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Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial

BMJ 2011; 343 doi: https://doi.org/10.1136/bmj.d5154 (Published 06 September 2011) Cite this as: BMJ 2011;343:d5154

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Adenoidectomy; a good operation with clear indications.

Dear Sir,

While Van den Aardweg and colleague's study (1) did not demonstrate a
significant benefit in immediate adenoidectomy versus watchful waiting in
children with recurrent upper respiratory tract infections, we were
surprised at the significance that was placed on this finding by the BMJ.

A look at the standard texts in ENT surgery will show that
indications for adenoidectomy include otitis media with effusion,
obstructive sleep apnoea, and in association with a tonsillectomy for
recurrent tonsillitis. (2, 3, 4) It is not practice in the UK to perform
adenoidectomy for recurrent upper respiratory tract infections. There is
good evidence presented for its effectiveness in conjunction with
tonsillectomy (5, 6) and evidence from Aardweg et. al. for its
effectiveness as an operation for otitis media in children. (7) Similarly,
there is a significant evidence base for its role in obstructive sleep
apnoea and its role is well established.(3)

Adenoidectomy remains a good operation with clear and increasingly
refined indications for its use. Unfortunately, Van den Aardweg and
colleague's most recent study will not impact on UK practice as it tells
us what we already know. However, the danger of this publication is that
the non-specialist reader may be persuaded that there is no useful role
for this procedure, which is far from the truth.

1 Effectiveness of adenoidectomy in children with recurrent upper
respiratory tract infections: open randomised controlled trail.
M T A van der Aarweg, C W B Boonacker, M M Rovers et al. BMJ 343:487-542
No 7822. Sept 2011.

2 Key Topics in Otolaryngology. 2nd Ed. N J Roland, R D R MaRae, A W
McCombe

3 Scott-Brown's Otorhinolaryngology, Head and Neck Surgery. 7th Ed.
Micheal Gleeson et al.

4 NICE guidelines for suction diathermy adenoidectomy. Dec 2009.

5 North of England and Scotland Study of Tonsillectomy and Adeno-
tonsillectomy in Children (NESSTAC) : a pragmatic randomised controlled
trial with a parallel non randomised preference study.
C Lock, J Wilson, N Steen at al. Health Technology Assessement 2010; Vol.
14: No. 13 DOI:10.3310/hta14130

6 Tonsillectomy or adeno-tonsillectomy versus non-surgical treatment
for chronic/recurrent acute tonsillitis. Burton MJ, Glasziou PP. Cochrane
Database of Systematic Reviews 2009, Issue 1. Art. No.: CD001802. DOI:
10.1002/14651858.CD001802.pub2

7 Adenoidectomy for otitis media in children. M T A van der Aardweg,
A G M Schilder, E Herkert et al. Cochrance Database of Systematic Reviews
2010, Issue 1. Art No: CD007810. DOI: 10.1002/14651858.CD00810.pub2.

Competing interests: No competing interests

07 October 2011
David J. Black
CT2 ENT
Andrew W. McCombe. Consultant ENT Surgeon
Frimley Park Hospital, Surrey