One of the most significant clinical trials, demonstrating the efficacy of
tonsillectomy (TE) for recurrent throat
infection in severely affected children, was published in 1984. This systematic review was undertaken to compile various indications for TE as suggested in the literature after 1984 and to stratify the papers according to the current concept of Evidence-based Medicine.
MATERIAL AND METHODS: A systematic Medline research was performed using the key word "
tonsillectomy" in combination with different filters such as "systematic reviews", "meta-analysis", "English", "German" and "from 1984/01/01 to 2015/05/31". Further research was performed in the Cochrane Database of Systematic Reviews, National Guideline Clearinghouse, Guidelines International Network and BMJ Clinical Evidence using the same key word. Finally, data from the "Trip Database" were researched for "
tonsillectomy" and "indication" and "from: 1984 to: 2015" in combination with either "systematic review" or "meta-analysis" or "metaanalysis.
RESULTS: CONCLUSIONS: 1) The literature suggests, that TE is not indicated to treat
otitis media with effusion. 2) It has been shown, that the PFAPA-syndrome is self-limiting and responds well to
steroid administration, at least in a considerable amount of children. The indication for TE therefore appears to be imbalanced but further research is required to clarify the value of surgery. 3) Abscesstonsillectomy as a routine is not justified and indicated only for cases not responding to other measures of treatment, evident complications, or with a significant history of
tonsillitis. In particular, interval-
tonsillectomy is not justified as a routine. 4) TE, with or without
adenoidectomy, is efficacious to resolve sleep-related breathing disorders resulting from (adeno)tonsillar
hypertrophy in children. However, the benefit is reduced by co-morbidities, such as
obesity, and further research required to identify prognostic factors for this subgroup of patients. Further research is indicated to clarify selection criteria not only for this subpopulation that may benefit from less invasive procedures such as tonsillotomy in the long-term. 5) Further trials are also indicated to evaluate the efficacy of TE on the
clinical course in children with
psoriasis guttata as well as on
psoriasis vulgaris in adults, not responding to first-line
therapy. 6) Conflicting results were reported concerning the role of TE in the concert to treat Ig-A nephropathy, mandating further clinical research. 7) Most importantly, randomized-controlled clinical trials with an adequate long-term follow-up are desirable to clarify the benefit of TE in patients with recurrent episodes of
tonsillitis, with or without
pharyngitis. Factors like age,
spontaneous healing rate and postoperative quality of life have to be included when comparing TE with
antibiotic therapy.