Adenoidectomy with tympanostomy or with myringotomy alone: A systematic review of pediatric randomized controlled trials.

BACKGROUND

Otitis media with effusion (OME) is a leading cause of acquired conductive hearing loss in children. When performing an adenoidectomy for OME, surgeons must decide whether to supplement the procedure with a simple myringotomy or a myringotomy with tympanostomy tube (TT) insertion. While TT offers extended middle ear ventilation, it carries a risk of long-term complications. This systematic review of randomized controlled trials (RCTs) aimed to compare the efficacy and safety of these two approaches.

METHODS

A comprehensive search of PubMed, Scopus, CENTRAL, and Web of Science was conducted for RCTs up to August 2025. Eligible RCTs were assessed for quality using the risk of bias (RoB)-2 tool. The primary outcomes were hearing improvement and resolution of effusion. Secondary outcomes included OME recurrence and postoperative complications.

RESULTS

Eleven RCTs involving 955 pediatric patients were included. The addition of TT consistently resulted in superior short-term outcomes, with significantly better hearing levels and faster resolution of middle ear effusion within the first 3-6 months. However, these advantages were not sustained, and no significant differences in hearing or effusion rates were observed at 12-month follow-ups. In contrast, the TT group experienced a significantly higher incidence of long-term complications, including otorrhea, tympanosclerosis, and persistent tympanic membrane perforation.

CONCLUSION

Adding a TT to adenoidectomy provides a transient benefit in hearing and effusion resolution but significantly increases the risk of long-term tympanic membrane complications. Adenoidectomy with myringotomy alone appears to be a safer and equally effective long-term strategy for managing pediatric OME.