Alterations in the nasopharyngeal bacterial flora after adenoidectomy in children: a systematic review

OBJECTIVE: To review the current literature on alterations in the nasopharyngeal bacterial flora in relation to adenoidectomy in children with recurrent upper respiratory tract infections (rURTIs).

DATA SOURCES: A systematic literature search of PubMed (from 1966 on) and EMBASE (from 1974 on) to May 3 2008.

REVIEW METHODS: A study was selected if it included children aged less than 18 years who had undergone adenoidectomy or adenotonsillectomy, and in whom nasopharyngeal bacterial flora was studied before and after or only after surgery. Data from eight studies were included in this review. We extracted from each study which potentially pathogenic and nonpathogenic nasopharyngeal flora were cultured before and after surgery.

RESULTS: Streptococcus pneumoniae and Haemophilus influenzae were most often detected in the nasopharynx of children with rURTI. Carriage of these bacteria decreased after adenoidectomy in the majority of studies. In contrast, carriage of bacteria belonging to the nonpathogenic nasopharyngeal flora increased after surgery.

CONCLUSION: Adenoidectomy seems to have a beneficial effect on the nasopharyngeal bacterial flora. Because the overall quality of the available evidence is low, it is important that controlled studies are initiated into the short- and long-term effect of adenoidectomy on the nasopharyngeal bacterial flora and its relationship with the recurrence of URTIs in children.