Adenoidectomy ‘confers no benefit’
Performing adenoidectomy in children with recurrent upper respiratory tract infections (URTIs) offers no benefits over a strategy of watchful waiting, a randomised trial has found.
The Dutch study, published in the BMJ, found that the frequency of URTIs declined in all children during 2 years of follow-up, irrespective of treatment. Furthermore, children who underwent adenoidectomy were at risk for complications.
Accordingly, Professor Anne Schilder (University Medical Centre Utrecht, The Netherlands) and co-authors of the study suggest that "the contribution of surgery to the favourable natural course of upper respiratory tract infections is trivial."
Their viewpoint is endorsed in an accompanying editorial, in which Professor Kari Kvaerner (Oslo University Hospital, Norway) says the best approach for children with recurrent URTIs is "careful follow-up and a strategy of watchful waiting."
The study included 111 children aged 1-6 years who had been referred for adenoidectomy for recurrent URTIs. They were randomly assigned to undergo immediate adenoidectomy, with or without myringotomy, or to a strategy of initial watchful waiting.
The primary outcome was the number of URTIs per year, which did not differ between the surgery and nonsurgery groups (7.91 vs 7.84). Also comparable were secondary outcomes such as days with URTIs, middle ear complaints with fever, and health-related quality of life. Two children developed complications related to surgery.
Professor Schilder and team conclude: "In 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."
GP News is an independent clinical news service provided by Springer Healthcare Limited. © Springer Healthcare Ltd; 2011
By Joanna Lyford