Tonsils and adenoids. Their relation to secretory otitis media

This study demonstrates a significant resolution of effusions which is maintained for at least 3 years. Improvement results both from adenoidectomy alone and in combination with tonsillectomy. Significant audiometric hearing gain also occurs. There is a slight but statistically insignificant trend in favour of the combined operation, compared with adenoidectomy alone. Similar improvements can be achieved by use of a ventilation tube. But re-insertion is required twice as frequently with a tube alone than in cases where it is combined with adenoidectomy or adeno-tonsillectomy. The relative rates for mortality and morbidity of ventilation tube alone, adenoidectomy or adeno-tonsillectomy are well recognised. Taking these into account and considering the findings of this study there would seem to be little additional benefit from combination of tonsillectomy with adenoidectomy compared with adenoidectomy alone. The necessity for a second or subsequent anaesthetic in cases treated with a tube alone must also be considered. These results give some support to the suggestion that the treatment of choice for established bilateral SOM may be adenoidectomy in selected cases, combined with unilateral insertion of a ventilation tube. The latter procedure effects immediate but short-lived hearing gain. Unilateral compared with bilateral insertion reduces the overall complication rate due to the tube by 50%. The former procedure effects sustained improvement which persists following extrusion of the tube. Further prospective studies are required to predict more precisely those cases in which adenoidectomy should be recommended.