Effectiveness of Adenoidectomy and Tympanostomy Tubes in the Treatment of Chronic Otitis Media with Effusion

Abstract

To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.

Hypothyroidism in Children with Serous Otitis Media

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

“…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.…”

Surgical Treatments for Otitis Media With Effusion: A Systematic Review

“…Twelve RCTs compared tubes with either myringotomy or no surgery (ie, watchful waiting, delayed treatment); of these, 10 studies [26][27][28][29][30][31][32][33][34][35] were included in previous systematic reviews, 10,11 and 2 were new. 36,37 Tube placement decreased the time with middle ear effusion by 32% in comparison with watchful waiting or delayed treatment at 1 year after surgery (high SOE).…”

“…Seven trials 29,[32][33][34][51][52][53] were from the van den Aardweg et al systematic review 12 ; the eighth was the newly published Trial of Alternative Regimens in Glue Ear Treatment study. 54 11 and Hellstrom et al 2011.…”

“…Three RCTs (4 articles) 29,46,53,54 reported harms related to adenoidectomy. Two of the trials 29,46,54 reported 1 case each (among 416 subjects) of a postoperative hemorrhage after adenoidectomy (low SOE).…”