Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomised controlled trial.

Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, PO Box 85060, 3508 AB Utrecht, Netherlands.
BMJ (online) (Impact Factor: 17.22). 10/2004; 329(7467):651. DOI: 10.1136/bmj.38210.827917.7C
Source: PubMed

ABSTRACT To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy.
Open, randomised controlled trial.
21 general hospitals and three academic centres in the Netherlands.
300 children aged 2-8 years requiring adenotonsillectomy.
Adenotonsillectomy compared with watchful waiting.
Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life.
During the median follow up period of 22 months, children in the adenotonsillectomy group had 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53, -0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectomy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had complications related to surgery.
Adenotonsillectomy has no major clinical benefits over watchful waiting in children with mild symptoms of throat infections or adenotonsillar hypertrophy.

  • [Show abstract] [Hide abstract]
    ABSTRACT: To compare the clinical and bacteriological features of recurrent tonsillitis between patients with and without juvenile idiopathic arthritis (JIA). A total of 122 participants, aged 2-18 years, were consecutively recruited into four groups: (i) JIA and recurrent tonsillitis; (ii) JIA; (iii) recurrent tonsillitis; and (iv) healthy. All the patients with recurrent tonsillitis underwent tonsillectomy. Swabs from tonsillar surface crypts of all children and samples from tonsillar core tissue in case of tonsillectomy were processed for culturing. Mycoplasma pneumoniae was determined by polymerase chain reaction (PCR). Significantly lower rates of recurrences but more frequent tonsillar detritus, paratonsillar scars, and more intensive bleeding during tonsillectomy were found in patients with JIA and recurrent tonsillitis, versus patients with recurrent tonsillitis without arthritis. In JIA patients with recurrent tonsillitis, Staphylococcus aureus was cultured from the tonsillar surface in 36%, and from the core tissue in 92% of cases (p = 0.0000). In patients suffering from recurrent tonsillitis alone, this pathogen was cultured from the core in 55.9% of cases (p = 0.0066 compared to JIA patients with recurrent tonsillitis). No M. pneumoniae was revealed by PCR in samples from the tonsillar surface and the core tissue. The increased rate of S. aureus in the core tissue of tonsils, the higher frequency of tonsillar detritus, the more pronounced paratonsillar scarring, and more intensive bleeding during tonsillectomy, associated with the lower frequency of tonsillitis recurrences, are characteristic for recurrent tonsillitis in JIA as compared to recurrent tonsillitis without arthritis.
    Scandinavian journal of rheumatology 08/2009; 38(5):349-52. · 2.51 Impact Factor
  • Clinical otolaryngology: official journal of ENT-UK; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 06/2011; 36(3):280; author reply 281. · 1.87 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: BACKGROUND:: In children presenting with obsessive compulsive disorder (OCD) and/or tics, especially those with a temporal association with streptococcal pharyngitis (e.g., PANDAS; Pediatric Autoimmune Neuropsychiatric Disorders Associated with Streptococcus), there is speculation about whether tonsillectomy/adenoidectomy might improve the child's neuropsychiatric course. Our objective was to examine whether removal of tonsils and/or adenoids impacted streptococcal antibody titers, the timing of onset of OCD and/or tics, and the clinical severity of these symptoms. METHODS:: Study participants (n = 112; average age = 9.2 ± 2.4; 44 female) were recruited as part of a prospective investigation of neuropsychiatric phenomena with temporal association to streptococcal pharyngitis and examined by family history, diagnostic interview, physical examination, medical record review, psychological testing, and streptococcal antibodies and divided into surgical or non-surgery groups. The surgical group consisted of children having previously had a tonsillectomy and/or adenoidectomy (n=32). The remaining children were categorized as non-surgery (N=76). Measures of OCD and tic severity, streptococcal antibody titers, and PANDAS classification were compared between both groups. RESULTS:: There were no significant differences as determined by streptococcal antibody titers, PANDAS classification, and OCD or tic severity between the surgical and non-surgery groups. Most participants had surgery before onset of neuropsychiatric symptoms and surgery did not affect symptomology. CONCLUSIONS:: Streptococcal antibodies and neuropsychiatric symptom severity did not differ on the basis of surgical status. From these data we cannot support that tonsillectomy and adenoidectomy are likely to impact positively the course of OCD/tics or streptococcal antibody concentrations.
    The Pediatric Infectious Disease Journal 03/2013; · 3.57 Impact Factor


Available from