Adenoidectomy and Adenotonsillectomy for Recurrent Acute Otitis Media

Paradise, Jack L.; Bluestone, Charles D.; Colborn, D. Kathleen; Bernard, Beverly S.; Smith, Clyde G.; Rockette, Howard E.; Kurs‐Lasky, Marcia

doi:10.1001/jama.282.10.945

Cited by 138 publications

(39 citation statements)

References 20 publications

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“…5,[79][80][81][82][83][84][85] In addition, the search was expanded to studies of children without CP or where the presence or absence of a cleft was not specified, this yielded a further 24 studies. [86][87][88][89][91][92][93][94][95][96][97][98][99][100][101][102][103][104][105][106][107][108][109] Studies did not always clearly state the primary outcome and when this was the case the primary outcome was inferred from the sample size calculation, the study title and/or the results presented first in the results section. Papers which did not explicitly identify a primary outcome are detailed in Table 17.…”

Section: Description Of Included Studiesmentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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BackgroundCleft lip and palate are among the most common congenital malformations, with an incidence of around 1 in 700. Cleft palate (CP) results in impaired Eustachian tube function, and 90% of children with CP have otitis media with effusion (OME) histories. There are several approaches to management, including watchful waiting, the provision of hearing aids (HAs) and the insertion of ventilation tubes (VTs). However, the evidence underpinning these strategies is unclear and there is a need to determine which treatment is the most appropriate.ObjectivesTo identify the optimum study design, increase understanding of the impact of OME, determine the value of future research and develop a core outcome set (COS) for use in future studies.DesignThe management of Otitis Media with Effusion in children with cleft palate (mOMEnt) study had four key components: (i) a survey evaluation of current clinical practice in each cleft centre; (ii) economic modelling and value of information (VOI) analysis to determine if the extent of existing decision uncertainty justifies the cost of further research; (iii) qualitative research to capture patient and parent opinion regarding willingness to participate in a trial and important outcomes; and (iv) the development of a COS for use in future effectiveness trials of OME in children with CP.SettingThe survey was carried out by e-mail with cleft centres. The qualitative research interviews took place in patients’ homes. The COS was developed with health professionals and parents using a web-based Delphi exercise and a consensus meeting.ParticipantsClinicians working in the UK cleft centres, and parents and patients affected by CP and identified through two cleft clinics in the UK, or through the Cleft Lip and Palate Association.ResultsThe clinician survey revealed that care was predominantly delivered via a ‘hub-and-spoke’ model; there was some uncertainty about treatment strategies; it is not current practice to insert VTs at the time of palate repair; centres were in a position to take part in a future study; and the response rate to the survey was not good, representing a potential concern about future co-operation. A COS reflecting the opinions of clinicians and parents was developed, which included nine core outcomes important to both health-care professionals and parents. The qualitative research suggested that a trial would have a 25% recruitment rate, and although hearing was a key outcome, this was likely to be due to its psychosocial consequences. The VOI analysis suggested that the current uncertainty justified the costs of future research.ConclusionsThere exists significant uncertainty regarding the best management strategy for persistent OME in children with clefts, reflecting a lack of high-quality evidence regarding the effectiveness of individual treatments. It is feasible, cost-effective and of significance to clinicians and parents to undertake a trial examining the effectiveness of VTs and HAs for children with CP. However, in view of concerns about recruitment rate and engagement with the clinicians, we recommend that a trial with an internal pilot is considered.FundingThe National Institute for Health Research Health Technology Assessment programme. This study was part-funded by the Healing Foundation supported by the Vocational Training Charitable Trust who funded trial staff including the study co-ordinator, information systems developer, study statistician, administrator and supervisory staff.

