Background:

Debate continues as to the benefit of tonsillectomy. A recent Cochrane review found that there were insufficient trials to fully evaluate the effectiveness of tonsillectomy (1). However, the author of the only studies included in this review stand by their conclusion that tonsillectomy was efficacious in reducing sore throat episodes (1). Furthermore, recent comment from a leading ENT academic asks the pertinent question of the whether the perceived supremacy of this type of review for answering questions related to the use of surgical interventions is justified (2).

Primary question:

Is there a manifest, bias balanced benefit from tonsillectomy versus non-operative management for children with recurrent tonsillitis?

Rationale for using ALSPAC data:

Although there are many studies into the benefit of tonsillectomy, we believe that the ALSPAC database will contain information to add significantly to this debate. Last year there were nearly 30,000 tonsillectomies carried out across England in the 0-14 age group (3). Assuming the national average rate of tonsillectomy applies to the ALSPAC population we expect around 300 tonsillectomies to have been performed on this cohort of children. This study size is comparable with other studies (1).

The incidence of self-reported sore throat is included in the questionnaires, this is the primary outcome that has been previously used to assess benefit of the intervention. However, other outcome measures such as SAT scores and school attendance may be used to demonstrate an association with tonsillectomy. Also, confounders such as socio-economic and smoking status may be examined to balance any potential bias.

Plan of action:

1. We intend to review the ALSPAC database to ascertain the incidence of the exposure variable (tonsillectomy) and the outcome measure (primary being reported sore throat episodes, secondary measures being school attendance/performance).

2. Assess likely bias from confounders between groups.

3. Extract data.

4. Statistical analysis (3. and 4. to be supported by the ALSPAC statistics team, funded by the applicants).

5. Presented locally, regionally and nationally.

6. Publish in the ENT-UK journal (Clinical Otolaryngology).