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Wait to remove kids' infected adenoids: study

By Genevra Pittman

NEW YORK (Reuters Health) - Removing the adenoids of kids who frequently get colds, sinus infections and laryngitis is more expensive and doesn't lead to better health or fewer symptoms than a "watchful waiting" approach, according to new research.

In other words, "waiting has no bad consequences," Chantal Boonacker, who led the new research at University Medical Center Utrecht in the Netherlands, told Reuters Health by email.

Adenoids are the tissue between the nose and back of the throat, similar to tonsils. They help fight infection in children but shrink and disappear by adulthood.

The tissue becomes enlarged in some kids, and those with chronic coughs and colds may have it removed in a procedure called adenoidectomy. The new findings suggest delaying those surgeries for kids with respiratory problems 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.

The new study, published Thursday in JAMA Otolaryngology-Head & Neck Surgery, focused on the costs of those two strategies. 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.

Boonacker cautioned that the financial and clinical findings may not apply to children who might get their adenoids removed because of ear infections or airway obstruction, for example.

In the United States, most adenoidectomies are done when the tissue is enlarged and obstructing the airways - rather than because of recurring infections, said Dr. Hassan Ramadan, an otolaryngologist from West Virginia University in Morgantown.

He said that in both cases, watchful waiting is often the way to go.

"Kids should not be put through the procedure before obviously trying medical therapy, and if medical therapy fails, then you proceed with the adenoidectomy," Ramadan, who wasn't involved in the new research, told Reuters Health.

HIGHER LOW COMPLICATION RATES FOR SOME

For kids with breathing problems, medical treatment would include antibiotics for infection or topical nasal steroids for allergies.

"A lot of times, those kids who have problems with frequent upper respiratory tract infections, the adenoid may contribute but it may not be the only part that's causing these infections," Ramadan said.

In the Netherlands, between one and two percent of kids age four and younger had their adenoids removed in 2009, the research team noted.

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.

In her study, one child had a tooth broken and another was hospitalized for bleeding after the surgery.

Boonacker said doctors and parents can use her team's findings to help make treatment choices for kids with recurring coughs and colds, in particular.

"This decision can now be based on careful consideration of anticipated benefits and risks, personal preference and costs," she said.

SOURCE: http://bit.ly/13IjSIP JAMA Otolaryngology-Head & Neck Surgery, online January 17, 2013.

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