Adenoidectomy for otitis media with effusion (OME) in children

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Evidence-Based Medicine

Background:

• Otitis media with effusion (OME) is a common childhood condition causing fluid in the middle ear, potentially leading to hearing loss and developmental issues.
• Management options for OME include watchful waiting, autoinflation, and surgical interventions like adenoidectomy, often with ventilation tubes.

Approach:

• A systematic review and meta-analysis of randomized and quasi-randomized controlled trials was conducted.
• Searches included major databases (Cochrane ENT Register, CENTRAL, MEDLINE, Embase, Web of Science) and clinical trial registries up to January 20, 2023.
• Studies compared adenoidectomy (alone or with ventilation tubes) against no treatment, watchful waiting, or non-surgical interventions in children aged 6 months to 12 years.

Key Points:

• Evidence for adenoidectomy's effect on hearing in OME is very uncertain, with some studies showing little difference compared to watchful waiting.
• Adenoidectomy may slightly reduce the persistence of OME, but the clinical significance for hearing outcomes remains unclear.
• The risk of postoperative hemorrhage from adenoidectomy appears small, though data on adverse effects and disease-specific quality of life were limited.

Conclusions:

• The overall certainty of evidence regarding adenoidectomy for OME in children is low to very low.
• While adenoidectomy might decrease OME persistence, its impact on hearing requires further investigation.
• Future research should focus on identifying specific patient subgroups who are most likely to benefit from adenoidectomy.