Intervention Review

Adenoidectomy for otitis media in children

  1. Maaike TA van den Aardweg1,*,
  2. Anne GM Schilder2,
  3. Ellen Herkert1,
  4. Chantal WB Boonacker3,
  5. Maroeska M Rovers2

Editorial Group: Cochrane Ear, Nose and Throat Disorders Group

Published Online: 12 MAY 2010

Assessed as up-to-date: 29 MAR 2009

DOI: 10.1002/14651858.CD007810.pub2

Database Title

Additional Information

How to Cite

van den Aardweg MTA, Schilder AGM, Herkert E, Boonacker CWB, Rovers MM. Adenoidectomy for otitis media in children. Cochrane Database of Systematic Reviews 2010, Issue 1. Art. No.: CD007810. DOI: 10.1002/14651858.CD007810.pub2.

Author Information

  1. 1

    University Medical Center Utrecht, Department of Otorhinolaryngology, Utrecht, Netherlands

  2. 2

    University Medical Center Utrecht, Department of Otorhinolaryngology & Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands

  3. 3

    University Medical Center Utrecht, Julius Center for Health Sciences and Primary Care, Utrecht, Netherlands

*Maaike TA van den Aardweg, Department of Otorhinolaryngology, University Medical Center Utrecht, Wilhelmina Children's Hospital, HP: KE.04.140.5, PO Box 85090, Utrecht, 3508 AB, Netherlands. M.T.A.vandenAardweg@umcutrecht.nl.

Publication History

  1. Publication Status: Edited (no change to conclusions)
  2. Published Online: 12 MAY 2010

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Abstract

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Background

Adenoidectomy, surgical removal of the adenoids, is a common ENT operation worldwide in children with otitis media. A systematic review on the effectiveness of adenoidectomy in this specific group has not previously been performed.

Objectives

To assess the effectiveness of adenoidectomy versus non-surgical management or tympanostomy tubes in children with otitis media.

Search methods

We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials. The date of the most recent search was 30 March 2009.

Selection criteria

Randomised controlled trials comparing adenoidectomy, with or without tympanostomy tubes, versus non-surgical management or tympanostomy tubes only in children with otitis media. The primary outcome studied was the proportion of time with otitis media with effusion (OME). Secondary outcomes were mean number of episodes, mean number of days per episode and per year, and proportion of children with either acute otitis media (AOM) or otitis media with effusion (OME), as well as mean hearing level. Tertiary outcome measures included atrophy of the tympanic membrane, tympanosclerosis, retraction of the pars tensa and pars flaccid and cholesteatoma.

Data collection and analysis

Two authors assessed trial quality and extracted data independently.

Main results

Fourteen randomised controlled trials (2712 children) studying the effectiveness of adenoidectomy in children with otitis media were evaluated. Most of these trials were too heterogeneous to pool in a meta-analysis. Loss to follow up varied from 0% to 63% after two years.

Adenoidectomy in combination with a unilateral tympanostomy tube has a beneficial effect on the resolution of OME (risk difference (RD) 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) for the non-operated ear at six and 12 months, respectively (n = 3 trials)) and a very small (< 5 dB) effect on hearing, compared to a unilateral tympanostomy tube only. The results of studies of adenoidectomy with or without myringotomy versus non-surgical treatment or myringotomy only, and those of adenoidectomy in combination with bilateral tympanostomy tubes versus bilateral tympanostomy tubes only, also showed a small beneficial effect of adenoidectomy on the resolution of the effusion. The latter results could not be pooled due to large heterogeneity of the trials.

Regarding AOM, the results of none of the trials including this outcome indicate a significant beneficial effect of adenoidectomy. The trials were too heterogeneous to pool in a meta-analysis.

The effects of adenoidectomy on changes of the tympanic membrane or cholesteatoma have not been studied.

Authors' conclusions

Our review shows a significant benefit of adenoidectomy as far as the resolution of middle ear effusion in children with OME is concerned. However, the benefit to hearing is small and the effects on changes in the tympanic membrane are unknown. The risks of operating should be weighed against these potential benefits.

The absence of a significant benefit of adenoidectomy on AOM suggests that routine surgery for this indication is not warranted.

 

Plain language summary

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

Adenoidectomy for recurrent or chronic middle ear disease in children

Both acute and chronic middle ear infections (acute otitis media and chronic otitis media with effusion or 'glue ear') are very common in children. Adenoidectomy is a surgical procedure to remove the adenoids and is often performed in these children as it is thought to prevent these problems.

