Matige klachten van recidiverende keelontstekingen of hypertrofie van de neus- en keelamandelen: adenotonsillectomie niet effectiever dan een expectatief beleid; een gerandomiseerde interventiestudie

To assess if adenotonsillectomy is beneficial to children with moderate symptoms of throat infection or adenotonsillar hypertrophy.

Design

Open randomised intervention trial.

Method

300 children, aged from 2 to 7, with an indication for adenotonsillectomy were included in the trial. Children who had very frequent throat infections and those with suspected obstructive sleep apnoea were excluded. Adenotonsillectomy was compared with a watchful waiting strategy. Check-ups were carried out at 3, 6, 12, 18 and 24 months. The primary outcome measure was the incidence of fever. Secondary outcome measures included the incidence of throat infection, sore throat, upper respiratory-tract infections and quality of life.

Results

The study group consisted of 153 girls and 147 boys with an average age of 4.5 years. Children in the adenotonsillectomy group experienced 0.21 (95 CI: –0.12-0.54) fewer episodes of fever per person year; 0.21 (95 CI: 0.06-0.36) fewer throat infections and 0.53 (95 CI: 0.08-0.97) fewer upper respiratory-tract infections compared with the children in the watchful waiting group. These differences were bigger in children with a history of 3-6 throat infections than in those with 0-2. No clinically relevant differences were found regarding health-related quality of life.

Conclusion

Adenotonsillectomy had no major clinical benefits over watchful waiting in children with moderate symptoms of throat infection or adenotonsillar hypertrophy.

Ned Tijdschr Geneeskd 2005;149:2052-6