The Protective Effect of Adenoidectomy on Pediatric Tympanostomy Tube Re-Insertions: A Population-Based Birth Cohort Study

Abstract

ObjectivesAdenoidectomy in conjunction with tympanostomy tube insertion for treating pediatric otitis media with effusion and recurrent acute otitis media has been debated for decades. Practice differed surgeon from surgeon. This study used population-based data to determine the protective effect of adenoidectomy in preventing tympanostomy tube re-insertion and tried to provide more evidence based information for surgeons when they do decision making.Study DesignRetrospective birth cohort study.MethodsThis study used the National Health Insurance Research Database for the period 2000–2009 in Taiwan. The tube reinsertion rate and time to tube re-insertion among children who received tympanostomy tubes with or without adenoidectomy were compared. Age stratification analysis was also done to explore the effects of age.ResultsAdenoidectomy showed protective effects on preventing tube re-insertion compared to tympanostomy tubes alone in children who needed tubes for the first time (tube re-insertion rate 9% versus 5.1%, p = 0.002 and longer time to re-insertions, p = 0.01), especially those aged over 4 years when they had their first tube surgery. After controlling the effect of age, adenoidectomy reduced the rate of re-insertion by 40% compared to tympanostomy tubes alone (aHR: 0.60; 95% CI: 0.41–0.89). However, the protective effect of conjunction adenoidectomy was not obvious among children with a second tympanostomy tube insertion. Children who needed their first tube surgery at the age 2–4 years were most prone to have tube re-insertions, followed by the age group of 4–6 years.ConclusionsAdenoidectomy has protective effect in preventing tympanostomy tube re-insertions compared to tympanostomy tubes alone, especially for children older than 4 years old and who needed tubes for the first time. Nonetheless, clinicians should still weigh the pros and cons of the procedure for their pediatric patients.

Assessment of sleep-disordered breathing in pediatric otitis media with effusion

“…18 Adjunct adenoidectomy may enhance the effectiveness of ventilation tube insertion in OME patients and reduce the need for repeated ventilation tube insertion because of the removal of microbial reservoir and mechanical obstruction of the Eustachian tube. 16,17 The present study further demonstrated that adenoidectomy in children with OME may also improve their sleep quality, which was significantly disturbed, though the severity was less than the children with SDB because of relatively smaller tonsils.…”

Otitis media with effusion in children: Pathophysiology, diagnosis, and treatment. A review

“…The risk of OME recurrence may be lower, and the time to subsequent TT placement may be significantly longer. The likelihood of subsequent TT placement is thought to be 40% lower in this context (Wang et al., 2014).…”

The pathogens profile in children with otitis media with effusion and adenoid hypertrophy

“…In children with AH and OME, the surgical removal of the adenoid (associated with ventilation tube insertion) accelerates the recovery of the middle ear mucosa, decrease the risk of recurrence and need of repetitive surgical procedures, and reduce treatment failure rate. However, new evidence point out that the benefits of adenoidectomy in children with OME older than 4 years-old is independently of the adenoid size [ 12 ], suggesting that the removal of a local reservoir of pathogenic microbiota (viruses, planktonic bacteria, and biofilms) is the key for such benefits [ 13 – 15 ]. Despite some studies have evaluated the microbial colonization of adenoid and middle ear, no studies have thoroughly studied the association of respiratory pathogenic microbiota between these two niches.…”