Tympanostomy Tube Insertion With and Without Adenoidectomy

Area of Science:

• Otolaryngology
• Pediatric Surgery
• Health Services Research

Background:

• The efficacy of adenoidectomy alongside tympanostomy tube (TT) insertion for otologic outcomes remains debated due to prior research limitations.
• Existing studies often suffer from small sample sizes, varied designs, and inconsistent outcome measures, hindering clear interpretation.

Purpose of the Study:

• To assess the association between adenoidectomy and otologic outcomes in a large US population of children undergoing TT insertion.
• To provide generalizable evidence for clinical decision-making regarding combined adenoidectomy and TT procedures.

Main Methods:

• A matched cohort study utilized claims data from the Merative MarketScan Research Databases (2007-2021).
• Included were 601,848 children receiving TTs, with a focus on those undergoing simultaneous adenoidectomy and TT insertion (Ad+TT).
• Controls without adenoidectomy were matched by age, sex, and prior TT procedures; outcomes analyzed included repeat TT insertions and oral antibiotic prescriptions.

Main Results:

• In children younger than 4 years, Ad+TT was linked to decreased oral antibiotic use (OR, 0.59) but increased repeat TT insertions (OR, 1.24).
• In children aged 4 years and older, Ad+TT was associated with reduced odds of repeat TT insertions (OR, 0.78) and subsequent oral antibiotic prescriptions (OR, 0.63).

Conclusions:

• For children under 4, Ad+TT may reduce antibiotic courses but does not decrease repeat TT insertions.
• For children 4 and older, Ad+TT demonstrates a benefit by reducing both repeat TT insertions and antibiotic use, supporting its consideration for improved otologic outcomes.