Tonsillitis, Adenoid Disease Cause Real Pain and Discomfort for Patients and Families

A number of recent studies published in the American media have suggested that parents forgo a surgical solution for tonsillectomies. One noted work concluded "histories of recurrent throat infection do not validly forecast subsequent experience and hence do not constitute an adequate basis for subjecting children to tonsillectomy."

Is such a conclusion fair or reasonable? These studies regarding the validity of tonsillectomy and adenoidectomy are often based on specific questionnaires designed by the researchers. The measures of the severity of a condition and treatment outcome is questionable due to bias, from a surgeon's perspective that may not reflect what is important for the individual patient, specific for a condition, and do not allow comparisons with other diseases, which has potentially significant implications for health policies in the United Kingdom.

A new research study quantitatively measures the impact of adenotonsillar disease on children and their caretakers. It is a "baseline" study and does not focus on any specific intervention. However, adenotonsillectomy is the second most common procedure done in children. Its indications, in the vast majority of cases, are relative - i.e. it is done to improve the well being of children. This study attempts to measure objectively the impact of adenotonsillar disease and note the areas of concern by the child's caretakers. At the same time comparisons were made with other conditions, such as asthma and juvenile rheumatoid arthritis. Essentially, the research defines a framework within which treatment decisions can be examined and validated.

The authors of "Quality of Life in Children with Adenotonsillar Disease: A First UK Study," are Christos Georgalas MRCS DLO, and Jeveendra Kanagalingam MRCS DLO, and Neil Samuel Tolley FRCS MD DLO from St Mary's Hospital, London in the United Kingdom. Their findings were presented at the Annual Meeting and OTO EXPO of the American Academy of Otolaryngology--Head and Neck Surgery Foundation, held September 22-25, 2002, at the San Diego Convention Center, San Diego, CA. Now a

Methodology: This is the first study in the United Kingdom to use a generic questionnaire (previously validated in the US) of overall quality of life in children (Child Health Questionnaire - PF28) in a group of children referred by their general practitioner to an otolaryngology clinic with adenotonsillar disease. The researchers used the CHQ-PF 28 survey instrument to measure characteristics in this UK sample and examined responses themselves.

Forty-three children with adenotonsillar disease and their caregivers completed the Child Health Questionnaire -- PF 28, addressing 14 different aspects of their well being. The questionnaires were analysed for data quality and completeness, items' internal consistency and discriminant validity and reliability estimates. External validity was assessed by comparing their sample with healthy children and children with rheumatoid arthritis.

Results: CHQ PF 28 demonstrated excellent measuring characteristics in this population. The survey results revealed:

* Eleven of 14 measures of quality of life were significantly depressed when compared with healthy children. Most prominent were the differences in overall health, general health perception, bodily pain and discomfort experienced, emotional impact of the child's problems on the parents and family activities as well as on parents' time. * In quality of life terms these children were better off than British children with systemic and polyarticular juvenile rheumatoid arthritis, but worse off than children with the persistent form of the disease in specific joints.

Conclusion: Practitioners who subjectively compare the discomfort caused by a tonsillectomy versus no surgical intervention have their own perceptions regarding the pain experienced by the child. This research study, utilizing the CHQ PF 28 survey instrument, proved to be accurate and reliable. The research revealed that pain from adenotonsillar disease has a significant impact on the quality of life of the young patients and their families. Intervention can prove to be beneficial.

For additional information regarding the diagnosis and treatment of adenotonsillar disease, log on to http://www.entnet.org/healthinfo/throat/tonsils.cfm