Repeated acute inflammation and enlargement of the palatine tonsils especially affect children and adolescents. In Germany, no uniform indication for surgical removal of the tonsils has so far been established, either as partial (tonsillotomy) or complete (tonsillectomy) removal. Regional differences in the frequency of surgery are sometimes considerable.

The German Institute for Quality and Efficiency in Health Care (IQWiG) was commissioned by the Federal Joint Committee (G–BA) to investigate whether tonsillotomy offers advantages. According to the findings, the short–term advantages of tonsillotomy are opposed by its long–term disadvantages in comparison with tonsillectomy: In the first 2 weeks after surgery, tonsillotomy is associated with less pain as well as fewer swallowing and sleeping problems. But after tonsillotomy, regrowing tissue may result in disadvantages: For instance, inflammation of the tonsils may reoccur even years later; therefore renewed surgery may also be required.

The benefit and harm of tonsillotomy in comparison with non–surgical management (e.g. watchful waiting) are unclear, as no studies on this topic could be identified.

The most common indications for tonsillectomy in children and adolescents are recurrent acute tonsillitis and hyperplasia of the tonsils. Tonsillitis is caused by viruses or bacteria and is accompanied by pain, swallowing problems and fever. Tonsillar hyperplasia can lead to obstruction and thus also to breathing problems while sleeping (e.g. sleep apnoea syndrome).

Within 2 weeks after surgery, less pain occurred, as well as fewer swallowing and sleeping problems, than with tonsillectomy. Hence a hint or an indication of lesser harm from tonsillotomy can be inferred.

However, for the further course after surgery, the data showed no hint of a greater or lesser benefit or harm in the comparison of tonsillotomy and tonsillectomy.

In relation to recurrent tonsillitis and other ear, nose and throat infections, the data provide a hint of a lesser benefit of tonsillotomy: 5 of 43 patients with tonsillar hyperplasia investigated in the Chaidas study experienced renewed inflammation in the remaining tonsillar tissue 6 years after tonsillotomy. In contrast, no further inflammation was shown in the 48 study participants with tonsillectomy.

Because during tonsillotomy the tonsillar tissue is only partly removed, there is a risk of regrowing tissue and thus of the recurrence of symptoms. In addition, further surgery may be required. But due to insufficient data on renewed tonsillar surgery, for this outcome there is no hint of a benefit or harm of tonsillotomy in comparison with tonsillectomy.

Only 1 of the 19 relevant studies on tonsillotomy is considered to be with a low risk of bias; all other 18 studies provide only moderately reliable to unreliable results. In addition, with only one study available on the outcome of health–related quality of life, the evidence base is more than sparse.

Potential advantages of tonsillotomy commonly mentioned in the scientific literature (e.g. a lower rate of postoperative complications such as infections and bleeding as well as faster recovery) are not confirmed by the study data available: With regard to patient–relevant outcomes such as postoperative bleeding, length of hospital stay, renewed hospitalization, and health–related quality of life, the study data provided no hints of a benefit or harm of tonsillotomy in comparison with tonsillectomy. Likewise, due to a lack of data on mortality, no conclusion on benefit can be made for this outcome.