BMJ  2004;329:1045 (30 October), doi:10.1136/bmj.329.7473.1045

Letter

Adenotonsillectomy in children with mild symptoms

Watchful waiting may deny children opportunity for development

The first 150 words of the full text of this article appear below.

Credit: DR P MARAZZI/SPL

EDITOR—van Staaij et al report a large study examining the effectiveness of adenotonsillectomy in children with mild symptoms of throat infection or adenotonsillar hypertrophy.1 They conclude that adenotonsillectomy confers no major clinical benefits over watchful waiting.

We are concerned that the conclusion may lead to a false sense of security about the safety of watchful waiting. The paper says that children with suspected obstructive sleep apnoea have been excluded because they scored more than 3.5 on Brouillette's obstructive sleep apnoea score.2 A more recent publication from Brouillette et al has indicated that, although a score of greater than 3.5 is suggestive of obstructive sleep apnoea, a score of less than this does not distinguish obstructive sleep apnoea from primary snoring.3

Children with obstructive sleep apnoea are therefore unlikely to have been excluded from the cohort described in the paper by van Staaij et al. . . . [Full text of this article]

Simon C Langton Hewer, consultant respiratory paediatrician

Flinders Medical Centre, SA 5042, Australia simon.langtonhewer@bris.ac.uk

Claire D Langton Hewer, otorhinolaryngology fellow

Queen Elizabeth Hospital, Woodville, Adelaide, SA 5011

Yvonne Pamula, sleep physiologist, James Martin, consultant respiratory paediatrician, Declan Kennedy, consultant respiratory paediatrician

Women's and Children's Hospital, North Adelaide, SA 5006


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Relevant Article

Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial
Birgit K van Staaij, Emma H van den Akker, Maroeska M Rovers, Gerrit Jan Hordijk, Arno W Hoes, and Anne G M Schilder
BMJ 2004 329: 651. [Abstract] [Full Text] [PDF]

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