Adenoidectomy outcomes in pediatric rhinosinusitis: A meta-analysis,☆☆

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Summary

Objective

To evaluate the currently available literature regarding the reported effectiveness of adenoidectomy alone in the management of medically refractory pediatric chronic rhinosinusitis.

Methods

The MEDLINE and EMBASE databases were systematically searched for English language manuscripts reporting on effectiveness of adenoidectomy alone in management of medically refractory pediatric rhinosinusitis. Additional manuscripts were identified by manual searching. Random effects modeling was performed to produce summary estimates of adenoidectomy effectiveness.

Results

Nine studies met the inclusion criteria. Six were cohort studies (level 2b) and four were case series (level 4). Mean sample size was 46 subjects (range = 10–121) with grand mean age of 5.8 years (range 4.4–6.9 years). All studies showed that sinusitis symptoms or outcomes improved in half or more patients after adenoidectomy. Eight studies were sufficiently similar to undergo meta-analysis. The summary estimate of the proportion of patients who significantly improved after adenoidectomy was 69.3% (95% CI = 56.8–81.7%, p < 0.001). The possibility of author bias was explored as one author group contributed a large proportion of patients to the study group.

Conclusion

Adenoidectomy reduces caregiver reported symptoms of chronic rhinosinusitis in a majority of pediatric patients. Given its simplicity, low risk profile, and apparent effectiveness, adenoidectomy should be considered first line therapy for medically refractory, uncomplicated pediatric rhinosinusitis.

Introduction

Adenoidectomy is one of the most commonly performed pediatric procedures in the world [1]. The most common indications for the procedure include chronic otitis media (often combined with bilateral myringotomy and tubes) and airway obstruction (often combined with tonsillectomy). However, another important indication for adenoidectomy is in the management of medically refractory chronic pediatric rhinosinusitis. Pediatric rhinosinusitis continues to be a prominent public health issue as pediatric outpatient visits for upper respiratory infection are second only to well baby visits amongst pediatric primary care providers [2]. Many patients fail conservative medical management and other treatments are actively sought. Scattered published reports have indicated measurable improvement in chronic rhinosinusitis symptoms such as rhinorrhea, cough, post-nasal drip, halitosis, and reduced antibiotic prescriptions following adenoidectomy. Given the simplicity and low complication rates of adenoidectomy in comparison to more complicated alternative procedures such as functional endoscopic sinus surgery (FESS), the effectiveness of adenoidectomy for this indication warrant careful analysis to establish its optimal role. The purpose of this review is to systematically analyze the currently available data in regards to the success of adenoidectomy alone in relief of typical pediatric chronic rhinosinusitis symptoms to guide future therapy.

Section snippets

Methods

This study is exempt from formal institutional review at our institution. The MEDLINE, EMBASE, and Cochrane computerized databases were systematically reviewed using the keywords “adenoidectomy” and “sinusitis” for pediatric human studies reporting the success of adenoidectomy in managing pediatric rhinosinusitis as of 1 September 2007. Inclusion criteria consisted of (1) study reporting on the effectiveness of adenoidectomy alone in managing pediatric (18 years or younger) rhinosinusitis, one

Results

Seventy-eight articles were identified on initial search (Fig. 1). Application of the inclusion criteria initially resulted in only six articles meeting the inclusion criteria. Hand searching of the references resulted in an additional three articles for a total of nine studies [3], [4], [5], [6], [7], [8], [9], [10], [11]. Table 1 is the evidence table that summarizes the general findings of the selected articles. The manuscripts were published between 1952 and 2007. The average sample size

Discussion

This study systematically examines the currently available evidence reporting on the effectiveness of adenoidectomy alone in the management of refractory pediatric rhinosinusitis. All identified studies reported that half or more of patients were observed by their caretakers to have improved symptoms after adenoidectomy. The quality of the data was moderate with five level 2b studies and four level 4 studies. A majority of studies were similar enough to permit meta-analysis with random effects

Conclusion

The data reporting on the effectiveness of adenoidectomy alone in the management of pediatric rhinosinusitis are sparse but are of moderate to good quality. All studies report symptomatic improvement in essential majority of patients. This combined with the simplicity of adenoidectomy versus the alternative of pediatric FESS, results in the conclusion that adenoidectomy should be considered first line management of medically refractory pediatric rhinosinusitis.

Conflict of interest

The authors have no conflict of interests to disclose in relation to this manuscript.

Acknowledgements

The authors had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

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The views herein are the private views of the authors and do not reflect the views of the Department of the Army, the Department of the Navy or the Department of Defense.

☆☆

Presented at the American Society of Pediatric Otolaryngology Annual Meeting San Diego, CA, USA, May 2007.

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