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Published on: May 23, 2021
Does an adenoidectomy with a second set of tympanostomy tubes reduce subsequent tube placements?
Megan B Saltsgaver1, Amanda Weis1, Weihai Zhan1
1University of Illinois College of Medicine, Rockford, IL, United States of America.
Insights
Performing adenoidectomy with a second tympanostomy tube (TT) placement did not reduce the need for a third TT. Younger children undergoing adenoidectomy showed a higher rate of needing a third TT, warranting further research.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Epidemiology
Background:
- Recurrent otitis media and middle ear effusions in children often necessitate tympanostomy tube (TT) placement.
- Some children require multiple TT insertions, increasing risks associated with repeated anesthesia.
- The benefit of concurrent adenoidectomy during a second TT procedure on subsequent tube needs is not well-established.
Purpose of the Study:
- To evaluate if adenoidectomy at the time of second tympanostomy tube (TT) placement reduces the need for a third TT.
- To investigate the association between adenoid surgery and the rate of repeat TT placement in pediatric patients.
Main Methods:
- Retrospective cohort study of 208 pediatric patients (aged 1-17) undergoing at least two TT placements (2014-2024).
- Patients were grouped based on whether adenoidectomy or adenotonsillectomy was performed during the second TT procedure.
- Primary outcome was the rate of third TT placement; statistical analysis included chi-square tests and risk ratios.
Main Results:
- No significant difference in third TT placement rates was observed between patients who had adenoid surgery (30.5%) and those who did not (35.1%).
- Adenoid obstruction was not significantly linked to recurrence.
- Exploratory analysis indicated younger children (≤4 years) undergoing adenoidectomy had a higher rate of third TT placement (47.5%) compared to older children (>4 years) (27.0%).
Conclusions:
- Adenoidectomy or adenotonsillectomy concurrent with second tympanostomy tube placement did not significantly decrease the likelihood of requiring a third TT.
- Preliminary findings suggest younger children undergoing adenoidectomy may have increased rates of subsequent TT placement, requiring cautious interpretation and further prospective validation.
- The retrospective nature and sample size limit definitive conclusions regarding adenoidectomy's role in managing recurrent otitis media requiring multiple tympanostomy tubes.
Objective:
Tympanostomy tube (TT) placement is a common surgical intervention for children with recurrent otitis media or middle ear effusions. While most patients benefit from a single procedure, some require multiple tube placements, increasing anesthesia exposure and procedural risk. The role of an adenoidectomy performed at the time of second TT placement in reducing the need for a third set of tubes remains unclear.
Methods:
This retrospective cohort study included 208 pediatric patients aged 1-17 years who underwent at least two TT placements at a single academic institution between 2014 and 2024. Patients were stratified according to whether adenoidectomy or adenotonsillectomy was performed at the time of second TT placement. The primary outcome was third tympanostomy tube placement following the second procedure. Statistical analyses included chi-square testing and estimation of risk ratios with 95% confidence intervals.
Results:
Among 207 eligible patients, 52 of 148 (35.1%) patients without adenoidectomy, 12 of 40 (30.0%) with adenoidectomy, and 6 of 19 (31.6%) with adenotonsillectomy required a third TT (P = 0.81). The combined adenoid surgery group had a similar rate of third TT placement compared with no surgery (18 of 59 (30.5%) vs 52 of 148 (35.1%); RR 0.87, 95% CI 0.56-1.35; P = 0.53). Adenoid obstruction was not associated with recurrence (P = 0.18). In an exploratory post hoc subgroup analysis restricted to children who underwent adenoidectomy at the time of second TT placement, 19 of 40 (47.5%) children aged ≤4 years subsequently underwent a third TT placement compared with 10 of 37 (27.0%) children aged >4 years (P = 0.01).
Conclusions:
Adenoidectomy or adenotonsillectomy performed with the second TT placement was not significantly associated with reduced risk of third TT placement. An exploratory post hoc subgroup analysis suggested higher rates of third TT placement among younger children undergoing adenoidectomy; however, these findings should be interpreted cautiously and require confirmation in larger prospective studies. Given the retrospective design and limited sample size, these findings should not be considered definitive evidence for or against adenoidectomy at the time of an additional tympanostomy tube placement.
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