Influence of adenoid hypertrophy on secretory otitis media

The prognostic influence of adenoidectomy on the clinical course of chronic secretory otitis media (SOM) is reported after an observation period of five years in 166 children. Adenoidectomy was performed in connection with the first tubulation on the basis of concurrent symptoms of nasal obstruction, and resulted in a significant reduction in the need for repeated insertion of tympanostomy tubes in patients younger than eight years of age. The tubulation rate was also significantly reduced when adenoidectomy was performed in association with the first recurrence of SOM. This effect was, however, absent when the operation was performed at later stages, and both the otoscopic and audiological findings after five years revealed no significant differences between the adenoidectomy and nonadenoidectomy groups. Possible pathogenetic mechanisms leading to the development of SOM in the presence of large adenoids are discussed.