BMJ  2004;329:651 (18 September), doi:10.1136/bmj.38210.827917.7C (published 10 September 2004)

Paper

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

Birgit K van Staaij, general practitioner1, Emma H van den Akker, otorhinolaryngologist2, Maroeska M Rovers, clinical epidemiologist1, Gerrit Jan Hordijk, professor3, Arno W Hoes, professor1, Anne G M Schilder, otorhinolaryngologist2

1 Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, Netherlands, 2 Department of Otorhinolaryngology, Wilhelmina Children's Hospital, University Medical Center Utrecht, PO Box 85090, 3508 AB Utrecht, Netherlands, 3 Department of Otorhinolaryngology, Head and Neck Surgery, University Medical Center Utrecht, 3584 CX Utrecht, Netherlands

Correspondence to: A G M Schilder A.Schilder{at}wkz.azu.nl

Objective To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

Design Open, randomised controlled trial.

Setting 21 general hospitals and three academic centres in the Netherlands.

Participants 300 children aged 2-8 years requiring adenotonsillectomy.

Intervention Adenotonsillectomy compared with watchful waiting.

Main outcome measures Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life.

Results During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery.

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


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This article has been cited by other articles:

  • Burton, M. J (2008). Commentary: Tonsillectomy--then and now. Int J Epidemiol 37: 23-25 [Full text]  
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Rapid Responses:

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