American journal of otolaryngology · 2026
Does an adenoidectomy with a second set of tympanostomy tubes reduce subsequent tube placements?
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Saltsgaver Megan B, Weis Amanda, Zhan Weihai, Thambi Rakhi
Аннотация
OBJECTIVE: Tympanostomy tube (TT) placement is a common surgical intervention for children with recurrent otitis media or middle ear effusions. While most patients benefit from a single procedure, some require multiple tube placements, increasing anesthesia exposure and procedural risk. The role of an adenoidectomy performed at the time of second TT placement in reducing the need for a third set of tubes remains unclear.
METHODS: This retrospective cohort study included 208 pediatric patients aged 1-17 years who underwent at least two TT placements at a single academic institution between 2014 and 2024. Patients were stratified according to whether adenoidectomy or adenotonsillectomy was performed at the time of second TT placement. The primary outcome was third tympanostomy tube placement following the second procedure. Statistical analyses included chi-square testing and estimation of risk ratios with 95% confidence intervals.
RESULTS: Among 207 eligible patients, 52 of 148 (35.1%) patients without adenoidectomy, 12 of 40 (30.0%) with adenoidectomy, and 6 of 19 (31.6%) with adenotonsillectomy required a third TT (P = 0.81). The combined adenoid surgery group had a similar rate of third TT placement compared with no surgery (18 of 59 (30.5%) vs 52 of 148 (35.1%); RR 0.87, 95% CI 0.56-1.35; P = 0.53). Adenoid obstruction was not associated with recurrence (P = 0.18). In an exploratory post hoc subgroup analysis restricted to children who underwent adenoidectomy at the time of second TT placement, 19 of 40 (47.5%) children aged ≤4 years subsequently underwent a third TT placement compared with 10 of 37 (27.0%) children aged >4 years (P = 0.01).
CONCLUSIONS: Adenoidectomy or adenotonsillectomy performed with the second TT placement was not significantly associated with reduced risk of third TT placement. An exploratory post hoc subgroup analysis suggested higher rates of third TT placement among younger children undergoing adenoidectomy; however, these findings should be interpreted cautiously and require confirmation in larger prospective studies. Given the retrospective design and limited sample size, these findings should not be considered definitive evidence for or against adenoidectomy at the time of an additional tympanostomy tube placement.
METHODS: This retrospective cohort study included 208 pediatric patients aged 1-17 years who underwent at least two TT placements at a single academic institution between 2014 and 2024. Patients were stratified according to whether adenoidectomy or adenotonsillectomy was performed at the time of second TT placement. The primary outcome was third tympanostomy tube placement following the second procedure. Statistical analyses included chi-square testing and estimation of risk ratios with 95% confidence intervals.
RESULTS: Among 207 eligible patients, 52 of 148 (35.1%) patients without adenoidectomy, 12 of 40 (30.0%) with adenoidectomy, and 6 of 19 (31.6%) with adenotonsillectomy required a third TT (P = 0.81). The combined adenoid surgery group had a similar rate of third TT placement compared with no surgery (18 of 59 (30.5%) vs 52 of 148 (35.1%); RR 0.87, 95% CI 0.56-1.35; P = 0.53). Adenoid obstruction was not associated with recurrence (P = 0.18). In an exploratory post hoc subgroup analysis restricted to children who underwent adenoidectomy at the time of second TT placement, 19 of 40 (47.5%) children aged ≤4 years subsequently underwent a third TT placement compared with 10 of 37 (27.0%) children aged >4 years (P = 0.01).
CONCLUSIONS: Adenoidectomy or adenotonsillectomy performed with the second TT placement was not significantly associated with reduced risk of third TT placement. An exploratory post hoc subgroup analysis suggested higher rates of third TT placement among younger children undergoing adenoidectomy; however, these findings should be interpreted cautiously and require confirmation in larger prospective studies. Given the retrospective design and limited sample size, these findings should not be considered definitive evidence for or against adenoidectomy at the time of an additional tympanostomy tube placement.