Mattila PS, Hammarén-Malmi S, Pelkonen AS, et al. Arch Dis Child. 2009;94(5):366–370
PURPOSE OF THE STUDY. Previous studies reported that the risk of childhood asthma is increased more than threefold in children with recurrent otitis media who have undergone adenoidectomy. The purpose of this study was to provide information on young children who were monitored to 3 years, to assess the effect of adenoidectomy on lung function and the development of atopy.
STUDY POPULATION. Of the 217 children recruited, 166 children completed the follow-up trial. These children were 12 to 48 months of age, had recurrent or persistent otitis media treated with adenoidectomy and tympanostomy or tympanostomy alone, and were monitored to 3 years after random assignment.
METHODS. The study included young children with recurrent otitis media (≥3 episodes in 6 months or ≥5 episodes in 12 months). All children underwent tympanostomy tube placement and were randomly assigned to undergo adenoidectomy as well. At the end of the 3-year follow-up period, impulse oscillometry (as a measure of exercise-induced bronchoconstriction), exhaled nitric oxide measurement (as a measure of bronchial inflammation), and skin-prick testing (as a measure of atopy) were performed for these children.
RESULTS. There was no significant difference in baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, or the development of positive skin-prick test results between children who underwent adenoidectomy and those who did not. During the first, second, and third years of the follow-up period, no significant differences in the mean number of otitis media episodes were observed between the 2 groups.
CONCLUSIONS. Adenoidectomy does not increase the risk of childhood asthma or the development of allergy. Recurrent respiratory tract infections during early childhood seem to be connected to the risk of bronchial hyperreactivity. The authors also suggest that adenoidectomy is not warranted as first-line treatment for the prevention of otitis media in children <4 years of age, especially those who do not have adenoidal hyperplasia or chronic adenoid infection.
REVIEWER COMMENTS. Adenoidectomy is one of the most common surgical procedures performed for children. It is reassuring to know that it does not promote the development of asthma or atopy. However, for children who do not have adenoidal hyperplasia or chronic adenoidal infection, adenoidectomy does not reduce the number of subsequent ear infections and may be unnecessary.
- Copyright © 2009 by the American Academy of Pediatrics