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Effect of Adenoidectomy on Respiratory Function. A Randomized Prospective Study.
  1. Petri S Mattila (petri.mattila{at}hus.fi)
  1. Helsinki University Central Hospital, Finland
    1. Sari Hammaren-Malmi (sari.hammaren-malmi{at}hus.fi)
    1. Helsinki University Central Hospital, Finland
      1. Anna S Pelkonen (anna.pelkonen{at}hus.fi)
      1. Helsinki University Central Hospital, Finland
        1. Pekka Malmberg (pekka.malmberg{at}hus.fi)
        1. Helsinki University Dept of Medicine, Finland
          1. Mika J Mäkelä (mika.makela{at}hus.fi)
          1. Helsinki University Dept of Medicine, Finland
            1. Harri Saxen (harri.saxen{at}duodecim.fi)
            1. Helsinki University, Finland
              1. Jussi Tarkkanen (jussi.tarkkanen{at}helsinki.fi)
              1. Helsinki University Central Hospital, Finland

                Abstract

                Objective: Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Here, we evaluated the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma.

                Design: Randomized controlled study.

                Setting: Tertiary care center.

                Patients: One hundred sixty-six children aged 12 to 48 months who had recurrent or persistent otitis media and who were followed-up for three years after randomization.

                Intervention: Randomization to undergo insertion of tympanostomy tubes with or without adenoidectomy.

                Main outcome measures: The primary out-come measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary out-come measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up otitis media episodes were documented in patient diaries.

                Results: Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (≥4 episodes) during the first follow-up year were associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27-34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98-10.8) regardless of adenoidectomy.

                Conclusions: Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyperreactivity.

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