title: Surgical treatments for otitis media with effusion: a systematic review.
abstract: OBJECTIVE
  The near universality of otitis media with effusion (OME) in children makes a comparative review of treatment modalities important. This study's objective was to compare the effectiveness of surgical strategies currently used for managing OME.
  
  
  METHODS
  We identified 3 recent systematic reviews and searched 4 major electronic databases. Eligible studies included randomized controlled trials, nonrandomized trials, and cohort studies that compared myringotomy, adenoidectomy, tympanostomy tubes (tubes), and watchful waiting. Using established criteria, pairs of reviewers independently selected, extracted data, rated risk of bias, and graded strength of evidence of relevant studies. We incorporated meta-analyses from the earlier reviews and synthesized additional evidence qualitatively.
  
  
  RESULTS
  We identified 41 unique studies through the earlier reviews and our independent searches. In comparison with watchful waiting or myringotomy (or both), tubes decreased time with OME and improved hearing; no specific tube type was superior. Adenoidectomy alone, as an adjunct to myringotomy, or combined with tubes, reduced OME and improved hearing in comparison with either myringotomy or watchful waiting. Tubes and watchful waiting did not differ in language, cognitive, or academic outcomes. Otorrhea and tympanosclerosis were more common in ears with tubes. Adenoidectomy increased the risk of postsurgical hemorrhage.
  
  
  CONCLUSIONS
  Tubes and adenoidectomy reduce time with OME and improve hearing in the short-term. Both treatments have associated harms. Large, well-controlled studies could help resolve the risk-benefit ratio by measuring acute otitis media recurrence, functional outcomes, quality of life, and long-term outcomes. Research is needed to support treatment decisions in subpopulations, particularly in patients with comorbidities.
authors.affiliation: Division for Health Services and Social Policy Research, RTI International, Research Triangle Park, North Carolina; and.
authors.forename: Ina F
authors.initials: IF
authors.lastname: Wallace
authors.forename: Nancy D
authors.initials: ND
authors.lastname: Berkman
authors.forename: Kathleen N
authors.initials: KN
authors.lastname: Lohr
authors.forename: Melody F
authors.initials: MF
authors.lastname: Harrison
authors.forename: Adam J
authors.initials: AJ
authors.lastname: Kimple
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Steiner
mesh_terms: D000233:Adenoidectomy; D002648:Child; D006801:Humans; D008876:Middle Ear Ventilation; D010034:Otitis Media with Effusion / Q000601:surgery*
keywords: adenoidectomy; comparative effectiveness; myringotomy; otitis media with effusion; surgical treatments; systematic review; tympanostomy tubes