Adenoidectomy for recurrent of chronic nasal symptoms in children

van den Aardweg MTA, Schilder AGM, Herkert E, Boonacker CWB, Rovers MM

Published Online:

March 17, 2010

Infections of the upper respiratory tract, presenting as recurrent nasal symptoms (nasal discharge with or without nasal obstruction) are very common in children. Removal of the adenoids (adenoidectomy) is a surgical procedure that is frequently performed in these children. It is thought that adenoidectomy prevents recurrence of nasal symptoms.

Our review, which includes two studies (256 children), shows that it is uncertain whether adenoidectomy is effective in children with recurrent or chronic nasal symptoms. Further high quality trials are needed.

Abstract (click to read)

Background:

Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with recurrent or chronic nasal symptoms. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed.

Objectives:

To assess the effectiveness of adenoidectomy versus non-surgical management in children with recurrent or chronic nasal symptoms.

Search strategy:

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009.

Selection criteria:

Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes alone in children with recurrent or chronic nasal symptoms. The primary outcome studied was the number of episodes, days per episode and per year with nasal symptoms and the proportion of children with recurrent episodes of nasal symptoms. Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with nasal obstruction alone.

Data collection and analysis:

Two authors assessed trial quality and extracted data independently.

Main results:

Only one study included children scheduled for adenoidectomy because of recurrent or chronic nasal symptoms or middle ear disease. In this study no beneficial effect of adenoidectomy was found. The numbers in this study were, however, small (n = 76) and the quality of the study was moderate. The outcome was improvement in episodes of common colds. The risk differences were non-significant, being 2% (95% CI -18% to 22%) and -11% (95% CI -28% to 7%) after 12 and 24 months, respectively.

A second study included children with recurrent acute otitis media (n = 180). As otitis media is known to be associated with nasal symptoms, the number of days with rhinitis was studied as a secondary outcome measure. The risk difference was non-significant, being -4 days (95% CI -13 to 7 days).

Authors' conclusions:

Current evidence regarding the effect of adenoidectomy on recurrent or chronic nasal symptoms or nasal obstruction alone is sparse, inconclusive and has a significant risk of bias.

High quality trials assessing the effectiveness of adenoidectomy in children with recurrent or chronic nasal symptoms should be initiated.

This record should be cited as:

van den Aardweg MTA, Schilder AGM, Herkert E, Boonacker CWB, Rovers MM. Adenoidectomy for recurrent or chronic nasal symptoms in children. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD008282. DOI: 10.1002/14651858.CD008282

Assessed as up to date:

March 30, 2009

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Primary Review Group:

Ear, Nose and Throat Disorders Group

PEARLS - Practical Evidence About Real Life Situations (click to read)

Clinical question:

How effective is adenoidectomy for recurrent or chronic nasal symptoms in children?

Bottom line:

Current evidence regarding the effectiveness of adenoidectomy for nasal symptoms is sparse, inconclusive and has a significant risk of bias. Only 2 studies were found – both involved adenoidectomy (with or without myringotomy) versus non-surgical treatment or myringotomy only. It therefore remains uncertain whether adenoidectomy has an effect on recurrent symptoms (3 or more episodes of nasal symptoms in a period of 6 months, or 4 or more episodes in a period of 12 months) or chronic nasal symptoms and nasal obstruction alone.

Caveat:

Due to the lack of data on factors that may modify the effect of adenoidectomy, such as age, adenoid size or allergic rhinitis, it was not possible to perform subgroup analyses and identify children that may benefit more or less from the operation. Both studies reviewed were small (76 and 180 participants, respectively), and differed regarding inclusion criteria and outcomes measured.

Context:

Infections of the upper respiratory tract, presenting as recurrent nasal symptoms (nasal discharge with or without nasal obstruction) are very common in children. Adenoidectomy is frequently performed and is thought to prevent recurrence of nasal symptoms.

Cochrane Systematic Review:

van den Aardweg MTA et al. Adenoidectomy for recurrent or chronic nasal symptoms in children. Cochrane Reviews 2010, Issue 1. Article No. CD008282. DOI: 10.1002/14651858. CD008282.pub2. This review contains 2 studies involving 256 participants.

Authored by:

Brian R McAvoy

Cochrane Primary Health Care Field

Health topics:

Ear, nose, & throat > Nose & sinus > Other nose & sinus disorders

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

Adenoidectomy for recurrent of chronic nasal symptoms in children

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