Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials

J. L. Paradise, C. D. Bluestone, K. D. Rogers, F. H. Taylor, D. K. Colborn, R. Z. Bachman, B. S. Bernard and R. H. Schwarzbach
Ambulatory Care Center, Children's Hospital of Pittsburgh, PA 15213-3417.

We studied the efficacy of adenoidectomy in 213 children who had received tympanostomy-tube placement because of persistent and/or recurrent otitis media and had again developed otitis media after tubal extrusion. Ninety-nine of the children were assigned randomly to either an adenoidectomy group or a control group; in a separate trial, 114 children whose parents withheld consent for randomization were assigned according to parental preference. In both trials, control group outcomes appeared to have been biased favorably by the withdrawal of certain severely affected subjects from control status to receive adenoidectomy. Nonetheless, in both trials, adenoidectomy group outcomes were more favorable than control group outcomes during the first 2 follow-up years. Statistically significant differences were found mainly in the randomized trial, where during the first and second years, respectively, adenoidectomy subjects had 47% and 37% less time with otitis media than control subjects and 28% and 35% fewer suppurative (acute) episodes than control subjects. We conclude that adenoidectomy is warranted on an individualized basis for children who develop recurrent otitis media after extrusion of tympanostomy tubes.

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Clinical Manifestations and Risk Factors of Children Receiving Triple Ventilating Tube Insertions for Treatment of Recurrent Otitis Media With Effusion
Ahn et al.
Pediatrics 2006;117:e1119-e1123.
ABSTRACT | FULL TEXT  

Tubal tonsil hypertrophy: a cause of recurrent symptoms after adenoidectomy.
Emerick and Cunningham
Arch Otolaryngol Head Neck Surg 2006;132:153-156.
ABSTRACT | FULL TEXT  

Prevention of paediatric respiratory tract infections: emphasis on the role of OM-85
Schaad
ERR 2005;14:74-77.
ABSTRACT | FULL TEXT  

Prophylactic or Therapeutic Adenoidectomy?: In Reply
Hammaren-Malmi et al.
Pediatrics 2005;116:1258-1258.
FULL TEXT  

Adenoidectomy Does Not Significantly Reduce the Incidence of Otitis Media in Conjunction With the Insertion of Tympanostomy Tubes in Children Who Are Younger Than 4 Years: A Randomized Trial
Hammaren-Malmi et al.
Pediatrics 2005;116:185-189.
ABSTRACT | FULL TEXT  

Systematic review to determine whether participation in a trial influences outcome
Vist et al.
BMJ 2005;330:1175.
ABSTRACT | FULL TEXT  

Impact of Participant and Physician Intervention Preferences on Randomized Trials: A Systematic Review
King et al.
JAMA 2005;293:1089-1099.
ABSTRACT | FULL TEXT  

Consultation With the Specialist: Tympanostomy Tubes: A Contemporary Guide to Judicious Use
Paradise and Bluestone
Pediatr. Rev. 2005;26:61-66.
FULL TEXT  

Otitis Media With Effusion
American Academy of Family Physicians et al.
Pediatrics 2004;113:1412-1429.
ABSTRACT | FULL TEXT  

Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial
Koivunen et al.
BMJ 2004;328:487.
ABSTRACT | FULL TEXT  

Tonsillectomies and Adenotonsillectomies--Will the Debate Never Be Over?
Rosefsky et al.
Pediatrics 2003;112:205-205.
FULL TEXT  

Does Adenoidectomy Prevent Recurrent Otitis in Young Children?
Choi and Schoem
AAP Grand Rounds 2003;9:56-57.
FULL TEXT  

Incidence of and Risk Factors for Additional Tympanostomy Tube Insertion in Children
Boston et al.
Arch Otolaryngol Head Neck Surg 2003;129:293-296.
ABSTRACT | FULL TEXT  

Prevention of Otitis Media by Adenoidectomy in Children Younger Than 2 Years
Mattila et al.
Arch Otolaryngol Head Neck Surg 2003;129:163-168.
ABSTRACT | FULL TEXT  

A 15-Month-Old Child With Recurrent Otitis Media
Paradise
JAMA 2002;288:2589-2598.
FULL TEXT  

Otitis Media
Hendley
NEJM 2002;347:1169-1174.
FULL TEXT  

Tonsillectomy and Adenotonsillectomy for Recurrent Throat Infection in Moderately Affected Children
Paradise et al.
Pediatrics 2002;110:7-15.
ABSTRACT | FULL TEXT  

The Role of Adjuvant Adenoidectomy and Tonsillectomy in the Outcome of the Insertion of Tympanostomy Tubes
Coyte et al.
NEJM 2001;344:1188-1195.
ABSTRACT | FULL TEXT  

A Comparison of Observational Studies and Randomized, Controlled Trials
Benson and Hartz
NEJM 2000;342:1878-1886.
ABSTRACT | FULL TEXT  

Adenoidectomy and Adenotonsillectomy for Recurrent Otitis Media
Rosenfeld et al.
JAMA 2000;283:1822-1824.
FULL TEXT  

Acute otitis media
Lindbaek et al.
BMJ 2000;320:182-182.
FULL TEXT  

Adenoidectomy and Adenotonsillectomy for Recurrent Acute Otitis Media: Parallel Randomized Clinical Trials in Children Not Previously Treated With Tympanostomy Tubes
Paradise et al.
JAMA 1999;282:945-953.
ABSTRACT | FULL TEXT  

Otitis Media--The Pharyngeal Connection
Gates
JAMA 1999;282:987-989.
FULL TEXT  

A Novel Use of Xylitol Sugar in Preventing Acute Otitis Media
Uhari et al.
Pediatrics 1998;102:879-884.
ABSTRACT | FULL TEXT  

Assessment of Adenoidal Obstruction in Children: Clinical Signs Versus Roentgenographic Findings
Paradise et al.
Pediatrics 1998;101:979-986.
ABSTRACT | FULL TEXT  

Otitis Media in Children
Berman
NEJM 1995;332:1560-1565.
FULL TEXT  

Mandatory HIV Testing in Criminal Justice Settings
Blumberg and Langston
Crime Delinquency 1991;37:5-18.
ABSTRACT  

ADENOIDECTOMY IS BENEFICIAL FOR RECURRENT OTITIS MEDIA
JWatch General 1990;1990:3-3.
FULL TEXT