Adenoidectomy as an Adjuvant to Primary Tympanostomy Tube Placement A Systematic Review and Meta-analysis

Importance Adenoidectomy at initial tympanostomy tube placement (TT) may reduce the rate of repeated surgery for otitis media. Objective To assess the effectiveness of primary adenoidectomy as an adjuvant to TT (Ad + TT) compared with TT alone. Data Sources PubMed and EMBASE electronic databases were searched with no publication year restrictions beyond those of the individual databases. Study Selection Articles that compared outcomes of children having undergone primary Ad + TT with children having undergone TT alone for middle ear disease. Data Extraction Medical literature addressing Ad + TT was systematically reviewed. Data extracted included study design, age of children, and follow-up time frame. Level of evidence was assessed, and data were pooled where possible. Main Outcomes and Measures Proportion of children requiring repeated TT (r-TT). Secondary outcomes included proportion of children with recurrent acute otitis media (RAOM), otitis media with effusion (OME), otorrhea, or any combination of the 3. Results Fifteen articles met inclusion criteria. Ten studies (n = 71 353) reported that primary Ad + TT decreased the risk of r-TT or risk of RAOM, OME, or otorrhea compared with TT alone. Four studies (n = 538) reported no difference between Ad + TT groups compared with TT-only groups in the prevention of r-TT or of RAOM, OME, or otorrhea. Despite significant heterogeneity, limited meta-analysis and pooling of data revealed that the estimated rate of r-TT for children undergoing primary adenoidectomy was 17.2% (95% CI, 12.2%-22.2%) vs 31.8% (95% CI, 23.9%-39.8%) for children undergoing primary TT only. When stratified by age younger than 4 years, the protective effects of adenoidectomy were diminished. Conclusions and Relevance The current evidence suggests that primary Ad + TT may be superior to TT only in decreasing the risk of r-TT and the risk of RAOM, OME, or otorrhea. Limitations include heterogeneity of the source data, with the predominance of retrospective data as well as studies with older children supporting the superiority of adjuvant adenoidectomy. The practice of Ad + TT may decrease the risk of repeated surgery in children older than 4 years.