our son has had three sets of tubes and our doctor is recommending another set and adenoid surgery. We feel strongly that when operating the risk should be weighed against the possible benefit. We have had an x-ray which indicates that the adenoids are not enlarged. The doctor has indicated that this does not mean the adenoids are not a problem. After his last set of tubes became non-functional he went for a year with very little problem until this March, since then he has had four ear infections. We are suspicous that allergies may be playing a role in his problem, but he does not seem to have any other symptons. Would you recommend that adenoid surgery be performed or could a new set of tubes be inserted and see if he grows out of the problem. Thank you for this forum and any help you can provide.
Answer -------------------
There is substantial evidence provided in recent medical literature supporting adenoid removal in the treatment of chronic otitis media in children over the age of 4. The rationale for adenoidectomy in this group is the probability that chronic ear infections may not only be related to inherent eustachian tube immaturity or other dysfunction, but may also be related to reflux of bacteria which have colonized the adenoid bed, sometimes referred to as "adenoid vegetation." Furthermore, the evidence supports the removal of adenoids in this age group, who have met appropriate surgical criteria, REGARDLESS of the actual size of the adenoid bed. A common misconception is that adenoidectomy in the treatment of otitis media is performed to relieve anatomical obstruction. While actual eustachian tube obstruction may occur with particularly large adenoid growth (which would also be associated with chronic nasal airway blockage), this is felt to be a relatively uncommon phenomena.
Keep in mind that we are speaking of young patients who have met criteria for surgical intervention in the treatment of chronic otitis media. Typically, this refers to children who have had documented fluid in both of their middle ears in excess of 3 continuous months despite at least one course of antibiotic therapy, or children who have recurrent acute ear infections and have failed prophylactic antibiotic therapy. Of course proper comprehensive management of this group of patients also requires attention to risk factors such as day care, cigarette smoke exposure, allergy, etc.
The current age criteria for adenoidectomy in the treatment of chronic otitis media simply reflects the age group that has been studied and in whom benefit has been demonstrated. Many feel that it is likely that some patients younger than 4 years of age may also benefit from adenoidectomy particularly if they continue to have chronic ear problems despite previous tympanostomy tube placement, however, further study is required to verify this.
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Steve Dankle, MD
Otolaryngology-Head and Neck Surgery
Milwaukee, Wis
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