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The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes.

Abstract

BACKGROUND

Otitis media is the most common medical problem in young children. The usual surgical treatment is myringotomy with insertion of tympanostomy tubes. There is debate about the usefulness of concomitant adenoidectomy or adenotonsillectomy. We examined the effects of these adjuvant procedures on the rates of reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media.

METHODS

Using hospital discharge records for the period 1995 through 1997, we examined the results of surgery for all 37,316 children (defined as persons 19 years of age or younger) in Ontario, Canada, who received tympanostomy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media and the time to the first reinsertion of tympanostomy tubes.

RESULTS

As compared with treatment involving the insertion of tympanostomy tubes alone, adjuvant adenoidectomy was associated with a reduction in the likelihood of reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant adenotonsillectomy was performed. The effect was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for children three years of age or older.

CONCLUSIONS

Performing an adenoidectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likelihood of additional hospitalizations and operations related to otitis media among children two years of age or older.

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  • Authors+Show Affiliations

    ,

    Department of Health Administration, and Home Care Evaluation and Research Centre, University of Toronto, ON, Canada. peter.coyte@utoronto.ca

    , , ,

    Source

    The New England journal of medicine 344:16 2001 Apr 19 pg 1188-95

    MeSH

    Adenoidectomy
    Adolescent
    Age Factors
    Child
    Child, Preschool
    Female
    Hospitalization
    Humans
    Infant
    Male
    Ontario
    Otitis Media
    Postoperative Complications
    Proportional Hazards Models
    Recurrence
    Reoperation
    Retrospective Studies
    Risk
    Tonsillectomy
    Treatment Outcome
    Tympanoplasty

    Pub Type(s)

    Journal Article
    Multicenter Study
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    11309633

    Citation

    Coyte, P C., et al. "The Role of Adjuvant Adenoidectomy and Tonsillectomy in the Outcome of the Insertion of Tympanostomy Tubes." The New England Journal of Medicine, vol. 344, no. 16, 2001, pp. 1188-95.
    Coyte PC, Croxford R, McIsaac W, et al. The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. N Engl J Med. 2001;344(16):1188-95.
    Coyte, P. C., Croxford, R., McIsaac, W., Feldman, W., & Friedberg, J. (2001). The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. The New England Journal of Medicine, 344(16), pp. 1188-95.
    Coyte PC, et al. The Role of Adjuvant Adenoidectomy and Tonsillectomy in the Outcome of the Insertion of Tympanostomy Tubes. N Engl J Med. 2001 Apr 19;344(16):1188-95. PubMed PMID: 11309633.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes. AU - Coyte,P C, AU - Croxford,R, AU - McIsaac,W, AU - Feldman,W, AU - Friedberg,J, PY - 2001/4/20/pubmed PY - 2001/5/5/medline PY - 2001/4/20/entrez SP - 1188 EP - 95 JF - The New England journal of medicine JO - N. Engl. J. Med. VL - 344 IS - 16 N2 - BACKGROUND: Otitis media is the most common medical problem in young children. The usual surgical treatment is myringotomy with insertion of tympanostomy tubes. There is debate about the usefulness of concomitant adenoidectomy or adenotonsillectomy. We examined the effects of these adjuvant procedures on the rates of reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media. METHODS: Using hospital discharge records for the period 1995 through 1997, we examined the results of surgery for all 37,316 children (defined as persons 19 years of age or younger) in Ontario, Canada, who received tympanostomy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media and the time to the first reinsertion of tympanostomy tubes. RESULTS: As compared with treatment involving the insertion of tympanostomy tubes alone, adjuvant adenoidectomy was associated with a reduction in the likelihood of reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant adenotonsillectomy was performed. The effect was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for children three years of age or older. CONCLUSIONS: Performing an adenoidectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likelihood of additional hospitalizations and operations related to otitis media among children two years of age or older. SN - 0028-4793 UR - https://www.unboundmedicine.com/medline/citation/11309633/full_citation L2 - https://www.nejm.org/doi/10.1056/NEJM200104193441602?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=www.ncbi.nlm.nih.gov DB - PRIME DP - Unbound Medicine ER -