Efficacy Of Adenoidectomy In Comprehensive Treatment Of Otitis Media With Effusion And Adenoid Hypertrophy In Children?A Systematic Review

Objective: The study aims to assess the difference of postoperative efficacy between tympanic membrane operations combined with or without adenoidectomy in children with otitis media with effusion(OME)and adenoid hypertrophic by means of systematic evaluation.To analyze the efficacy of adenoidectomy in comprehensive treatment of children combined OME with adenoid hypertrophic.Methods: Electronic searched included CBM,CKNI,VIP,Wan Fang,Pub Med,Wiley,EBSCO and Ovid database with a cut-off date on December 31,2017.Hand searched three domestic related magazines.The patients had to be diagnosed as secretory otitis media with adenoid hypertrophy and their age range 0 year old from14 years old.The study type was the randomized controlled trial.Intervention was adenoidectomy.The follow-up time was more than six months.The primary outcome studied was the efficient and the time of removing middle ear effusion.Secondary outcomes were degree of hearing improvement,postoperative recurrence and infection.Two researchers evaluated the quality of the trials and extracted the data independently.Sixty 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 Man5.3.For dichotomous outcomes,we compare outcome measures using the relative ratio(RR)with 95% confidence intervals(CI).For continuous outcomes,the means difference(MD)with 95% confidence intervals(CI)was used.If meta-analysis cannot be done,qualitative descriptions were made.Results: At 3-6 months and 12 months postoperatively,adenoidectomy with tympanic tube for the treatment of OME with adenoid hypertrophy was more effective than tympanic tube.The difference was significant [RR=1.22,95%CI(1.11,1.34),P<0.001;RR=1.25,95%CI(1.13,1.39),P<0.001].The clearance time of middle ear effusion will be shortened by 2.45 days.The difference was significant [95%CI(1.92,2.97),P<0.001],Postoperative infection rate will be lower.The difference was significant [RR=0.30,95%CI(0.19,0.46),P<0.001].Postoperative recurrence rate will be lower.The difference was significant [RR=0.42,95%CI(0.33,0.54),P<0.001].However,there is no difference in improvement of hearing loss(P=0.08).Conclusion: The study shows a significant benefit of adenoidectomy as far as the resolution of middle ear effusion,postoperative recurrence and infection in children with OME is concerned.However,there is no benefit to hearing.The risks of operating should be weighed against these potential benefits.