Acute mastoiditis in children is an entity that is poorly evaluated and understood in the modern literature. There is a lack of consensus regarding the criteria and strategies for diagnosing acute mastoiditis in the pediatric population. It is crucial that such criteria are established, and consensus is achieved so that prognostic and controlled studies can be initiated to identify risk factors and establish the most effective management of this condition in children.

Objective To assess the effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections.Design Open randomised controlled trial.Setting 11 general hospitals and two academic centres.Participants 111 children aged 1-6 with recurrent upper respiratory tract infections selected for adenoidectomy.Intervention A strategy of immediate adenoidectomy with or without myringotomy or a strategy of initial watchful waiting.Main outcome measure Primary outcome measure: number of upper respiratory tract infections per person year calculated from data obtained during the total follow-up (maximum 24 months). Secondary outcome measures: days with upper respiratory tract infection per person year, middle ear complaints with fever in episodes and days, days with fever, prevalence of upper respiratory tract infections, and health related quality of life.Results During the median follow-up of 24 months, there were 7.91 episodes of upper respiratory tract infections per person year in the adenoidectomy group and 7.84 in the watchful waiting group (difference in incidence rate 0.07, 95% confidence interval −0.70 to 0.85). No relevant differences were found for days of upper respiratory tract infections and middle ear complaints with fever in episodes and days, nor for health related quality of life. The prevalence of upper respiratory tract infections decreased over time in both groups. Children in the adenoidectomy group had significantly more days with fever than the children in the watchful waiting group. Two children had complications related to surgery. ConclusionIn children selected for adenoidectomy for recurrent upper respiratory tract infections, a strategy of immediate surgery confers no clinical benefits over a strategy of initial watchful waiting.Trial registration Dutch Trial Register NTR968: ISRCTN03720485. IntroductionAn acute upper respiratory tract infection is the most common diagnosis in children in primary care: every year the diagnosis is made in one in every two children aged 0-4 and in one in 10 of those aged 5-9. 1 The true incidence of the condition in the community is much higher as usually parents do not consult their doctor when their child develops an upper respiratory tract infection. Upper respiratory tract infections not only affect children's health but also account for a large proportion of annual healthcare expenditure and high indirect costs for the family and society. [2][3][4] An estimated 20% of children experience recurrent upper respiratory tract infections, and many of these children are referred to the ear, nose, and throat surgeon for surgery. [5][6][7][8] Adenoidectomy is one of the most commonly performed surgical procedures in children in western countries. In 2009 in the Netherlands 15 179 children (16.3 per 1000) aged 0-4 and 5573 children (5.5 per 1000) aged 5-9 underwent adenoidectomy. 9 10 In 60% of these children, recurrent upper respiratory tract infections were the indication for surgery.11 In 2006 in the United States 129 540 children (1.7...

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trialregister.nl Identifier:NTR968; isrctn.org Identifier:ISRCTN03720485.

Adenoidectomy seems to have a beneficial effect on the nasopharyngeal bacterial flora. Because the overall quality of the available evidence is low, it is important that controlled studies are initiated into the short- and long-term effect of adenoidectomy on the nasopharyngeal bacterial flora and its relationship with the recurrence of URTIs in children.