Effect of adenoidectomy on respiratory function: a randomised prospective study.
OBJECTIVE
Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Therefore, the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma was evaluated.


METHODS
Randomised controlled study.


METHODS
Tertiary care centre.


METHODS
166 children aged 12-48 months who had recurrent or persistent otitis media and who were followed-up for 3 years after randomisation.


METHODS
Randomisation to undergo insertion of tympanostomy tubes with or without adenoidectomy.


METHODS
The primary outcome measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary outcome measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up period otitis media episodes were documented in patient diaries.


RESULTS
Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, the development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (>or=4 episodes) during the first follow-up year was associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27 to 34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98 to 10.8) regardless of adenoidectomy.


CONCLUSIONS
Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyper-reactivity.
Mattila
P S
PS
Department of Otorhinolaryngology, Helsinki University Central Hospital, Helsinki, Finland. petri.mattila@hus.fi
Hammarén-Malmi
S
S
Pelkonen
A S
AS
Malmberg
L P
LP
Mäkelä
M J
MJ
Saxen
H
H
Tarkkanen
J
J
D000233:Adenoidectomy / Q000009:adverse effects*; D000293:Adolescent; D000367:Age Factors; D001249:Asthma / Q000209:etiology*; D016084:Bronchoconstriction; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000379:methods; D009991:Oscillometry / Q000379:methods; D010033:Otitis Media / Q000517:prevention & control* / Q000601:surgery; D011446:Prospective Studies; D012008:Recurrence; D012141:Respiratory Tract Infections / Q000209:etiology* / Q000601:surgery; D012882:Skin Tests