Paradise J L, Bluestone C D, Rogers K D, Taylor F H
Ann Otol Rhinol Laryngol Suppl. 1980 May-Jun;89(3 Pt 2):319-21. doi: 10.1177/00034894800890s375.
Adenoidectomy is well established as a procedure for treating children with recurrent or persistent otitis media. Many physicians also believe that when adenoidectomy is undertaken for otitis media, tonsillectomy also should be done routinely. Thus otitis media serves as the justification for a substantial proportion of the tonsil and adenoid operations carried out on children. Nonetheless, evidence supporting the efficacy of adenoidectomy, or tonsillectomy and adenoidectomy (T&A), for otitis media is scant and inconclusive. Only six prospective studies have been reported, and in all but two of them, the combination of adenoidectomy with tonsillectomy, rather than adenoidectomy alone, was tested. The results were contradictory, perhaps because of all the studies contained flaws in design or methodology or both. Whether adenoidectomy or T&A are efficacious remains entirely uncertain. We are attempting to address the question currently in a prospective study in which children considered at high risk for otitis media are entered into a randomized, controlled clinical trial of adenoidectomy. The trial is complicated by the need to take adequate account of subject variables such as age, sex, adenoid size, and the presence or absence of allergy, and of the important treatment variables of concomitant myringotomy with tympanostomy tube insertion. Outcome measurements employed in the trial include the number of episodes per year of acute otitis media, the persistence of middle ear effusion, and the frequency of subsequent myringotomy. Data thus far collected in the study are not sufficient to reach a conclusion for or against the efficacy of adenoidectomy for otitis media, but it is apparent that adenoidectomy by no means eliminates the problem.
腺样体切除术作为治疗复发性或持续性中耳炎患儿的一种手术方法已得到广泛认可。许多医生还认为，当因中耳炎进行腺样体切除术时，也应常规进行扁桃体切除术。因此，中耳炎成为了对儿童进行大量扁桃体和腺样体手术的理由。尽管如此，支持腺样体切除术或扁桃体切除术加腺样体切除术（T&A）治疗中耳炎疗效的证据却很少且尚无定论。仅报道了六项前瞻性研究，除两项研究外，其他研究均测试了腺样体切除术与扁桃体切除术联合进行，而非单独进行腺样体切除术。结果相互矛盾，这可能是因为所有研究在设计或方法或两者方面都存在缺陷。腺样体切除术或T&A是否有效仍然完全不确定。我们目前正在一项前瞻性研究中试图解决这个问题，在该研究中，将被认为有中耳炎高风险的儿童纳入腺样体切除术的随机对照临床试验。该试验因需要充分考虑年龄、性别、腺样体大小以及是否存在过敏等受试者变量，以及同时进行鼓膜切开术加鼓膜置管术这一重要治疗变量而变得复杂。该试验采用的结果测量指标包括每年急性中耳炎发作的次数、中耳积液的持续时间以及后续鼓膜切开术的频率。迄今为止，该研究收集的数据不足以得出支持或反对腺样体切除术治疗中耳炎疗效的结论，但很明显，腺样体切除术绝不能消除这个问题。
