Adenotonsillectomy for upper respiratory infections: evidence based?
Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. Methods: A literature search was performed to identify randomised trials...
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Published in | Archives of disease in childhood Vol. 90; no. 1; pp. 19 - 25 |
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Main Authors | , , , , |
Format | Journal Article |
Language | English |
Published |
London
BMJ Publishing Group Ltd and Royal College of Paediatrics and Child Health
01.01.2005
BMJ BMJ Publishing Group Ltd BMJ Publishing Group LTD |
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Abstract | Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution. Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was −1.2 episodes per person-year (95% CI −1.3 to −1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was −2.8 days per person-year (95% CI −3.9 to −1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was −0.5 episodes per person-year (95% CI −0.7 to −0.3). Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting |
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AbstractList | Background:
Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.
Methods:
A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.
Results:
Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was –1.2 episodes per person-year (95% CI –1.3 to –1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was –2.8 days per person-year (95% CI –3.9 to –1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was –0.5 episodes per person-year (95% CI –0.7 to –0.3).
Conclusions:
All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution. Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was −1.2 episodes per person-year (95% CI −1.3 to −1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was −2.8 days per person-year (95% CI −3.9 to −1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was −0.5 episodes per person-year (95% CI −0.7 to −0.3). Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution. Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was -1.2 episodes per person-year (95% CI -1.3 to -1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was -2.8 days per person-year (95% CI -3.9 to -1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was -0.5 episodes per person-year (95% CI -0.7 to -0.3). All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting. Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation. Methods: A literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution. Results: Six randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was -1.2 episodes per person-year (95% CI -1.3 to -1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was -2.8 days per person-year (95% CI -3.9 to -1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was -0.5 episodes per person-year (95% CI -0.7 to -0.3). Conclusions: All available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting BACKGROUNDDespite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in deciding which child might benefit from the operation.METHODSA literature search was performed to identify randomised trials and non-randomised controlled studies into the efficacy of tonsillectomy with or without adenoidectomy in children under 18 years. For the outcomes sore throat episodes, sore throat associated school absence, and upper respiratory infections, pooled estimates of the incidence rate ratios and rate differences with 95% confidence intervals were calculated, assuming a Poisson distribution.RESULTSSix randomised trials and seven non-randomised controlled studies on the efficacy of adenotonsillectomy in children were evaluated. For sore throat episodes data for 2483 person-years were available. The pooled risk difference was -1.2 episodes per person-year (95% CI -1.3 to -1.1). For sore throat associated school absence 1669 person-years were analysed. The pooled risk difference was -2.8 days per person-year (95% CI -3.9 to -1.6). For upper respiratory infections 1596 person-years were available. The pooled risk difference was -0.5 episodes per person-year (95% CI -0.7 to -0.3).CONCLUSIONSAll available randomised trials and non-randomised controlled studies into the efficacy of (adeno)tonsillectomy had important limitations. The frequency of sore throat episodes and upper respiratory infections reduces with time whether (adeno)tonsillectomy has been performed or not. (Adeno)tonsillectomy gives an additional, but small, reduction of sore throat episodes, days of sore throat associated school absence, and upper respiratory infections compared to watchful waiting. |
Audience | Professional Academic |
Author | Hoes, A W van Staaij, B K Schilder, A G van den Akker, E H van der Heijden, G J M G |
AuthorAffiliation | Julius Center for Health Sciences and Primary Care, location Stratenum 6.131, Universiteitsweg 100, 3584 CG Utrecht, Netherlands. B.K.vanStaaij@med.uu.nl |
AuthorAffiliation_xml | – name: Julius Center for Health Sciences and Primary Care, location Stratenum 6.131, Universiteitsweg 100, 3584 CG Utrecht, Netherlands. B.K.vanStaaij@med.uu.nl |
Author_xml | – sequence: 1 givenname: B K surname: van Staaij fullname: van Staaij, B K organization: Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands – sequence: 2 givenname: E H surname: van den Akker fullname: van den Akker, E H organization: Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands – sequence: 3 givenname: G J M G surname: van der Heijden fullname: van der Heijden, G J M G organization: Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands – sequence: 4 givenname: A G surname: Schilder fullname: Schilder, A G organization: Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands – sequence: 5 givenname: A W surname: Hoes fullname: Hoes, A W organization: Department of Otorhinolaryngology, Wilhelmina Children’s Hospital, University Medical Center, Utrecht, Netherlands |
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Keywords | Human Pediatrics Upper respiratory tract Respiratory disease Indication Respiratory system infection Evidence-based medicine Recommendation Adenoidectomy Treatment Tonsillectomy Surgery Adenoid enlargement Child |
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Notes | Correspondence to:
Mrs B K van Staaij
University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, location Stratenum 6.131, Universiteitsweg 100, 3584 CG Utrecht, Netherlands; B.K.vanStaaij@med.uu.nl istex:0E5E71B4A3B60DD13F717270E338BA7602453F66 ark:/67375/NVC-JRKSL7NB-F href:archdischild-90-19.pdf PMID:15613505 local:0900019 ObjectType-Article-2 SourceType-Scholarly Journals-1 ObjectType-Feature-3 content type line 23 ObjectType-Review-1 |
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Snippet | Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician... Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little support in... BACKGROUNDDespite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician little... Background: Despite high rates of (adeno)tonsillectomy for upper respiratory infections in western countries, the medical literature offers the physician... |
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SubjectTerms | (adeno)tonsillectomy Absenteeism Adenoidectomy - methods adenotonsillectomy Biological and medical sciences Care and treatment Child Children Clinical outcomes Control Groups Diseases Ear diseases Eligibility Estimates Evidence Evidence-Based Medicine Head and neck surgery. Maxillofacial surgery. Dental surgery. Orthodontics Humans Infections Intervention Medical sciences Methods Original Outcome Measures Patient outcomes Patients Pharyngitis - prevention & control Quality Randomized Controlled Trials as Topic Respiratory tract infections Respiratory Tract Infections - prevention & control Risk Factors Statistical Analysis Studies Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the upper aerodigestive tract systematic review Throat surgery Tonsillectomy Tonsillectomy - methods Treatment Outcome T±Ads upper respiratory infection upper respiratory infections URI Validity |
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Title | Adenotonsillectomy for upper respiratory infections: evidence based? |
URI | http://dx.doi.org/10.1136/adc.2003.047530 https://api.istex.fr/ark:/67375/NVC-JRKSL7NB-F/fulltext.pdf https://www.ncbi.nlm.nih.gov/pubmed/15613505 https://www.proquest.com/docview/1828249440 https://search.proquest.com/docview/67340433 https://pubmed.ncbi.nlm.nih.gov/PMC1720065 |
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