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Section: Description Of Included Studiesmentioning

confidence: 99%

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Bruce

Harman

Williamson

et al. 2015

Health Technol Assess

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“…Respiratory tract infection, for example, has been associated with a low level of education and unemployment [5][6][7][8]. However, the impact of socioeconomic factors on the frequency of admissions during childhood is complex and scarcely examined [9].…”

Section: Introductionmentioning

confidence: 99%

Socioeconomic factors and risk of hospitalization with infectious diseases in 0- to 2-year-old Danish children

et al. 2005

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Although the association between low socioeconomic status and illness in childhood is well known, the impact of socioeconomic factors on risk and frequency of hospitalizations for infectious diseases, the most frequent disease category, during the first 2 years of life has scarcely been studied. Through linkage of records drawn from public administrative and health registries, we conducted a population-based cohort study of 5024 Danish children born in 1997 to examine the frequency of hospitalization for infectious diseases in very young children. The main exposure variables, adjusted for potential confounding factors, were mother's education level, household income, and cohabitation status. The outcome was number of hospital admissions (0, 1-2, or 3+) for infectious diseases. A total of 737 children (14.7%) were admitted to hospital 1-2 times, and 83 (1.6%) were admitted 3-10 times. The risk of hospitalization was increased in children of mothers with a low level of education compared with vocational education (1-2 admissions: adjusted odds ratio (OR) 1.3 (95% confidence interval [CI]: 1.1-1.6). Children from low-income families had an increased risk of 3 or more admissions (low cf middle income: adjusted OR 2.0 [95% CI: 0.6-6.0]). Children of single mothers had an increased risk of hospitalization (1-2 admissions: adjusted OR 1.7 [95% CI: 1.1-2.6]. We found the highest risk of hospitalization for infectious diseases in children of mothers with only basic schooling, and particularly among those coming from single parent homes with a low income.

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“…Four or more of adeno-tonsillar infections were recorded in more than 50% of patients with diagnosed acute otitis media. Paradise et al (16) found that children with adenotonsillectomy had less frequent otitis media in comparison with children who had undergone adenoidectomy alone, while other authors do not recommend adenoidectomy or adenotonsillectomy as a preventive surgical procedure for recurrent acute otitis media. The morbidity associated with these surgical procedures, although not mentioned, exceeds their limited efficacy (17).…”

Section: Discussionmentioning

confidence: 99%

Acute otitis media in children: Correlation with palatine tonsil size, adenoidectomy and adenotonsillectomy

et al. 2014

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Objective -The objective of the survey was to assess the role and importance of the hypertrophy of palatine tonsils and previously performed adenoidectomy and adenotonsillectomy for the incidence of the acute otitis media in children. Materials and methods -The prospective and controlled study was carried out among 160 patients of both genders, aged between 6 months and 7 years, with an acute otitis media, during a 12-month period. The control group consisted of 40 examinees who had not been diagnosed with this disease. Clinical assessment of the palatine tonsil size was performed according to the degree of obstruction of the isthmus faucium: hypertrophy -grade I (both palatine tonsils obstruct up to ½ of the isthmus faucium), and hypertrophy -grade II (both palatine tonsils obstruct more than ½ of the isthmus faucium). Patients were stratified by age into three groups: 3 -11 months, 1 -2.5 years and 2.6 -7 years. The association between antibiotic therapy and new cases of adenotonsillar infections was evaluated. Follow-up audiological examinations were conducted. The study was carried out on the basis of a questionnaire survey. Results -Adenoidectomy was performed in 8.3% of examinees with acute otitis media, adenotonsillectomy in 7.5%, while 84.2% of examinees were not treated with any of the above mentioned surgical procedures. No statistically significant differences were found compared to the control group (p=0,213). The palatine tonsils were eutrophic in 26.8% of the examinees with the acute otitis media, 55.4% had hypertrophy -grade I, and 17.9% hypertrophy -grade II. The differences between the observed groups were statistically significant (p=0.019). ConclusionThe hypertrophy of palatine tonsils was statistically significantly more prevalent in examinees with acute otitis media compared with the control group. This kind of level of significance was not recorded regarding previously performed adenoidectomy and adenotonsillectomy.

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Adenoidectomy and Adenotonsillectomy for Recurrent Acute Otitis Media

Cited by 138 publications

References 20 publications

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

The management of Otitis Media with Effusion in children with cleft palate (mOMEnt): a feasibility study and economic evaluation

Socioeconomic factors and risk of hospitalization with infectious diseases in 0- to 2-year-old Danish children

Acute otitis media in children: Correlation with palatine tonsil size, adenoidectomy and adenotonsillectomy

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