Does Adenoidectomy Prevent Recurrent Otitis in Young Children?

Abstract

Otolaryngology| May 01 2003 Does Adenoidectomy Prevent Recurrent Otitis in Young Children? AAP Grand Rounds (2003) 9 (5): 56–57. https://doi.org/10.1542/gr.9-5-56 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Facebook Twitter LinkedIn MailTo Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Does Adenoidectomy Prevent Recurrent Otitis in Young Children?. AAP Grand Rounds May 2003; 9 (5): 56–57. https://doi.org/10.1542/gr.9-5-56 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search toolbar search search input Search input auto suggest filter your search All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adenoidectomy, otitis Source: Mattila PS, Joki-Erkkila V, Kilpi T, et al. Prevention of otitis media by adenoidectomy in children younger than 2 years. Arch Otolaryngol Head Neck Surg. 2003;129:163–168. The authors from Helsinki University Central Hospital, Tampere University Hospital, and National Public Health Institute, Finland, conducted a prospective study comparing adenoidectomy and tympanostomy with tympanostomy alone in preventing acute otitis media (AOM) in children younger than 2 years of age. Participants were selected from 2,497 children enrolled in the Finnish Otitis Media Vaccine Trial.1 A diagnosis of AOM was made if there were signs of effusion and symptoms related to acute otitis. Signs of effusion included “a visually abnormal membrane…suggesting middle ear effusion.” Symptoms included fever, ear pain, signs of upper respiratory infection, irritability, diarrhea, vomiting, or discharge from the ear. A total of 306 children between ages 1 and 2 who had experienced recurrent AOM (defined as 3 to 5 episodes of AOM during the last 6 months or 4 to 6 episodes of AOM during the past 12 months) were randomized into 1 of 2 groups. One hundred sixty-two of the 306 children were randomized to undergo tympanostomy alone and 144 to undergo tympanostomy and adenoidectomy. Of the 306 children randomized, 137 agreed to participate in the trial. Sixty-three of the 137 children had been randomized to the tympanostomy alone group (39% of the 162 children initially randomized to be treated with tympanostomy alone). Five of these 63 children later received adenoidectomy (before follow-up ended at the age of 2 years) and were transferred to the tympanostomy and adenoidectomy group for analysis. Seventy-five of the 137 patients had been randomized to the tympanostomy and adenoidectomy group (51% of the 144 children initially randomized to have tympanostomy and adenoidectomy). The children were followed to the age of 2 years. Specimens of middle ear effusion for culture were obtained from tympanostomy tube drainage or myringotomy in children presenting with AOM. Outcome measures included overall rate of AOM and rates of AOM caused by Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. A secondary outcome measure was the number of days of otorrhea. The comparison of the risk of AOM between the treatment groups was made by Cox proportional hazards model adjusted for pneumococcal vaccine status, sex, number of siblings, and preoperative number of AOM episodes. In the randomized group, the rate of overall AOM per person-year was 2.40 for the tympanostomy group and 2.05 for the tympanostomy with adenoidectomy group. The efficacy of concurrent adenoidectomy was 19% (95% CI, −14% to 43%). The reduction in overall rate of AOM was mainly due to reduction in the rate of pneumococcal AOM (58%; 95% CI, 16% to 79%). There was no statistically significant difference in the frequency of days with purulent ear discharge between the 2 groups. In the non-randomized group, the efficacy of concurrent adenoidectomy was 25% (95% CI, −13% to 50%). Although there was a trend in favor of beneficial effect of concurrent adenoidectomy, the... You do not currently have access to this content.