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06-09-2011 | General practice | Article

Adenoidectomy does not reduce childhood respiratory infection risk


Free abstract

MedWire News: Removal of adenoids in children has no effect on the incidence of upper respiratory tract infections, show study results.

Adenoidectomy is commonly performed in young children to try and reduce the incidence of upper respiratory tract infections, but evidence to support the clinical effectiveness of this procedure is lacking.

To investigate further, Anne Schilder and colleagues, from the University Medical Centre Utrecht in The Netherlands, followed-up 111 children aged between 1 and 6 years who were scheduled to undergo adenoidectomy.

Half the children had the operation and the other half (controls) were assigned to a strategy of "initial watchful waiting." In total, four children from the adenoidectomy and seven from the control group were lost to follow-up for nonmedical reasons.

The children were monitored for incidence of upper respiratory tract infections for up to 2 years from the point of surgery onward.

As reported in the BMJ, children who had surgery had no significant reduction in risk for upper respiratory tract infection during this time compared with controls, at 7.91 infections, on average, versus 7.84.

In addition, no differences in days of upper respiratory infection per year, episodes and days with middle ear problems plus fever, or health-related quality of life were found between the two groups, although children in the adenoidectomy group had more days with fever than those in the control group, at 20.0 versus 16.5 days per person year.

In general, the incidence of upper respiratory infection decreased over time in both groups, write the authors, "suggesting that the contribution of surgery to the favorable natural course of upper respiratory tract infections is trivial."

This study also "highlights the difficulty in selecting children for surgery because symptom severity often reduces as the child grows older," said editorialist Kari Kvaerner, from Oslo University Hospital in Norway.

She concluded: "Careful follow-up and a strategy of watchful waiting seem prudent in the light of this study, especially because the incidence of upper respiratory infections declines with age."

By Helen Albert

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