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. Therefore, the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma was evaluated.
Design: Randomised controlled study.
Setting: Tertiary care centre.
Patients: 166 children aged 12–48 months who had recurrent or persistent otitis media and who were followed-up for 3 years after randomisation.
Intervention: Randomisation to undergo insertion of tympanostomy tubes with or without adenoidectomy.
Main outcome measures: The primary outcome measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary outcome measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up period otitis media episodes were documented in patient diaries.
Results: Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, the 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 was associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27 to 34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98 to 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 hyper-reactivity.
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Competing interests: None.
Funding: This work received financial support from the Helsinki University Central Hospital Research Funds, Allergy Research Foundation and Sigrid Juselius Foundation.
Ethics approval: The Ethics Review Committee of Helsinki University Central Hospital approved the study.
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