ORIGINAL ARTICLE

Adenotonsillectomy for upper respiratory infections: evidence based?

B K van Staaij¹, E H van den Akker², G J M G van der Heijden¹, A G Schilder², A W Hoes¹

¹ Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht, Netherlands
² Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands

Correspondence to:
Correspondence to:
Mrs B K van Staaij
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, location Stratenum 6.131, Universiteitsweg 100, 3584 CG Utrecht, Netherlands; B.K.vanStaaij{at}med.uu.nl

Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.

Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.

Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was –1.2 episodes per person-year (95% CI –1.3 to –1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was –2.8 days per person-year (95% CI –3.9 to –1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was –0.5 episodes per person-year (95% CI –0.7 to –0.3).

Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting

Abbreviations: T±Ads, (adeno)tonsillectomy; URI, upper respiratory infection

Keywords: adenotonsillectomy; systematic review; upper respiratory infections

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This article has been cited by other articles:

• Buskens, E., van Staaij, B., van den Akker, J., Hoes, A. W., Schilder, A. G. M. (2007). Adenotonsillectomy or Watchful Waiting in Patients With Mild to Moderate Symptoms of Throat Infections or Adenotonsillar Hypertrophy: A Randomized Comparison of Costs and Effects. Arch Otolaryngol Head Neck Surg 133: 1083-1088 [Abstract] [Full Text]  
• Alho, O.-P., Koivunen, P., Penna, T., Teppo, H., Koskela, M., Luotonen, J. (2007). Tonsillectomy versus watchful waiting in recurrent streptococcal pharyngitis in adults: randomised controlled trial. BMJ 334: 939-939 [Abstract] [Full Text]  
• Paradise, J L, van Staaij, B, Rovers, M, Hoes, A, Schilder, A (2005). Effectiveness of tonsillectomy depends on stringency of indications * Authors' reply. Arch. Dis. Child. 90: 1318-1319 [Full Text]  

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