medwireNews: Performing simultaneous adenoidectomy in children undergoing tympanostomy tube (TT) insertion may reduce the need for subsequent oral antibiotic prescriptions regardless of age, but only lowers the risk for repeat insertions in children aged 4 years or older, US research shows.
Z Jason Qian (University of California San Diego School of Medicine, La Jolla, USA) and co-investigators therefore suggest: “In children 4 years or older, adenoidectomy may be offered with TTs to improve otologic outcomes; however, in children younger than 4 years, adenoidectomy should only be offered with TTs for symptoms of adenoid hyperplasia but may have a secondary benefit in reducing future oral antibiotic courses.”
The findings are based on US insurance claims data from which the researchers identified 601,848 children (58% male) aged 0–11 years (median 2 years) who underwent TT insertion between 2007 and 2021. Of these, 201,932 children who simultaneously underwent adenoidectomy without tonsillectomy at the time of TT insertion (Ad+TT) were matched by sex, age, and the number of prior TT procedures to an equal number of children who received TTs without adenoidectomy.
As reported in JAMA Otolaryngology Head & Neck Surgery, 16.0% of children who underwent Ad+TT and 14.5% of those who underwent TT-only received repeat TT insertions. The median number of oral antibiotic prescriptions received after the procedure was 0 and 1, respectively.
When Qian and team accounted for covariates associated with otitis media, namely atopic dermatitis, environmental allergies, gastro-esophageal reflux, obstructive sleep apnea, cleft palate, and trisomy 21, they found that the odds for repeat TT insertions in children aged 4 years or older were a significant 22% lower with Ad+TT than with TT alone.
Conversely, the likelihood of repeat TT insertions was a significant 24% higher with Ad+TT than with TT alone in children younger than 4 years old.
The odds for oral antibiotic prescriptions following the procedure were a significant 37% lower with Ad+TT versus TT in children aged 4 years or older and a significant 41% lower in younger children.
The fact that Ad+TT reduced the incidence of subsequent oral antibiotics but not repeat TT insertions in the younger cohort may indicate “that Ad+TT is beneficial for preventing subsequent recurrent acute otitis media but not otitis media with effusion in children younger than 4 years,” Qian et al remark.
They note, however, that “inconsistent use of specific diagnosis codes across institutions precludes recurrent acute otitis media and otitis media with effusion from being distinguished in this database.”
The authors conclude that their findings “provide further data that support Ad+TT in children, particularly those aged 4 years or older.”
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JAMA Otolaryngol Head Neck Surg 2024 doi:10.1001/jamaoto.2024.3584
