OBJECTIVES

To evaluate decisive factors related to indications for tonsillar surgery among ENT surgeons.

METHODS

Webbased questionnaire presenting a number of representative cases to Swedish ENT surgeons with threealternatives: Recommend surgery, recommend further examinations or recommend no surgery. By changingone factor in the case description a value regarding the importance of each single factor could be estimated.

RESULTS

328 of 728 known ENT surgeons answered the questionnaire. An analysis of the answering population

compared to the total population of Swedish ENT surgeons showed them to be representative. The

proportion of Swedish ENT surgeons recommending surgery was 48 % higher for cases with recurrent StrepA tonsillitis compared to non Strep A tonsillitis and 53 % higher when tonsillar frequency was at least 4 episodes/year compared to 2 episodes/year.

CONCLUSIONS

Case presentations to practicing ENT surgeons can be used to achieve information on the national

perception of best practice. This information was used in the development of a national consensus documenton indications for tonsillar surgery. An iterated use of the questionnaire can furthermore give valuable information on the changes in practice over time, e.g. to evaluate the impact of new recommendations.

RESULTS

Fourteen RCT’’s (2712 children) were evaluated; most were too heterogeneous to pool into a meta-analysis.Loss to follow-up varied from 0% to 63% after 2 years.

Adenoidectomy in combination with a unilateral tympanostomy tube (n=3 trials) has a beneficial effect on the resolution of OME: risk difference 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at 6 and 12 months, respectively. The effect of adenoidectomy on hearing is very small:<5dB compared to a unilateral tympanostomy tube only.

Regarding AOM (n=8 trials), adenoidectomy appears to have no significant beneficial effect.

CONCLUSIONS

Our review shows a significant effect of adenoidectomy as far as the resolution of middle ear effusion inchildren with OME is concerned. However, the benefit to hearing is small. The risks of operating should beweighed against these potential benefits. The absence of a significant effect on AOM suggests that routine surgery for this indication is not warranted.