February 13, 2013

Adenoidectomy ineffective in treating chronic upper respiratory infections

Approximately 8,000 adenoidectomies are performed in Utah hospitals yearly, according to the Utah Department of Health, resulting in a cost of $1,290 per surgery. Physicians, especially ear, nose and throat specialists, frequently recommend this procedure when a child experiences recurrent upper respiratory infections (URIs).

New research published online September 6, 2011 in the British Medical Journal suggests this procedure may be ineffective in treating upper respiratory infections. Researchers conducted an open, randomized clinical trial that included 111 children aged one to six with recurrent URIs, and who had been advised by a physician to have an adenoidectomy. Children were randomly assigned to one of two strategies, either adenoidectomy surgery or a period of watchful waiting.

After following participants for three years, researchers found that there was no significant difference between the two groups in reoccurrence of URIs. In fact, those who were assigned to the watchful waiting group experienced slightly less URIs as compared to those who had their adenoids removed – 7.84 to 7.91 per person year. The study authors concluded that adenoidectomy confers no clinical benefit over a strategy of initial watchful waiting in the prevention of URIs.

The adenoids are lumpy clumps of lymphatic tissue located at the back of the throat. They are an important part of your child’s immune system and help to prevent infections by trapping bacteria and viruses, which you breathe in or swallow. They become less important as your child grows older because his body has developed other means to fight germs.

During an acute infection, the adenoids enlarge. Once the infection clears, they usually shrink back to normal size. However, they may remain swollen, infrequently resulting in mouth breathing, constant runny nose, snoring and even a blockage of the Eustachian tube – the tube that connects the middle ear to the back of the throat.

This study suggests it is prudent for physicians and parents to exercise caution before considering the removal of a child’s adenoids to prevent recurrent URIs.