Brietzke SE, Brigger MT. Int J Pediatr Otorhinolaryngol. 2008;72(10):1541–1545
PURPOSE OF THE STUDY. The objective of this study was to evaluate the available medical literature for evidence that adenoidectomy is an effective procedure for treating children with medically refractory rhinosinusitis.
STUDY POPULATION. Articles were obtained by using database searches and manual searches. These articles studied children, ≤18 years of age, who underwent adenoidectomy alone for management of medically refractory rhinosinusitis. The mean of the mean age of patients for each included series was 5.8 years, with a range of means of 4.4 to 6.9 years.
METHODS. A meta-analysis was performed of the available literature on adenoidectomy as treatment for sinusitis in this population, using searches of Medline, Embase, and Cochrane databases as well as manual searches of reference lists. Studies were selected for meta-analysis by meeting the following criteria: (1) the study evaluated the efficacy of adenoidectomy as the only surgical intervention for sinusitis, (2) the study was published in the English language, and (3) the study had a sample size of ≥5. Statistical analysis was performed with random-effects modeling, with the outcome measure being caregiver report or perceived presence or absence of symptomatic improvement.
RESULTS. Of the 78 articles identified through the database search and several others through manual search of references published between 1952 and 2007, 9 met inclusion criteria and 8 were statistically analyzed. These included 5 cohort studies and 4 case series. There were no randomized, controlled trials. The mean sample size was 46 (range: 10–121). All studies reported an improvement in symptoms or outcomes in ≥50% of patients. The statistical model accounting for interstudy variance estimated that 69.3% (95% confidence interval: 56.8%–81.7%; P < .001) of patients experienced symptomatic improvement with adenoidectomy. When the 3 articles submitted by a single author were excluded, the improvement after adenoidectomy was >83%.
CONCLUSIONS. The authors concluded that, although the literature is sparse and of only moderate-to-good quality, there is substantial support for the efficacy of adenoidectomy for treatment of children with medically refractory sinus disease. In addition, they suggested that these results, combined with the simplicity of adenoidectomy, compared with other surgical procedures, support the use of adenoidectomy before other surgical procedures in this population.
REVIEWERS COMMENTS. Adenoidectomy has long been used as a treatment for sinusitis in children who do not respond to observation or medical therapy. This systematic literature review supports such use of adenoidectomy. Although a large majority of children experience improvement after adenoidectomy, it is clear that this procedure is not curative for many and may be ineffective for some. The need for prospective study of the various medical and surgical treatments for pediatric sinusitis remains, with uniform entry criteria, well-defined outcomes, and randomization between treatment modalities and appropriate controls.
- Copyright © 2009 by the American Academy of Pediatrics