Our review, which includes 14 studies and 2712 children, shows that adenoidectomy is effective in getting rid of middle ear fluid ('glue') but does not have a significant effect on acute otitis media or the child's hearing.

 

摘要

  1. Top of page
  2. Abstract
  3. Plain language summary
  4. 摘要

背景

腺樣體切除 (Adenoidectomy) 用於兒童中耳炎 (Otitis media in children)

腺樣體切除，即手術切除腺樣體，在全世界患有的中耳炎的兒童當中，是一種常見的耳鼻喉科手術。過去還沒有關於腺樣體切除在這個特殊族群的效果的系統性回顧。

目標

評估腺樣體切除與非手術治療或通氣管 (tympanostomy tube) 在患有中耳炎的兒童的效果。

搜尋策略

我們搜尋了the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE;CINAHL;Web of Science; BIOSIS Previews;Cambridge Scientific Abstracts;mRCT以及其他已發表或尚未發表的試驗。最近一次搜尋是在2009年3月30日。

選擇標準

比較在患有的中耳炎的兒童中，腺樣體切除不論有無併用通氣管，跟非手術治療或是只使用通氣管的隨機對照試驗。第一結果是比較中耳積液 (otitis media with effusion) 的時間比例。第二結果是比較平均發作次數，平均每次發作日數以及平均每年發作日數，兒童急性中耳炎或是中耳積液的比率，還有平均聽力程度。第三結果是評估包括鼓膜萎縮 (atrophy of the tympanic membrane) ，鼓室硬化 (tympanosclerosis) ，鼓膜緊張部和鬆弛部凹陷 (retraction of the pars tensa and pars flaccid) 及膽脂瘤 (cholesteatoma) 的狀況。

資料收集與分析

兩位作者評估試驗品質以及獨立地擷取資料。

主要結論

評估了14篇研究腺樣體切除於患有中耳炎兒童的效果的隨機對照試驗 (總共2712個兒童) 。大部分的試驗因為異質性 (heterogeneous) 過大而無法合併計算結果成統合分析 (Metaanalysis) 。經過兩年，失去後續追蹤的病人介於0% −63% 。腺樣體切除伴隨單側通氣管使用對中耳積液的緩解跟未手術耳相較，在第6及第12個月各別有好的效果 (risk difference (RD) 22% (95% CI 12% to 32%) and 29% (95% CI 19% to 39%) (3個試驗) ，而且跟只有單側使用通氣管相比，對聽力改變的效果非常小 (小於5dB) 。 文獻有關腺樣增殖切除有或無併行鼓膜切開 (myringotomy) 跟非手術治療或只有鼓膜切開相比較，以及腺樣體切除併行兩側通氣管跟只有兩側通氣管相比較，都顯示腺樣體切除對於緩解積液有小的益處。因為各試驗的異質性過大，所以後續的結果無法合併。沒有研究結果指出腺樣體切除對於急性中耳炎有顯著的好處，這些試驗因為異質性過大而無法統合分析。至於腺樣體切除對於鼓膜改變或膽脂瘤的效果，沒有相關的研究。

作者結論

我們的回顧，顯示腺樣體切除在緩解兒童的中耳積液有顯著好處。然而，對於聽力的好處是有限的，而且對於鼓膜改變的效果不明。手術的風險跟手術的潛在好處應一起評估。腺樣體切除對於急性中耳炎缺乏顯著的好處，因此在這種適應症下常規地執行這項手術是不合理。

翻譯人

本摘要由基隆長庚醫院沈芳瑩翻譯。

此翻譯計畫由臺灣國家衛生研究院 (National Health Research Institutes, Taiwan) 統籌。

總結

腺樣體切除用於兒童的覆發型或慢性中耳炎急性及慢性中耳感染 (急性中耳炎和慢性中耳炎積液，或 ‘膠水耳’) 在兒童都很常見，腺樣體切除意謂以手術方式切除腺樣體，而腺樣體切除常被用於這些兒童因為這個手術被認為可以預防這些中耳的問題。我們回顧了14篇研究總共2712兒童，結果顯示腺樣體切除對於移除中耳積液 (膠水) 是有效的，可是腺樣體切除用於急性中耳炎或兒童的聽力並沒有顯著的效果。

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