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Background Otitis media is the most common medical problem in young children. The usual surgical treatment is myringotomy with insertion of tympanostomy tubes. There is debate about the usefulness of concomitant adenoidectomy or adenotonsillectomy. We examined the effects of these adjuvant procedures on the rates of reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media.
Methods Using hospital discharge records for the period 1995 through 1997, we examined the results of surgery for all 37,316 children (defined as persons 19 years of age or younger) in Ontario, Canada, who received tympanostomy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media and the time to the first reinsertion of tympanostomy tubes.
Results As compared with treatment involving the insertion of tympanostomy tubes alone, adjuvant adenoidectomy was associated with a reduction in the likelihood of reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant adenotonsillectomy was performed. The effect was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for children three years of age or older.
Conclusions Performing adenoidectomy or adenotonsillectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likelihood of additional hospitalizations and operations related to otitis media among children two years of age or older.
Source Information
From the Departments of Health Administration (P.C.C.), Family and Community Medicine (W.M.), and Pediatrics (W.F.) and the Home Care Evaluation and Research Centre (P.C.C.), University of Toronto; the Institute for Clinical Evaluative Sciences (P.C.C.); the Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre (R.C.); the Departments of Otolaryngology (P.C.C., J.F.) and Family Medicine (W.M.), Mount Sinai Hospital; and the Divisions of General Pediatrics (W.F.) and Otolaryngology (J.F.), Hospital for Sick Children — all in Toronto.
Address reprint requests to Dr. Coyte at the Department of Health Administration, 2nd Fl., McMurrich Bldg., Faculty of Medicine, University of Toronto, Toronto, ON M5S 1A8, Canada, or at peter.coyte{at}utoronto.ca.
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