Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial

Staaij, Birgit K. van; Akker, Emma H. van den; Rovers, Maroeska M.; Hordijk, G. J.; Hoes, Arno W.; Schilder, Anne G. M.

doi:10.1136/bmj.38210.827917.7c

Cited by 121 publications

(139 citation statements)

References 25 publications

(23 reference statements)

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“…However, children younger than 6 years of age may also suffer from recurrent episodes of tonsillitis and are therefore candidates for tonsillectomy too. This statement is supported by the studies of Paradise [1 ]who included children 3-15 years of age or van Staaij [2] including children aged 2-8 years. Indication for surgery should rely on the grade, and how seriously the quality of life in that particular individual is impaired rather than counting episodes of tonsillitis or years.…”

mentioning

confidence: 58%

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Mt¹,

Hultcrantz²,

Ericsson³

et al. 2013

ORL

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mentioning

confidence: 58%

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Mt¹,

Hultcrantz²,

Ericsson³

et al. 2013

ORL

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“…Randomized trials comparing surgical treatment versus medical treatment published since 1966 were selected. They found 1 adult study with 70 patients [40] and 4 pediatric studies totalizing 719 children [41,42,43]. The studies were so heterogeneous that a meta-analysis could not be performed.…”

Section: Recurrent Tonsillitismentioning

confidence: 99%

“…In an open randomized controlled trial, van Staaij et al [43] included 300 children aged 2-8 years requiring TA. The study was conducted in 21 centers.…”

Section: Recurrent Tonsillitismentioning

confidence: 99%

Indications of Pediatric Tonsillectomy

Gysin

2013

ORL

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Possible indications for tonsillectomy include sleep apnea and other obstructive sleep-related breathing disorders, recurrent tonsillitis, peritonsillar abscess, periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA), and other miscellaneous rare conditions. Over the last century indications have changed, with a decrease in infectious causes and an increase in sleep apnea disorders. Sleep apnea in children is difficult to diagnose short of polysomnography (PSG) which is expensive and disturbing, especially in young children. In sleep apnea confirmed by PSG, tonsillectomy relieves the trouble in close to 80% of patients. What remains unclear is how to diagnose sleep-related breathing disorders without PSG and the efficacy of tonsillectomy in this population. Recurrent tonsillitis is generally poorly documented and randomized studies assessing the efficacy of tonsillectomy are sparse. When frequent infections are present for several years (>7 episodes/1 year, >5/2, >3/3) some benefit from tonsillectomy could be found. If fewer infectious episodes are present, the benefit of tonsillectomy is low. Peritonsillar abscess tends to be treated with quinsy tonsillectomy. Some PFAPA and psoriasis children might benefit from tonsillectomy. Tonsillectomy for other conditions is not warranted.

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“…A recent Dutch randomised controlled trial of adenotonsillectomy versus watchful waiting reported no differences between treatment arms for children with mild symptoms and only a small difference of less than one episode of fever a year between treatment arms for children with moderate symptoms. 27 The Scottish National Tonsillectomy Audit 14 showed high levels of patient satisfaction and that 80% of subjects did not consult a doctor in the subsequent 12 months. However, over the past 30 years a number of controlled studies with longer follow-up indicate marginal and diminishing levels of clinical benefit over a period of nonintervention.…”

Section: 12mentioning

confidence: 99%

“…Another relative [18][19][20][21][22][23][24][25][26] A friend [27][28][29][30][31][32][33][34][35] A child minder [36][37][38][39][40][41][42][43][44] A nanny [45][46][47][48][49][50][51][52][53] Other (please write in who) …”

mentioning

confidence: 99%

Comparison of case note review methods for evaluating quality and safety in health care

Lock

Wilson²,

Steen³

et al. 2010

Health Technol Assess

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Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial

Abstract: Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

Cited by 121 publications

References 25 publications

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Indications of Pediatric Tonsillectomy

Comparison of case note review methods for evaluating quality and safety in health care

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