Adenotonsillar Surgery and Guidelines in Italy

Abstract

Objective: 1) Ascertain the impact that guidelines on (adeno)-tonsillectomy have had on the clinical behavior of ENT specialists in Italy. 2) Evaluate the indications—inclusion criteria—for adeno-tonsillar surgery in children, adopted by ENT specialists, particularly referring to comorbidities. Method: A multicentric study including 14770 children undergoing (adeno)-tonsillectomy in 2002, 2004, 2006, and 2008 was conducted in 14 Italian otorhinolaryngological units. Data regarding indications and surgical procedures were gathered using a predesigned questionnaire and elaborated with analysis of variance, taking P value <.05 as the threshold for statistical significance. Results: Over the 4-year study period, the incidence of the analyzed interventions did not significantly change ( P value >.05), with adenotonsillectomy comprising the most commonly performed (64.1%). No significant variations in the indications for these operations were observed, except for adenotonsillectomy in children having 5 or more feverish episodes in the preceding year without nasal obstruction (decreased: P = .010). The coexistence of feverish episodes and nasal obstruction was the most frequent surgical indication (65.2%). We also found a high preoperative incidence of middle ear inflammations (43.3%), recovered or improved persistently in 88.5% of the cases after surgery. Conclusion: Italian guidelines were not implemented by ENT units involved in the survey; in most cases the indications for adeno-tonsillectomy are based on the overall clinical presentation rather than on a single symptom. The need to review the Italian guidelines is evident.