Chronic otitis media with effusion and adeno-tonsillectomy--a prospective randomized controlled study

Area of Science:

• Pediatric Otolaryngology
• Evidence-Based Medicine

Background:

• Otitis media with effusion (OME) is a prevalent chronic childhood ear condition with varied global management strategies.
• Surgical interventions like adenoidectomy and tonsillectomy are common for OME, yet robust evidence from randomized controlled trials is lacking.

Purpose of the Study:

• To evaluate the efficacy of adenoidectomy and adenotonsillectomy in resolving established OME in children resistant to medical therapy.
• To compare surgical outcomes against a non-surgical control group through a prospective, randomized study.

Main Methods:

• A cohort of 103 children with OME unresponsive to medical treatment was randomly assigned to undergo adenoidectomy, adenotonsillectomy, or no surgery.
• Outcomes were assessed at 6 weeks, 3 months, 6 months, 9 months, and one year post-intervention.

Main Results:

• Adenoidectomy alone resulted in OME resolution rates increasing from 39% at 6 weeks to 72% at one year, significantly higher than the 26% in the no-surgery group (P ≤ 0.001).
• Adenotonsillectomy showed resolution rates from 59% at 6 weeks to 62% at one year, also significantly better than the control group (P ≤ 0.01).
• No additional benefit was observed with the addition of tonsillectomy compared to adenoidectomy alone.

Conclusions:

• Adenoidectomy is a highly effective treatment for established OME in children, resolving the condition in 36-46% of cases up to 12 months.
• Tonsillectomy does not enhance the resolution rates of OME when performed alongside adenoidectomy.