Prevention of otitis media by adenoidectomy in children younger than 2 years.
OBJECTIVE
To test the effect of adenoidectomy in connection with tympanostomy compared with tympanostomy only in preventing otitis media in children younger than 2 years.


METHODS
Prospective trial with randomized and nonrandomized arms.


METHODS
Primary care study clinics.


METHODS
The study participants were selected from 2497 children who had been enrolled in the Finnish Otitis Media Vaccine Trial at the age of 2 months. A total of 306 children, aged 1 to 2 years, who had experienced recurrent episodes of otitis media were randomized into 2 treatment groups: tympanostomy with or without adenoidectomy. Of the 306 children, 137 were operated on according to random basis (randomized trial). The 169 children whose parents declined participation in the randomized trial were operated on according to the parents' preferences (nonrandomized trial). All children were followed up until 2 years of age. The mean follow-up time was 7 months.


METHODS
The rate of acute otitis media episodes.


RESULTS
The average reduction in the rate of all acute otitis media episodes in the adenoidectomy group was 19% (95% confidence interval [CI], -14% to 43%) among children enrolled in the randomized trial and 25% (95% CI, -13% to 50%) in the nonrandomized trial. The reduction in the randomized trial was mainly due to reduction in the rate of pneumococcal otitis media (58%, 95% CI, 16%-79%).


CONCLUSIONS
In children younger than 2 years, concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media.
Mattila
Petri S
PS
Department of Otorhinolaryngology, Helsinki University Central Hospital, PO Box 220, 00029 Helsinki, Finland. petri.mattila@hus.fi
Joki-Erkkilä
Veli-Pekka
VP
Kilpi
Terhi
T
Jokinen
Jukka
J
Herva
Elja
E
Puhakka
Heikki
H
D000233:Adenoidectomy; D000367:Age Factors; D005260:Female; D005500:Follow-Up Studies; D016905:Gram-Negative Bacterial Infections / Q000150:complications; D006192:Haemophilus Infections / Q000150:complications; D006193:Haemophilus influenzae / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008297:Male; D008876:Middle Ear Ventilation; D001936:Moraxella catarrhalis / Q000302:isolation & purification; D010033:Otitis Media / Q000209:etiology / Q000382:microbiology / Q000517:prevention & control*; D017063:Outcome Assessment, Health Care; D011008:Pneumococcal Infections / Q000150:complications; D011446:Prospective Studies; D013296:Streptococcus pneumoniae / Q000302:isolation & purification; D013997:Time Factors