Study: Wait Instead of Adenoidectomy

If your child frequently gets colds, sinus infections and laryngitis you may have considered having his or her adenoids removed to see if the infections would lesson. A new study from the Netherlands says you might want to rethink that.

According to Chantal Boonacker, who led the research team at the University Medical Center Utrecht, waiting has no bad consequences.  The watchful waiting approach seems to be as effective as surgery.

Adenoids are tissue that sit in the back of the nasal cavity and are above the roof of the mouth. You can see your tonsils when you look in the mirror and open your mouth, but you can't see your adenoids. Their purpose is to help fight infection in children and usually shrink and disappear by adulthood.

Sometimes the tissue becomes enlarged. A surgery called an adenoidectomy may be performed in children with a chronic cough and cold. The study suggests that in children with respiratory problems, delaying the surgery may be a smart financial and medical decision.

The research included 111 children, age one to six, who'd had an average of nine or ten respiratory infections - including colds and sinus infections - in the past year.

Half of them were randomly chosen to have an adenoidectomy right away and the rest were assigned to a watchful waiting strategy over the next two years.

In a report released in 2011, the study team found no difference in future respiratory infections or ear problems in kids who did or didn't have immediate adenoidectomy. Of the 57 kids initially allocated to watchful waiting, 23 went on to have their adenoids removed.

Researchers also looked into the expense of the two medical approaches. Boonacker and her colleagues found that once surgery, drugs, doctors' appointments and family expenses were considered, immediate adenoidectomy was about one and a half times more expensive than waiting - at an average of $1,995 versus $1,216. The cost may be different in the U.S.

There are other reasons a child may undergo an adenoidectomy, such as ear infections or airway obstruction. Boonacker cautioned that the financial and clinical findings might not apply in those cases.

Many U.S. physicians prefer the watchful waiting approach before having a child undergo surgery when possible. The typical treatment for children with breathing problems would include antibiotics for infection or topical nasal steroids for allergies.

In another study published alongside the new report, researchers from Montreal Children's Hospital in Canada found African American kids were at higher risk of having major respiratory complications after removal of their adenoids and tonsils.

Boonacker said that in general, complication rates tied to adenoidectomy are low. The procedure typically lasts about 30 minutes and doesn't require an overnight stay.

Boonacker would like parents to know about the study's findings to help them make good treatment choices if their child is battling recurring coughs and colds. "This decision can now be based on careful consideration of anticipated benefits and risks, personal preference and costs," she said.

The study was published in JAMA Otolaryngology-Head & Neck Surgery.


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