Adenoidectomy has been demonstrated in randomized controlled studies to be effective in the prevention of
otitis media with effusion (OME). Despite an apparent lack of correlation between adenoid size and outcome, it has been suggested that the role of adenoid tissue in the pathophysiology of OME relates either to obstruction of the Eustachian tube (ET) with impairment of its function, or to adenoid tissue serving as a reservoir of
infection. The aim of this study was to further delineate the relationship between adenoid
hypertrophy and OME. This prospective survey was performed in an
ambulatory care setting of a tertiary care pediatric hospital, where data was collected on 273 consecutive
adenoidectomy patients. At the time of surgery, adenoid position in relation to the ET orifice was recorded as well as concurrent procedures performed (e.g. pressure equalization tubes; PET). Sixty percent of patients undergoing simultaneous PET insertion were found to have laterally hypertrophic adenoid tissue encroaching upon the ET orifice versus only 22% for those undergoing
adenoidectomy alone. Thus, a strong correlation was found to exist between OME, requiring the placement of PET and lateral adenoids abutting the torus tubarius (chi2 = 39.12; P < 0.001). The clinical relevance of this finding is that it may allow the prediction of children with OME, who will benefit most from undergoing
adenoidectomy. Patients with OME requiring PET insertion, who are found to have lateral adenoid
hypertrophy encroaching upon the ET orifice, could be selected for
adenoidectomy, thus allowing a more judicious application of this
surgical procedure in the setting of OME.