Commentary on Dutch guidelines regarding diseases of adenoids and tonsils

Commentary on Dutch guidelines regarding diseases of adenoids and tonsils. Problem: The Dutch Society of Otorhinolaryngology and Head Neck Surgery recently approved a revised version of the national multidisciplinary clinical guidelines for treatment, and referral to secondary care, of patients with diseases of the adenoids and tonsils. These guidelines have already proven somewhat controversial. In this manuscript, we discuss our hesitations and disagreements regarding the interpretation of what constitutes the best available evidence, and its translation to general ENT practice.

Methodology: We thoroughly reviewed the national and international literature with regards to the evidence for conservative treatment versus (adeno)tonsillectomy, particularly the articles used by the guidelines committee. We further compared our results and conclusions with those drawn in the guidelines.

Results: We found similar discussions occurring in other European countries. The development of appropriate indication criteria is hampered because the available scientific evidence is characterized by loss to follow-up and crossover of children who are assigned to non-surgical treatment, but ultimately undergo surgery. Nonetheless, convincing evidence suggests that (adeno)tonsillectomy is a highly beneficial surgical procedure when selected based on a suitable indication.

Conclusions: The revised Dutch guidelines promote a relatively conservative attitude towards referral for surgery, essentially concluding that there is insufficient evidence supporting the effectiveness of (adeno)tonsillectomy. This trend is also apparent in other countries. Here we discuss pivotal points of discrepancy regarding the interpretation of study results that demonstrate the exact opposite. We are concerned that implementation of the current guidelines may lead to under-treatment and a higher patient burden.