Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss
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Objectives. Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. Methods. This prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. Results. There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Conclusion. Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.
Abstract
Objectives. Surgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis. Methods. This prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively. Results. There were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01). Conclusion. Although both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.
참고문헌 (30)
- Tos M, "Epidemiology and natural history of secretory otitis", Am J Otol, 5(6), pp.459~462 (1984)
- Casselbrant ML., "Evidence-based otitis media", pp.147~162 (2003), BC Decker
- Rosenfeld RM., "Natural history of untreated otitis media", Laryngoscope, 113(10), pp.1645~1657 (2003)
- R. M. Rosenfeld, "Clinical Practice Guideline: Tympanostomy Tubes in Children", Otolaryngology -- Head and Neck Surgery, 149(1 Suppl), pp.S1~S35 (2013), SAGE Publications[DOI]
- Paradise JL., "Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials", JAMA, 263, pp.2066~2073 (1990)
- Torretta S., "Topographic distribution of biofilm-producing bacteria in adenoid subsites of children with chronic or recurrent middle ear infections", Ann Otol Rhinol Laryngol, 122(2), pp.109~113 (2013)
- "Guidelines for manual pure-tone threshold audiometry"[URL]
- Cassano P., "Adenoid tissue rhinopharyngeal obstruction grading based on fiberendoscopic findings : a novel approach to therapeutic management", Int J Pediatr Otorhinolaryngol, 67(12), pp.1303~1309 (2003)
- Marseglia GL., "Role of adenoids and adenoiditis in children with allergy and otitis media", Curr Allergy Asthma Rep, 9(6), pp.460~464 (2009)
- Onusko E, "Tympanometry", Am Fam Physician, 70(9), pp.1713~1720 (2004)
- Torretta S., "Nasopharyngeal fiberendoscopy in children : a diagnostic challenge in current clinical practice : how we do it", Int J Pediatr Otorhinolaryngol, 77(5), pp.747~751 (2013)
- Browning GG., "Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children", Cochrane Database Syst Rev, (10), pp.CD001801~ (2010)
- Feng Y., "Comparison of the powered-assisted adenoidectomy with adenoid curette adenoidectomy", Lin Chuang Er Bi Yan Hou Ke Za Zhi, 20(2), pp.54~57 (2006)
- Bross-Soriano D., "Endoscopic adenoidectomy;use or abuse of the technology?", Cir Cir, 72(1), pp.15~19 (2004)
- van den Aardweg MT., "Adenoidectomy for otitis media in children", Cochrane Database Syst Rev, (1), pp.CD007810~ (2010)
- Robb PJ., "Otitis media with effusion in children : current management", Paediatr Child Health (Oxford), 22(1), pp.9~12 (2012)
- MRC Multicentre Otitis Media Study Group, "Adjuvant adenoidectomy in persistent bilateral otitis media with effusion : hearing and revision surgery outcomes through 2 years in the TARGET randomised trial", Clin Otolaryngol, 37(2), pp.107~116 (2012)
- "Appropriateness and safety of tonsillectomy and/or adenoidectomy. Italian guidelines" (2008)[URL]
- Boonacker CW., "Adenoidectomy with or without grommets for children with otitis media : an individual patient data meta-analysis", Health Technol Assess, 18(5), pp.1~118 (2014)
- Kujala T., "Tympanostomy with and without adenoidectomy for the prevention of recurrences of acute otitis media : a randomized controlled trial", Pediatr Infect Dis J, 31(6), pp.565~569 (2012)
- Wallace IF., "Surgical treatments for otitis media with effusion : a systematic review", Pediatrics, 133(2), pp.296~311 (2014)
- "Otitis media with effusion: comparative effectiveness of treatments" (2013)[URL]
- Saxby AJ., "Residual adenoid tissue post-curettage : role of nasopharyngoscopy in adenoidectomy", ANZ J Surg, 79(11), pp.809~811 (2009)
- Songu M., "Endoscopic-assisted versus curettage adenoidectomy : a prospective, randomized, double-blind study with objective outcome measures", Laryngoscope, 120(9), pp.1895~1899 (2010)
- Havas T., "Obstructive adenoid tissue : an indication for powered-shaver adenoidectomy", Arch Otolaryngol Head Neck Surg, 128(7), pp.789~791 (2002)
- Ark N., "Comparison of adenoidectomy methods: examining with digital palpation vs. visualizing the placement of the curette", Int J Pediatr Otorhinolaryngol, 74(6), pp.649~651 (2010)
- Rapola S., "Comparison of four different sampling methods for detecting pharyngeal carriage of Streptococcus pneumoniae and Haemophilus influenzae in children", J Clin Microbiol, 35(5), pp.1077~1079 (1997)
- Mattila PS., "Adenoidectomy and nasopharyngeal carriage of Streptococcus pneumoniae in young children", Arch Dis Child, 95(9), pp.696~702 (2010)
- Hall-Stoodley L., "Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media", JAMA, 296(2), pp.202~211 (2006)
- Saylam G., "Association of adenoid surface biofilm formation and chronic otitis media with effusion", Arch Otolaryngol Head Neck Surg, 136(6), pp.550~555 (2010)