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Adenoid removal may not cut childhood infections

Wednesday September 7th, 2011

Having the adenoids removed will not necessarily benefit children with recurring upper respiratory tract infections, new research finds.

About one in five children get recurrent upper respiratory tract infections such as colds, say Professor Anne Schilder of University Medical Centre Utrecht, the Netherlands, and colleagues. Many are referred to an ear, nose, and throat surgeon who may recommend adenoidectomy.

However, evidence for its effectiveness is scarce and international guidelines are lacking, the researchers write on the website of the British Medical Journal. They carried out a randomised controlled trial of 111 children aged one to six years.

All had recurrent upper respiratory tract infections. Half were given an adenoidectomy and half were just observed. Two of the children given surgery had complications afterwards.

Over the next two years, the adenoidectomy group had an average of 7.91 upper respiratory tract infections per year and the "watchful waiting" group had 7.84. There were no significant differences in the rate of middle ear complaints or health related quality of life.

"The prevalence of upper respiratory tract infections decreased over time in both groups," report the team. They conclude: "A strategy of immediate surgery confers no clinical benefits over a strategy of initial watchful waiting."

Professor Kari Kvaerner of Oslo University Hospital, Norway, writes in an accompanying editorial: "Further studies are needed to replicate the findings, to refine the study design and increase the sample size so that comparisons between different age groups can be made."

But he agrees that: "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."

van den Aardweg, M. T. A. et al. Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial. The British medical Journal, 2011;343:d5154.

Kvaerner, K. J. Adenoidectomy in children with recurrent upper respiratory infections. The British medical Journal, 2011;343:d5274.

Tags: Child Health | Europe | Respiratory

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