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Objectives: To determine whether the oropharyngeal microbial flora changes after adenotonsillectomy (ATY) in children with mild to moderate symptoms of throat infections or adenotonsillar hypertrophy and to relate these findings to recurrence of throat infections. Design: Randomized controlled trial. Setting: Twenty-three general hospitals and 3 academic centers. Patients: Three hundred children aged 2 to 8 years who were selected for ATY because of recurrent throat infections (3-6 episodes per year) or obstructive complaints. Children with a history of 7 or more throat infections in the previous year and those with a high suspicion of obstructive sleep apnea according to current medical practice were excluded. Interventions: Children were randomly assigned to either ATY or watchful waiting. Oropharyngeal swabs were taken at baseline and at 3 and 12 months after baseline. Main Outcome Measures: The primary outcome measure was the prevalence of potentially pathogenic bacteria in the oropharynx at 3 and 12 months. The secondary outcome measure was the association between carriage of group A β-hemolytic streptococci (GABHS) at baseline and at 3 months' follow-up and the number of throat infections during the 12 months of follow-up. Results: In the ATY group, prevalences of Haemophilus influenzae, GABHS, and Staphylococcus aureus decreased from 40%, 13%, and 5%, respectively, at baseline to respective levels of 24%, 0%, and 0% at 3 months and 26%, 0%, and 0% at 12 months. In the watchful waiting group, prevalences of H influenzae, GABHS, and Saureus did not change substantially. In neither the ATY nor the watchful waiting group was carriage of GABHS associated with recurrence of throat infections. Conclusions: Adenotonsillectomy reduced oropharyngeal carriage of potential respiratory pathogens. Changes in the carriage rate of GABHS, however, had no beneficial effect on recurrence of throat infections. [ABSTRACT FROM AUTHOR]

Objective: To determine the effects of adenotonsillectomy as compared with watchful waiting on the middle ear status of children. Study Design: Randomized controlled trial. Methods: We recruited 300 children between 2 and 8 years of age who were selected for adenotonsillectomy according to current medical practice. Excluded from the trial were children with very frequent throat infections (more than 6 per year) or obstructive sleep apnea. Participants were randomly assigned to either adenotonsillectomy or watchful waiting. Main outcome measure was the percentage of children with unilateral or bilateral otitis media diagnosed at the scheduled follow-up visits according to an algorithm combining tympanometry and otoscopy. Results: The percentages of children in the adenotonsillectomy and watchful waiting group diagnosed with otitis media at baseline and at 3, 6, 12, 18, and 24 months were 27.7 versus 30.5, 16.8 versus 25.2, 18.3 versus 21.2, 12.3 versus 15.2, 17.6 versus 15.5, and 14.7 versus 10.3%, respectively ( P < .10). In the subgroup of children selected for adenotonsillectomy predominantly because of recurrent or persistent otitis media, hearing loss, or recurrent upper respiratory tract infections (n = 111) and in the subgroup of children diagnosed with otitis media at inclusion (n = 82), the occurrence of otitis media did not differ significantly between the adenotonsillectomy and watchful waiting group during the entire follow-up period. Conclusion: We conclude that in a large proportion of children selected for adenotonsillectomy according to current medical practice, including those with otitis media or related complaints, no beneficial effect of adenotonsillectomy on middle ear status is to be expected. [ABSTRACT FROM AUTHOR]

Objective To assess the effectiveness of adenotonsillectomy in children with mild symptoms of throat infection or adenotonsillar hypertrophy. Design Open, randomized controlled trial. Setting 21 general hospitals and three academic centers in the Netherlands. Participants 300 children aged 2-8 years requiring adenotonsillectomy. Intervention Adenotonsillectomy compared with watchful waiting. Main outcomes measures Episodes of fever, throat infections, upper respiratory tract infections, and health related quality of life. Results During the median follow up period of 22 months, children in the adenotonsillectomy group 2.97 episodes of fever per person year compared with 3.18 in the watchful waiting group (difference -0.21, 95% confidence interval -0.54 to 0.12), 0.56 throat infections per person year compared with 0.77 (-0.21, -0.36 to -0.06), and 5.47 upper respiratory tract infections per person year compared with 6.00 (-0.53,-0.97 to -0.08). No clinically relevant differences were found for health related quality of life. Adenotonsillectormy was more effective in children with a history of three to six throat infections than in those with none to two. 12 children had surgery related complications. Conclusion Adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy has no major clinical benefits over watchful waiting. [ABSTRACT FROM AUTHOR]

Presents a response by Anne G. M. Schilder, Maroeska M. Rovers, E. Henriette van den Akker, Birgit K. van Staaij, and Arno W. Hoes, to letters to the editor about their article, "Effectiveness of adenotonsillectomy in children with mild symptoms of throat infections or adenotonsillar hypertrophy: open, randomized controlled trial," in the September 18, 2004 issue.

Objectives: To determine whether the oropharyngeal microbial flora changes after adenotonsillectomy (ATY) in children with mild to moderate symptoms of throat infections or adenotonsillar hypertrophy and to relate these findings to recurrence of throat infections., Design: Randomized controlled trial., Setting: Twenty-three general hospitals and 3 academic centers., Patients: Three hundred children aged 2 to 8 years who were selected for ATY because of recurrent throat infections (3-6 episodes per year) or obstructive complaints. Children with a history of 7 or more throat infections in the previous year and those with a high suspicion of obstructive sleep apnea according to current medical practice were excluded., Interventions: Children were randomly assigned to either ATY or watchful waiting. Oropharyngeal swabs were taken at baseline and at 3 and 12 months after baseline., Main Outcome Measures: The primary outcome measure was the prevalence of potentially pathogenic bacteria in the oropharynx at 3 and 12 months. The secondary outcome measure was the association between carriage of group A beta-hemolytic streptococci (GABHS) at baseline and at 3 months' follow-up and the number of throat infections during the 12 months of follow-up., Results: In the ATY group, prevalences of Haemophilus influenzae, GABHS, and Staphylococcus aureus decreased from 40%, 13%, and 5%, respectively, at baseline to respective levels of 24%, 0%, and 0% at 3 months and 26%, 0%, and 0% at 12 months. In the watchful waiting group, prevalences of H influenzae, GABHS, and S aureus did not change substantially. In neither the ATY nor the watchful waiting group was carriage of GABHS associated with recurrence of throat infections., Conclusions: Adenotonsillectomy reduced oropharyngeal carriage of potential respiratory pathogens. Changes in the carriage rate of GABHS, however, had no beneficial effect on recurrence of throat infections.