The Systematic Review Of Adenoidectomy In The Treatment Of Otitis Media With Effusion In Children

Object:Otitis media with effusion is a disease, which defined middle ear effusion and hearing loss as the main clinical manifestations, without ear acute infection symptoms and signs. The incidence of OME in children is relatively high.OME is one of the important causes of hearing loss in children. The main treatments of OME include observation, drug therapy, tympanic membrane puncture, myringotomy,ventilation tube etal. Resently, more researches reported that OME has been associated with adenoid hypertrophy and adenoiditis. Adenoidectomy is also used for treating OME in children. But, at present the efficacy and security of adenoidectomy still need further research. There were some randomized controlled clinical trials about adenoidectomy therapy published, but the results are not consistent and even contradictory. Hence, systematic reviews and meta-analyses involving all published randomized clinical trials which were relevant with adenoidectomy therapy are conducted to assess the efficacy and security of adenoidectomy for OME in children.Methods:This meta-analysis was followed the widely accepted methodological recommendations. Randomized clinical trials were identified through systematic searches. Electronic search included Pub Med, Medline,Elisevier,Ovid, CBM,CKNI,VIP and Wanfang database with a cut-off date in December 2013. The patients had to be diagnosed as OME and their age range 1 year old from 15 years old.Intervention was adenoidectomy. The outcome measures of efficacy include the improvement of hearing level, the proportion of existence time of middle ear effusion,the episode frequency of otitis media, and the outcome measures of safety include complication rates. Twelve randomized clinical trials were included in the systematic reviews. Methodological quality was evaluated using the Cochrane bias risk assessment tools. For the meta- analysis, outcome measures were assessed by Rev Man software version 5.2. For dichotomous outcomes, we compare outcome measures using the odds ratio(OR) with 95%confidence intervals(CI). For continuous outcomes, the means difference(MD) with 95 % confidence intervals(CI) was used.After heterogeneity test,date without heterogeneity could be using fixed effect model.Those with heterogeneity could be using randomized effect model estimated.If meta- analysis can’t be done, qualitative descriptions were made.ResultsAdenoidectomy or combined with myringotomy in improving hearing level and removing the middle ear effusion were superior to observation or myringotomy.Adenoidectomy combined with ventilation tube in improving hearing level and in the removal of the middle ear effusion were superior to ventilation tube. For OME patients younger than 2 years old, adenoidectomy combined with ventilation tube in reducing the time of middle ear effusion exsit and frequency of otitis media episodes were not better than ventilation tube.Conclusion:Our review shows a significant benefit of adenoidectomy. Combined with adenoidectomy in the treatment of OME has clinical significance. For OME patients younger than 2 years,adenoidectomy is not recommended. Adenoidectomy is safe,and postoperative hemorrhage is a common complication.