Adenoidectomy in Children with Otitis media with effusion.

A recent randomised controlled trial in UK, MRC multicentre Otitis Media Group (2012) has shown that adenoidectomy leads to longer term hearing benefits than grommets alone.
-In the no-treatment group over a 2 year period  only one in five of the children had complete remission.
-The tympanostomy tube group nearly all returned to near normal hearing levels in the short term.
-But adjuvent adenoidectomy provided a prolonged advantage by preventing recurrence of OME after extrusion in one in four children.

Of course a study like this still doesn't have all the answers.

• The question is would all children benefit from adenoidectomy with grommet insertion. 
• Does the size of the adenoids matter or the history of UTIs. 
• One has to weigh up the risks of adenoidectomy. 
• Would just putting in longer lasting grommets be the option in-spite of the probable  higher drum damage from larger grommets. 
• The availability of resources may be the main obstacle to adjuvant adenoidectomy as a first-line intervetion.

In Northland we tend to do an Adenoidectomy on all children who are booked for their second lot of grommets as well as children with significant nasal symptoms with their first set of grommets. Resources are certainly a factor though.