Does the benefit of adenoidectomy in addition to ventilation tube insertion persist long‐term?

Objectives.  TARGET randomised 376 children with persistent OME to 3 regimens: watchful waiting (WW), ventilation-tubes only (VTO), and ventilation tubes-adenoidectomy (VTA). At 2-year follow-up, the demonstrated greater benefits of VTA than VTO in terms of respiratory problems and hearing thresholds were still present. Records from the largest centre were examined to determine how long benefits of +adenoidectomy continue beyond 2 years. Methods.  Retrospective records analyses of Leicester children captured consultations and treatments outside the TARGET protocol, plus pure-tone-average (0.5–4 kHz) at latest clinical entry. Results.  Ninety-four of 95 notes (99%) were available, with time-lags of 7.5–11.6 years. On intention-to-treat analysis, children receiving treatment additional to allocation comprised 61% of WW, 59% of VTO, and 44% of VTA, with average surgical procedures numbering 1.0, 2.1, and 1.7. Proportions of children requiring >1 additional procedure were 13%, 34%, and 15%. Differences (VTO-VTA) for consultations, operations and combined were marginal for this single centre but consistent with the significant all-centre data for 3–6 years from randomisation. Mean latest pure-tone-averages were 15.84, 11.73, and 12.44 dBHL. Conclusions.  (1) Additional adenoidectomy has enduring benefits over VTO, although most clinical benefit appears to arise in the early years. (2) The two fifths of children randomised to WW not requiring surgery merit detailed epidemiological characterisation. (3) The benefits of surgery in OME are modest, requiring large-number trials, but are genuine.