title: Adenoidectomy as an adjuvant to primary tympanostomy tube placement: a systematic review and meta-analysis.
abstract: OBJECTIVE
  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.
  
  
  METHODS
  PubMed and EMBASE electronic databases were searched with no publication year restrictions beyond those of the individual databases.
  
  
  METHODS
  Articles that compared outcomes of children having undergone primary Ad + TT with children having undergone TT alone for middle ear disease.
  
  
  METHODS
  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.
  
  
  METHODS
  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
  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.
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Samantha J
authors.initials: SJ
authors.lastname: Mikals
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, San Diego, California.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Brigger
mesh_terms: D000233:Adenoidectomy / Q000009:adverse effects / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008876:Middle Ear Ventilation / Q000009:adverse effects / Q000379:methods*; D010033:Otitis Media / Q000175:diagnosis* / Q000601:surgery*; D010034:Otitis Media with Effusion / Q000175:diagnosis / Q000601:surgery; D010035:Otitis Media, Suppurative / Q000175:diagnosis / Q000601:surgery; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery; D012008:Recurrence; D012086:Reoperation / Q000379:methods; D018570:Risk Assessment; D012720:Severity of Illness Index; D013997:Time Factors; D016896:Treatment Outcome