The Outcome of Adenoidectomy and Tympa- nostomy Tube Insertion in Patients with Otitis Media with Effusion and Factor that Influences the Recurrence

Abstract

Objective: The adenoid is an important contributing factor for otitis media with effusion by serving as the reservoir for patho- genic bacteria. Adenoidectomy is suggested in the guidelines as an adjunctive surgical treatment for otitis media with effusion. Recurrence of otitis media after adenoidectomy should be evaluated and concomitant adenoidal diseases should be taken into consideration. The objective of this study was to evaluate the outcome of the patients who had simultaneous adenoidectomy and tympanostomy tube insertion, in terms of recurrence of otitis media, adenoid-related diseases and repeated surgery.

Methods: A retrospective study was performed in those patients who had adenoidectomy with tympanostomy tube insertion during 1994-2003. Medical records were reviewed from the time of surgery until the last contact of each patient. Data col- lection included indications for surgery, culture results, post-operative recurrence of otitis media, adenoid-related diseases and additional operations.

Results: There were sixty-six patients with 47 boys and 19 girls. The mean age was 6.27 ± 3.05 years. Co-existing adenoidal diseases consisted of rhinosinusitis (54.5%), obstructive sleep disorder (42.4%), and adenotonsillitis (3%). Nine cases (13.6%) had no associated adenoidal disease. and adenoidectomy was done in conjunction with the insertion of their second set of tym- panostomy tubes. The predominant bacteria from the adenoid cultures were Streptococcus pneumoniae (21.7%), Pseudomonas aeruginosa (21.7%) and Streptococcus viridans (17.4%). The mean period of follow up was 23.8 months. Forty-one patients (62.1%) had no recurrence of otitis media. Nine cases (13.6%) had repeated myringotomy and tube insertion. Significant correlation was found between recurrent rhinosinusitis and recurrent otitis media (p = 0.001). The relative risk of recurrent otitis media in patients with recurrent rhinosinusitis was 3.63 (95% CI 1.4 to 9.4).

Conclusion: Simultaneous adenoidectomy with tympanostomy tube insertion produced satisfactory results in reducing the recurrence of otitis media during the follow-up period. Recurrent rhinosinusitis was correlated with recurrent otitis media and repeated myringotomy and tube insertion.