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Adenotonsillectomy for upper respiratory infections: evidence based?
B K van Staaij1, E H van den Akker, G J M G van der Heijden
1Julius Center for Health Sciences and Primary Care, location Stratenum 6.131, Universiteitsweg 100, 3584 CG Utrecht, Netherlands. B.K.vanStaaij@med.uu.nl
Insights
Adenotonsillectomy offers a small additional benefit for reducing sore throat episodes and upper respiratory infections in children. However, these conditions naturally improve over time, even without surgery.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Evidence-Based Medicine
Background:
- High rates of tonsillectomy for pediatric upper respiratory infections (URIs) lack clear clinical guidance.
- Physicians need better evidence to determine which children benefit from adenotonsillectomy.
Purpose of the Study:
- To evaluate the efficacy of adenotonsillectomy in children under 18 years.
- To synthesize evidence from randomized trials and controlled studies on surgical outcomes.
Main Methods:
- Literature search for randomized trials and non-randomized controlled studies on adenotonsillectomy efficacy.
- Pooled analysis of incidence rate ratios and risk differences for sore throat, school absence, and URIs.
- Calculations assumed a Poisson distribution for outcomes.
Main Results:
- Six randomized trials and seven non-randomized studies were analyzed.
- Adenotonsillectomy showed a pooled risk difference of -1.2 sore throat episodes/person-year.
- A pooled risk difference of -2.8 days of school absence/person-year was observed.
- A pooled risk difference of -0.5 URI episodes/person-year was found.
Conclusions:
- Available studies on adenotonsillectomy have significant limitations.
- Sore throat and URI frequency decrease over time, irrespective of surgery.
- Adenotonsillectomy provides a modest additional reduction in sore throat, school absence, and URIs compared to watchful waiting.
Background:
Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.
Methods:
A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.
Results:
Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was -1.2 episodes per person-year (95% CI -1.3 to -1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was -2.8 days per person-year (95% CI -3.9 to -1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was -0.5 episodes per person-year (95% CI -0.7 to -0.3).
Conclusions:
All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting.
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