For the fourth time this year, young Brian G, age three,
has been brought to his pediatrician's office by his mother.
By now, even she recognizes the telltale signs of another
case of otitis media (OM). Brian's discomfort keeps them
both up at night and she insists that something has to
be done. She's been researching the problem and wants
to know if surgery is an option.
Many physicians feel removing the
adenoids and tonsils is indicated in children with frequent
throat infections or obstructive sleep apnea (OSA).
But what about children like Brian, who have milder
symptoms such as recurrent OM? Would Brian benefit from
adenotonsillectomy?
"In a large proportion of children
selected for adenoton- sillectomy according to current
medical practice, including those with otitis media
or related complaints, no beneficial effect of adenotonsillectomy
on middle ear status is to be expected," says Dr Karin
Oomen, lead author of a Dutch clinical trial published
in the April issue of The Laryngoscope.
Dr Oomen and her colleagues at
the University Medical Center Utrecht have been evaluating
the effectiveness of adenotonsillectomy to treat a number
of mild ear, nose and throat conditions in children.
Improvements seen in the first six months following
the operation may contribute to the impression among
patients and doctors alike that surgery is an effective
solution, the researchers surmise.
NO
LONGTERM BENEFIT
In the short term adenotonsillectomy reduced episodes
of fever and throat infections and improved sleeping
and eating patterns in kids with mild symptoms of throat
infection or adenotonsillar hypertrophy. However, over
the longer term, from six to 24 months, there was no
benefit over simply watching and waiting, the team reported
in the September 2004 British Medical Journal.
In the latest study, the researchers
looked at rates of OM. They enrolled 300 children with
mild symptoms who were candidates for adenotonsillectomy
in Dutch hospitals. Patients were randomly assigned,
151 to surgery within six weeks of inclusion, and 149
to a watchful waiting group.
At baseline, a diagnosis of OM
was made in 27.7% of the surgical group and 30.5% of
the watchful waiting group. At 24 months, rates were
14.7% and 10.3%, respectively. What's more, in the subgroup
with recurrent or persistent OM, hearing loss or upper
respiratory infections and in the subgroup with OM at
baseline, the authors found "the occurrence of otitis
media did not differ significantly between the adenotonsillectomy
and watchful waiting group during the entire followup
period."
OM is the most common reason for
childhood visits to the doctor — and adenotonsillectomy
is one of the most common surgeries in kids — but
Dr Oomen cautions "adenotonsillectomy should not be
recommended for children with otitis media or related
complaints, unless other indications for surgery exist."
The Laryngoscope April, 2005;115(4):731-4.
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