The Role of Tonsillectomy and Adenoidectomy in Otitis Media

Abstract

Otolaryngology| December 01 1999 The Role of Tonsillectomy and Adenoidectomy in Otitis Media AAP Grand Rounds (1999) 2 (6): 64–65. https://doi.org/10.1542/gr.2-6-64 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation The Role of Tonsillectomy and Adenoidectomy in Otitis Media. AAP Grand Rounds December 1999; 2 (6): 64–65. https://doi.org/10.1542/gr.2-6-64 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: adenoidectomy, otitis media, tonsillectomy and adenoidectomy Source: Paradise J, Bluestone C, Colborn D, et al. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media. JAMA. 1999;282:945–953. Does the removal of the adenoids and tonsils reduce the frequency of acute otitis media (OM) or the persistence of middle ear effusions in children? Current dogma has implicated the nasopharynx (rather than the oropharynx) in middle ear disease. Several studies have supported the removal of the adenoids in conjunction with tympanostomy tube placement in the management of recurrent OM,1 and otolaryngologists continue to cite the diagnosis of recurrent OM as the primary reason for performing adenotonsillectomy (T&A) and adenoidectomy.2 To evaluate the role of these procedures without tympanostomy tube insertion in the treatment of OM, Paradise et al recruited 582 children, aged 3 to 15 years referred to the Children’s Hospital of Pittsburgh, who had not previously undergone tympanostomy tube placement and who had either recurrent OM (3 acute episodes in 6 months or 4 episodes in 1 year) or OM with effusion (middle ear effusion persisting for at least 180 days). Children with a history of sore throats or tonsilar hypertrophy were enrolled in a 2-way trial and randomized to either T&A (n=77) or a control group (n=80). Children without tonsilar obstruction or a history of recurrent throat infections were randomized to one of 3 groups: T&A (n=103), adenoidectomy alone (n=100), or a control group (n=101). The number of episodes of acute OM and duration of effusion were the primary outcome measures monitored over the 3-year follow-up period. In the 3-way trial the authors found that children who had undergone T&A were significantly less likely to have episodes of acute OM during the first follow-up year than either the control group or children who had undergone adenoidectomy alone (P<.03). However, though statistically significant, the difference between groups in the mean rate of recurrence per patient during the first year of follow-up was small: adenoidectomy 1.8 and T&A 1.4 versus control of 2.1. Compared to controls, children in both the T&A group and the adenoidectomy group experienced significantly fewer days with OM during the first year of follow-up—adenoidectomy 22.4 (P=.03) and T&A 18.6 (P=.002) versus control 29.9—but not in subsequent years. The 2-way trial demonstrated smaller increments in the mean recurrence rate of acute OM between T&A subjects and control subjects for years 1, 2 and 3. Only when the 3 follow-up years were combined did children who had undergone T&A have a significantly lower rate of acute OM than did the controls (P<.009). The authors conclude that the morbidity associated with these surgeries, although not specified, outweighs their limited efficacy. They do not recommend either T&A or adenoidectomy as the sole, initial surgical procedure for recurrent OM. This long-term collaborative effort by the pediatricians and otolaryngologists in Pittsburgh deserves our appreciation. Virtually every day we cite their studies as we care for patients. This study suggests that the morbidity of tonsillectomy demands that a... You do not currently have access to this content.