The role of adjuvant adenoidectomy and tonsillectomy in the outcome of theinsertion of tympanostomy tubes.

Background: Otitis media is the most common medical problem in young childr en. The usual surgical treatment is myringotomy with insertion of tympanost omy tubes. There is debate about the usefulness of concomitant adenoidectom y or adenotonsillectomy. We examined the effects of these adjuvant procedur es 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 per sons 19 years of age or younger) in Ontario, Canada, who received tympanost omy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media a nd 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 pe rcent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readm ission for conditions related to otitis media (relative risk, 0.5; 95 perce nt confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes wa s further reduced if an adjuvant adenotonsillectomy was performed. The effe ct was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was a pparent in two-year-olds and was greatest for children three years of age o r older. Conclusions: Performing adenoidectomy or adenotonsillectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likel ihood of additional hospitalizations and operations related to otitis media among children two years of age or older. (N Engl J Med 2001;344:1188-95.) Copyright (C) 2001 Massachusetts Medical Society.