacious in relieving the various conditions for which it is undertaken [2,3,6,8,10,13-15,181. There is thus a large group of pediatricians (Fig. 1) who harbor generally negative attitudes about tonsil and adenoid surgery, and who also, being responsible and conscientious, are on the alert for opportunities to undertake such worthwhile endeavors as protecting children from apparent injury, denouncing practices that seem unscientific, and conserving health care dollars. Such pediatricians are not likely to agree readily to parents’ requests for tonsil or adenoid surgery, or to accept easily other physicians’ recommendations for surgery. On the contrary, they may be inclined to oppose tonsil and adenoid surgery and especially tonsillectomy more or less routinely and automatically, reassuring parents that their children will “outgrow” whatever conditions constitute the basis for concern. Quite a different point of view is held by another large group comprising