Objective: Risk of childhood asthma is increased in children with recurrent otitis media. This may be associated with recurrent respiratory tract infections in these children, but the role of adenoidectomy, a frequent operation during childhood, is unknown. Here, we evaluated the role of adenoidectomy in the development of atopy and respiratory function changes characteristic of asthma.
Design: Randomized controlled study.
Setting: Tertiary care center.
Patients: One hundred sixty-six children aged 12 to 48 months who had recurrent or persistent otitis media and who were followed-up for three years after randomization.
Intervention: Randomization to undergo insertion of tympanostomy tubes with or without adenoidectomy.
Main outcome measures: The primary out-come measure was exercise-induced bronchoconstriction as evaluated by impulse oscillometry. The secondary out-come measures were bronchial inflammation as evaluated by exhaled nitric oxide and atopy as evaluated by skin prick tests. During the 3-year follow-up otitis media episodes were documented in patient diaries.
Results: Adenoidectomy did not significantly influence baseline lung function, exercise-induced bronchoconstriction, exhaled nitric oxide concentration, development of positive skin prick tests, or doctor-diagnosed asthma. Adenoidectomy did not significantly prevent otitis media. Recurrent otitis media (≥4 episodes) during the first follow-up year were associated with an abnormal exercise-induced bronchoconstriction (OR 6.62, 95% CI 1.27-34) and an elevated exhaled nitric oxide concentration (OR 3.26, 95% CI 0.98-10.8) regardless of adenoidectomy.
Conclusions: Adenoidectomy did not promote asthma or allergy. Recurrent respiratory tract infections during early childhood are associated with the risk of bronchial hyperreactivity.