Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial

Abstract

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...

Immediate Adenoidectomy vs Initial Watchful Waiting Strategy in Children With Recurrent Upper Respiratory Tract Infections

“…4,5 In a recent randomized controlled trial, we compared 2 common clinical strategies in children with recurrent URTIs: immediate adenoidectomy vs initial watchful waiting. 6 We found no relevant differences between both strategies in the incidence of URTIs and middle ear problems or health-related quality of life. We concluded that immediate adenoidectomy confers no clinical benefits over an initial watchful waiting strategy.…”

Fehler und Gefahren: Tonsillektomie und andere Standard-Eingriffe

“…Obere Atemwegsobstruktion, rezidivierende Infekte der oberen Atemwege und sekundäre Mittelohrerkrankungen wegen adenoider Vegetation sind die klassischen Indikationen zur AT [ 62 ] . Paukenergüsse und Hörvermögen lassen sich durch die AT positiv beeinfl ussen, die Häufi gkeit von rezidivierender akuter Otitis media jedoch nicht [ 104 ] . In einer prospektiven multizentrischen Untersuchung ließ sich jedoch auch kein positiver Eff ekt der AT auf die Häufi gkeit wiederkehrender Infektionen des obe- Tab.…”

Adjuvant adenoidectomy in persistent bilateral otitis media with effusion: hearing and revision surgery outcomes through 2 years in the TARGET randomised trial

“…Because of the inconsistent evidence, NICE restricted its recommendation of adenoidectomy to children with co‐present severe or persistent upper respiratory tract infection. However, a recent trial has shown that these are themselves not indications for adenoidectomy 6 …”