Adenoidectomy: selection criteria for surgical cases of otitis media.
OBJECTIVE
Nasopharyngeal adenoids may serve as a mechanical obstruction to the eustachian tube and contribute to the pathophysiology of otitis media (OM). The purpose of this study was to determine whether abutment of adenoids laterally against the torus tubaris affects the outcome of patients requiring pressure equalization tubes (PET) for OM.


METHODS
Randomized, controlled, prospective clinical trial.


METHODS
Patients requiring PET for recurrent acute OM or OM with persistent effusion were randomized into two groups: 1) PET placement and 2) PET placement and adenoidectomy, regardless of whether the adenoids were abutting or not abutting the torus tubaris. Patients were followed for a minimum of 1 year to determine rate of treatment failure, defined as recurrence of acute OM (>3 times/year), OM with effusion, or reinsertion of PET.


RESULTS
Of the 34 patients in the abutting group, 16 patients underwent only PET insertion, of whom 8 (50%) failed, whereas 18 patients had combined PET placement and adenoidectomy, of whom 3 (17%) failed. There was a statistical difference between these two groups (P < 05). Of the 29 patients in the nonabutting group, 24 patients underwent only PET insertion, of whom 9 (37.5%) failed, whereas 5 patients underwent combined PET placement and adenoidectomy, of whom 2 (40%) failed. There was no statistical difference between these two groups (P =.92).


CONCLUSIONS
This study demonstrates that the position of hypertrophied adenoids may alter the final otologic outcome of patients requiring PET insertion for OM. Patients with adenoids abutting the torus tubaris may benefit most from an adjuvant adenoidectomy.
Nguyen
Lily H P
LH
Department of Otolaryngology, McGill University, Montreal, Quebec, Canada.
Manoukian
John J
JJ
Yoskovitch
Adi
A
Al-Sebeih
Khalid H
KH
D000208:Acute Disease; D000233:Adenoidectomy / Q000706:statistics & numerical data*; D000234:Adenoids / Q000473:pathology / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D006984:Hypertrophy / Q000453:epidemiology / Q000473:pathology; D008297:Male; D009305:Nasopharynx / Q000473:pathology* / Q000601:surgery*; D010033:Otitis Media / Q000453:epidemiology / Q000473:pathology / Q000601:surgery; D018579:Patient Selection; D011446:Prospective Studies; D014068:Tonsillectomy / Q000706:statistics & numerical data