Adenotonsillectomy for upper respiratory infections: evidence based?

Abstract

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 21.2 episodes per person-year (95% CI 21.3 to 21.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was 22.8 days per person-year (95% CI 23.9 to 21.6). For upper respiratory infections 1596 personyears were available. The pooled risk difference was 20.5 episodes per person-year (95% CI 20.7 to 20.3). 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

MBL2 genetic polymorphisms in Italian children with adenotonsillar hypertrophy

“…accepted guidelines on the indications for this procedure are available [5,6]. Respiratory disease in children, including infections, are among the most important public health problems [7]. Many factors are involved in the recurrence of disease as such as genetic, environmental and host predisposition.…”

Acute otitis media in children: Correlation with palatine tonsil size, adenoidectomy and adenotonsillectomy

“…Adeno/tonsillectomy leads to an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections, compared to watchful waiting (15). This research showed that there was a highly statistically significant association between adenotonsillar infections and antibiotic therapy with acute otitis media.…”

Patient-reported outcomes in children suffering with mild to moderate tonsillitis versus those in children with severe tonsillitis

“…7 It is believed that this small benefit is offset by the increased morbidity associated with surgery and the higher cost of treatment. 8,9 Hence, the current practice in England is that of watchful waiting.…”