Surgery of the tonsils and adenoids in relation to secretory otitis media in children.

One hundred and fifty children aged between 2 and 9 years with bilateral SOM were allocated at random to three groups: Adeno-tonsillectomy (47 cases), adenoidectomy (47 cases) and neither procedure (53 cases). A further 42 children were allocated to either adenoidectomy or no surgery. In all only one ear was treated at random by myringotomy and insertion of a ventilation tube. The unoperated ear was examined six weeks, six months, nine months, one, two and three years post-operatively for otoscopic clearance of the effusion, impedance change and improvement in mean hearing threshold. Thus the effects on middle ear status of adenoidectomy alone and in combination with tonsillectomy were assessed. There was a significant clearance of middle ear fluid, change from no peak to peak impedance measurement and hearing gain as a result of both procedures with a late trend favouring the combined operation. Neither pre-operative tonsils size nor the number of attacks of tonsillitis affect outcome. However there is a relationship between age and radiographic post-nasal space airway size with clearance of the effusion one year after surgery. These findings permit recommendation for adenoidectomy with improved expectation for resolution of SOM if cases are selected with reference to these two variables. They also suggest in which cases the operation should not be recommended. Despite the trends in outcome favouring combined operations, the extra morbidity associated with the addition of tonsillectomy does not at present justify recommendation for removal of the tonsils in addition to adenoidectomy for cases with SOM. Tonsillectomy in these children should be assessed on grounds of tonsillar pathology per se and not on the status of the middle ear.