Int J Pediatr Otorhinolaryngol. 2008 Oct;72(10):1541-5. Epub 2008 Aug 23.
Brietzke SE, Brigger MT.
Department of Otolaryngology, Walter Reed Army Medical Center, 6900 Georgia Avenue, Washington, DC 20307, USA. SEBrietzke@msn.com
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.