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Tympanostomy with or without adenoidectomy reduced recurrent AOM
Children with recurrent acute otitis media treated by tympanostomy with or without adenoidectomy do not have any additional quality of life improvement; however, the surgery prevents more episodes, according to recent study findings published in The Pediatric Infectious Disease Journal.
Tiia Kujala, MD, of the department of otolaryngology at Oulu University Central Hospital in Finland, and colleagues evaluated 159 children aged 10 months to 2 years to determine their quality of life (QOL) after recurrent episodes of AOM. Children were randomly assigned to tympanostomy tubes, tympanostomy tubes with adenoidectomy or no surgery. Parents of patients completed the Otitis Media-6 questionnaires at entry and after 4 and 12 months of follow-up.
At the 12-month follow-up, all patients showed improvement in ear-related QOL. Among subsets in the questionnaire, caregiver concern showed the greatest improvement at the 12-month follow-up. QOL was not affected by tympanostomy, with or without adenoidectomy, at the 12-month follow-up vs. patients in the no-surgery group.
Patients in the surgery groups showed the greatest decrease in AOM episodes. Treatment failed in 34% of the patients in the no-surgery group compared with 21% in the tympanostomy group and 17% in the tympanostomy with adenoidectomy group.
“Even though the insertion of tympanostomy tubes reduces the number of AOM episodes, the QOL of children with [recurrent AOM] may improve with time in a similar manner simply by virtue of close follow-up, without surgery,” the researchers wrote. “Thus, the indications for surgery in cases of [recurrent AOM] should be carefully considered and watchful observation could be regarded as one option if the QOL of the child is the main concern.”
Disclosure: Kujala reports financial ties with the Alma and K.A. Snellman Foundation, the Maud Kuistila Memorial Foundation, the Orion Pharmacy Foundation, and the Päivikki and Sakari Sohlberg Foundation, Finland. The other researchers report no relevant financial disclosures.
Perspective
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Researchers from the departments of otolaryngology and pediatrics at the University of Oulu in Finland reported that there were no differences in quality-of-life assessment by primary caregivers among children undergoing surgical vs. expectant management for otitis media at the conclusion of a 12-month study period. Among the 159 children with recurrent otitis media (three or more episodes in 6 months or four or more episodes in 12 months) who were randomized to tympanostomy only (n=53), tympanostomy with adenoidectomy (n=54) or no surgery (n=52), 21% of those who underwent tympanostomy tube placement only, 15% who underwent tympanostomy with adenoidectomy and 32% who received no surgical intervention were lost to follow-up. While episodes of AOM assessed by study otolaryngologists declined more significantly in the children who underwent tympanostomy tube placement only or tympanostomy tube with adenoidectomy, this decreased frequency did not translate into a change in responses to the Otitis Media 6-item survey.
Within the limits of a relatively small sample size with some loss to follow-up, the results of this sub-study suggest that functional health status of Finnish children with recurrent AOM is not impacted by surgical intervention. The study design provided frequent access to the study otolaryngologists, suggesting that “the Hawthorne effect,” or observational effect, may have resulted in the positive responses to the assessments in all three groups. While there are clinical advantages to reducing recurrent episodes of AOM, perhaps frequent office visits and support similar to that provided in this study could result in caregiver satisfaction that would decrease the need for tympanostomy tube placement. Conservative nonsurgical management may be as beneficial as tympanostomy tube placement for the quality of life of children and their parents, especially in situations where hearing loss and the sequelae of recurrent episodes are not significant characteristics of the child’s clinical presentation.
