van den Aardweg Maaike Ta, Schilder Anne Gm, Herkert Ellen, Boonacker Chantal Wb, Rovers Maroeska M
Department of Otorhinolaryngology, University Medical Center Utrecht, Wilhelmina Children's Hospital, HP: KE.04.140.5, PO Box 85090, Utrecht, Netherlands, 3508 AB.
Cochrane Database Syst Rev. 2010 Jan 20(1):CD007810. doi: 10.1002/14651858.CD007810.pub2.
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.
To assess the effectiveness of adenoidectomy versus non-surgical management or tympanostomy tubes in children with otitis media.
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CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; mRCT and additional sources for published and unpublished trials.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.
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.
Two authors assessed trial quality and extracted data independently.
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.
腺样体切除术，即手术切除腺样体，是全球范围内针对患有中耳炎的儿童进行的常见耳鼻喉科手术。此前尚未对腺样体切除术在这一特定群体中的有效性进行系统评价。
评估腺样体切除术与非手术治疗或鼓膜置管术相比，对患有中耳炎的儿童的有效性。
我们检索了Cochrane耳鼻喉疾病组试验注册库；Cochrane对照试验中央注册库（CENTRAL）；PubMed；EMBASE；CINAHL；科学网；BIOSIS预评文摘；剑桥科学文摘；mRCT以及已发表和未发表试验的其他来源。最近一次检索日期为2009年3月30日。
随机对照试验，比较腺样体切除术（伴或不伴鼓膜置管术）与仅针对患有中耳炎的儿童的非手术治疗或仅鼓膜置管术。研究的主要结局是中耳积液（OME）的时间比例。次要结局包括发作的平均次数、每次发作和每年的平均天数、患有急性中耳炎（AOM）或中耳积液（OME）的儿童比例，以及平均听力水平。三级结局指标包括鼓膜萎缩、鼓室硬化、紧张部和松弛部回缩以及胆脂瘤。
两位作者独立评估试验质量并提取数据。
对14项研究腺样体切除术对患有中耳炎儿童有效性的随机对照试验（2712名儿童）进行了评估。这些试验大多异质性过大，无法纳入荟萃分析。两年后的失访率从0%到63%不等。与仅单侧鼓膜置管术相比，腺样体切除术联合单侧鼓膜置管术对中耳积液的消退有有益影响（非手术耳在6个月和12个月时的风险差（RD）分别为22%（95%CI 12%至32%）和29%（95%CI 19%至39%）（n = 3项试验）），对听力有非常小（<5 dB）的影响。腺样体切除术伴或不伴鼓膜切开术与仅非手术治疗或仅鼓膜切开术的研究结果，以及腺样体切除术联合双侧鼓膜置管术与仅双侧鼓膜置管术的研究结果，也显示腺样体切除术对积液消退有小的有益影响。由于试验的异质性过大，后一组结果无法合并。关于急性中耳炎，包括该结局的试验结果均未表明腺样体切除术有显著的有益效果。这些试验异质性过大，无法纳入荟萃分析。腺样体切除术对鼓膜变化或胆脂瘤的影响尚未研究。
我们的综述表明，就患有中耳积液的儿童的中耳积液消退而言，腺样体切除术有显著益处。然而，对听力的益处较小，对鼓膜变化的影响尚不清楚。手术风险应与这些潜在益处相权衡。腺样体切除术对急性中耳炎无显著益处，这表明针对该适应症的常规手术并无必要。
