Clinical Question: Is adenotonsillectomy effective in decreasing the number of throat infections in children?

Setting: Outpatient (any)

Study Design: Randomized controlled trial (nonblinded)

Allocation: Uncertain

Synopsis: The authors of this study, which was conducted in the Netherlands, enrolled patients by asking otolaryngologists to identify children between two and eight years of age whom they believed had indications for adenotonsillectomy. The researchers excluded approximately 18 percent of children with very frequent throat infections, defined as seven or more throat infections in the previous year, five or more in each of the previous two years, or three per year for three years. They also could not include the 45 percent of children whose parents or physicians insisted they have surgery.

The 300 children who were enrolled in the study were randomized (allocation concealment unknown) to receive adenotonsillectomy or no treatment. The average age of the children was 4.5 years, they had a median of three throat infections in the previous year, and they were divided equally by sex. Parents kept a diary of upper respiratory tract infections, temperature, and school absences. Fifty (34 percent) of the children assigned to no therapy eventually received surgery, although they were analyzed in the groups to which they were assigned initially (intention-to-treat analysis).

The primary and most objective outcome, the number of fever episodes during the following 22 months, was not different between the two groups. The number of throat infections was statistically less in the surgery group, although the difference was small (0.56 versus 0.77 infections per year). The surgery group also experienced fewer days with sore throat (9.81 versus 15.71 days) and fewer days with upper respiratory tract infections (78.2 versus 90.0 days). There was no difference in absence from day care or school. Brouillette’s scores were lower at six months after surgery but were no different after two years. Of all the children who underwent surgery, 6 percent had surgery-related complications.

Bottom Line: Adenotonsillectomy decreases the number of throat infections and the number of days with sore throat. The more objective outcomes in this unblinded study—the number of episodes of fever and number of days with fever—were unaffected by surgery. The number of days lost from day care or school also was not changed by surgery. (Level of Evidence: 1b–)