Clinical Question: Is adenotonsille...

Clinical Question: Is adenotonsillectomy effective in decreasing the number of throat infections in children?

Setting: Outpatient (any)

meditation Design: Randomized controlled trial (nonblinded)

Allocation: Uncertain

Synopsis: The authors of this subject of attention which was conducted in the Netherlands, registered patients by asking otolaryngologists to identify children between brace and eight years of age whom they believed had indications for adenotonsillectomy. The researchers exclud approximately 18 percent of children with real frequent throat infections, defined as seven or more throat infections in the previous year, five or more in each of the previous brace years, or three per year for three years. They also could not include the 45 percent of children whose parents or physicians insisted they have surgery

The 300 children who were recorded in the study were randomized (allocation concealment unknown) to receive adenotonsillectomy or no treatment. The average age of the children was 45 years, they had a median of three throat infections in the previous year, and they were divided equally on sex. Parents kept a diary of upper respiratory tract infections, temperature, and denomination absences. Fifty (34 percent) of the children assigned to no therapy eventually received surgery although they were analyzed in the clusters to which they were assigned initially (intention-to-treat analysis).

The primary and greatest in number objective outcome, the number of febrile disease episodes during the following 22 month was not different between the pair groups. The number of throat infections was statistically les in the surgery assemblage although the difference was small (056 versus 077 infections for year). The surgery group also experienced fewer days with sore throat (981 versus 1571 days) and fewer days with upper respiratory tract infections (782 versus 900 days). There was no difference in absence from day care or educate Brouillette's scores were lower at six month after surgery however were no different after sum of two units years. Of all the children who underwent surgery 6 percent had surgery-related complications.

Bottom Line: Adenotonsillectomy decreases the number of throat infections and the number of days with sore throat. The more objective consequences in this unblinded study--the number of episodes of febrile affection and number of days with fever--were unaffected from surgery. The number of days dissipated from day care or gymnasium also was not changed by means of surgery. (Level of Evidence: 1b-)

research Reference: van Staaij BK, et al. Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: lay open randomised controlled trial. BMJ September 18 2004;329:651-4 Used with permission from Shaughnessy AF. Tonsillectomy ineffective for mild throat infections. Accessed online November 1 2004 at: http://www.InfoPOEMs.com.

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