UK 'doing too few tonsil operations'

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.