Ann Otol 88 :1979
ADENOIDS AND OTITIS MEDIA WITH EFFUSION ]ORMA RUOKONEN,
MD
KARIN SANDELIN, PhD
]UDIT
MAKINEN, MD
HELSINKI, FINLAND
At adenoidectomy specimens for bacteriological, virological, and histological investigation were obtained from the adenoids of 144 children, 53 of whom suffered from otitis media with effusion, or frequently recurring otitis media. Comparison of findings in the children with ear diseases with those obtained in the rest of the material showed that Hemophilus influenza was cultured from 50% of the specimens from the children with ear diseases, while only 14% of the cultures from the other children yielded H. influenza. Virus isolates were made from 17 adenoids. In children with ear diseases a virus was isolated from 28% of the specimens, whereas positive isolates were obtained in only 3% of the rest of the specimens. Both findings are statistically significant and support the view that the adenoid tissue may play an important role in the etiology of otitis media with effusion. The infected adenoid may be the direct source of the primary infections, or continuous microbial irritation in the nasopharynx may indirectly be the cause of otitis media with effusion, as persistent infection and edema maintain chronic dysfunction of the eustachian tube. Thus adenoidectomy may be beneficial in the treatment of frequently recurring otitis media, preventing otitis media with effusion from developing.
In 1973 an ad hoc committee was formed, the aim being to define "the state of the art" of tonsillectomy (TE) and adenoidectomy and to arrive at a consensus on management. Nine members of the committee prepared a report' on current problems which were discussed at a workshop on tonsillectomy and adenoidectomy arranged in 1974. When examining the available information on the diseases of the adenoids and the tonsils the committee found that one of the main problems concerning adenoidectomy was inadequate knowledge of microbiological eriteria for the diagnosis of adenoiditis and of the pathogenesis and pathophysiology of the diseases of the adenoids. As long as these problems remain unsolved it is obvious that there will be differences of opinion as to the value of including adenoidectomy in the treatment of diseases associated with adenoid in fection, eg, otitis me d ia wit h ef fusion (OME). Despite an immense number of publications on this subject there are only a few controlled studies on the effects of adenoidectomy or adenotonsillectomy (TEA) on middle ear diseases. In 1930 Kaiser- noticed in a series of 2,200 cases (and 2,200 controls) that the incidence of purulent otitis media decreased after TEA. McKee 3 , 4 reported in 1963 that
there was a decrease of 48% in incidence of otitis media in children undergoing TEA, or adenoidectomy only, as compared with children not operated on. These results led him to conclude that it was the adenoidectomy part of the combined operation which was responsible for the good results. In 1967 Mawson et al," on the other hand, did not record any significant difference between operated (TEA) and unoperated patients in the occurrence of otitis media. In Roydhouse's" experience the incidence of otitis media decreased during the first year following TEA, and during the second postoperative year the attacks of otitis media were less severe. The experimental design of all these studies had many limitations mentioned in the report by the ad hoc committee. There are only a few studies on the results of adenoidectomy in the treatment of children suffering from recurrent otitis media or OME. Cottschalk? performed myringotomy in 311 ears at the same time as adenoidectomy, finding mucoid exudate in 164 and serous exudate in 94 ears. As a result of this treatment 97.6% of the ears with mucoid and 95.7% of the ears with serous otitis media were free from effusion one month after the operation. One year later otitis media had not recurred in 68% of the ears. Bluestone" suggested
166
ADENOIDS AND O.M.E. TABLE 1. PATIENTS' AGE DISTRIBUTION
167
with catheters so as to obtain a direct view into the nasopharynx which was washed with physiological saline. Specimens were taken Age Group Group (yr) Total from each patient for bacteriological, virologiB A cal and histological investigations. In order to obtain specimens for bacteriological and viro0 5 5
ADENOIDS AND OTITIS MEDIA WITH EFFUSION ]ORMA RUOKONEN,
MD
KARIN SANDELIN, PhD
]UDIT
MAKINEN, MD
HELSINKI, FINLAND
At adenoidectomy specimens for bacteriological, virological, and histological investigation were obtained from the adenoids of 144 children, 53 of whom suffered from otitis media with effusion, or frequently recurring otitis media. Comparison of findings in the children with ear diseases with those obtained in the rest of the material showed that Hemophilus influenza was cultured from 50% of the specimens from the children with ear diseases, while only 14% of the cultures from the other children yielded H. influenza. Virus isolates were made from 17 adenoids. In children with ear diseases a virus was isolated from 28% of the specimens, whereas positive isolates were obtained in only 3% of the rest of the specimens. Both findings are statistically significant and support the view that the adenoid tissue may play an important role in the etiology of otitis media with effusion. The infected adenoid may be the direct source of the primary infections, or continuous microbial irritation in the nasopharynx may indirectly be the cause of otitis media with effusion, as persistent infection and edema maintain chronic dysfunction of the eustachian tube. Thus adenoidectomy may be beneficial in the treatment of frequently recurring otitis media, preventing otitis media with effusion from developing.
In 1973 an ad hoc committee was formed, the aim being to define "the state of the art" of tonsillectomy (TE) and adenoidectomy and to arrive at a consensus on management. Nine members of the committee prepared a report' on current problems which were discussed at a workshop on tonsillectomy and adenoidectomy arranged in 1974. When examining the available information on the diseases of the adenoids and the tonsils the committee found that one of the main problems concerning adenoidectomy was inadequate knowledge of microbiological eriteria for the diagnosis of adenoiditis and of the pathogenesis and pathophysiology of the diseases of the adenoids. As long as these problems remain unsolved it is obvious that there will be differences of opinion as to the value of including adenoidectomy in the treatment of diseases associated with adenoid in fection, eg, otitis me d ia wit h ef fusion (OME). Despite an immense number of publications on this subject there are only a few controlled studies on the effects of adenoidectomy or adenotonsillectomy (TEA) on middle ear diseases. In 1930 Kaiser- noticed in a series of 2,200 cases (and 2,200 controls) that the incidence of purulent otitis media decreased after TEA. McKee 3 , 4 reported in 1963 that
there was a decrease of 48% in incidence of otitis media in children undergoing TEA, or adenoidectomy only, as compared with children not operated on. These results led him to conclude that it was the adenoidectomy part of the combined operation which was responsible for the good results. In 1967 Mawson et al," on the other hand, did not record any significant difference between operated (TEA) and unoperated patients in the occurrence of otitis media. In Roydhouse's" experience the incidence of otitis media decreased during the first year following TEA, and during the second postoperative year the attacks of otitis media were less severe. The experimental design of all these studies had many limitations mentioned in the report by the ad hoc committee. There are only a few studies on the results of adenoidectomy in the treatment of children suffering from recurrent otitis media or OME. Cottschalk? performed myringotomy in 311 ears at the same time as adenoidectomy, finding mucoid exudate in 164 and serous exudate in 94 ears. As a result of this treatment 97.6% of the ears with mucoid and 95.7% of the ears with serous otitis media were free from effusion one month after the operation. One year later otitis media had not recurred in 68% of the ears. Bluestone" suggested
166
ADENOIDS AND O.M.E. TABLE 1. PATIENTS' AGE DISTRIBUTION
167
with catheters so as to obtain a direct view into the nasopharynx which was washed with physiological saline. Specimens were taken Age Group Group (yr) Total from each patient for bacteriological, virologiB A cal and histological investigations. In order to obtain specimens for bacteriological and viro0 5 5
