Surgery for Otitis Media: Maybe Not the Best Option
Adenoidectomy (removal of the adenoids) and adenotonsillectomy (removal of adenoids and/or tonsils) are the most commonly performed major surgeries among children in the United States. Adenotonsillectomy (T&A) was performed on 286,000 children under 15 years of age in 1994 alone.
Frequently, the rationale behind these invasive procedures is the relief of persistent or recurrent otitis media - inflammation of the inner ear.
Adenoidectomy has been recognized as more efficacious in reducing the recurrence of otitis media (OM), yet many physicians recommend T&A for children with persistent OM. Little high-powered research has been conducted to test the efficacy of these procedures in children who have not had tympanostomy tube replacement, which was the purpose of this study.
Children with suspected recurrent otitis media, but without recurrent throat infection, tonsillar hypertrophy or previous typanostomy tube replacement, were randomized to either an adenoidectomy, adenotonsillectomy, or control group. Of the initial 2,122 children evaluated for the study, 461 were admitted. After the procedures, children were monitored for OM by treatment group and the estimated proportion of time suffering from the condition.
The effectiveness of surgery in both trials was modest and limited mainly to the first follow-up year; in the second and third years of follow-up, the average percentage of days with otitis media present differed only marginally between surgery patients and controls.
Additionally, complications or other adverse events associated with surgery occurred "not infrequently," especially among subjects undergoing T&A (14.6% of patients suffering complications).
As the authors note, this study shows only limited and short-term efficacy of adenoidectomy and adenotonsillectomy for management of otitis media. They conclude that "...given the risks, morbidity, and costs of these procedures... neither operation should ordinarily be considered as a first surgical in-
tervention in children whose only indication is recurrent acute otitis media."
Paradise JL, Bluestone CD, Colborn DK, et al. Adenoidectomy and adenotonsillectomy for recurrent acute otitis media. Journal of the American Medical Association
, Sept. 8, 1999:282(10), pp945-53.