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April 12, 2000

Adenoidectomy and Adenotonsillectomy for Recurrent Otitis Media

Author Affiliations

Phil B.FontanarosaMD, Deputy EditorIndividualAuthorStephen J.LurieMD, PhD, Fishbein FellowIndividualAuthor

JAMA. 2000;283(14):1822-1824. doi:10.1001/jama.283.14.1821

To the Editor: Dr Paradise and colleagues1 describe an effective way to reduce the incidence of recurrent acute otitis media (AOM) by more than 50%: be patient. Children entering their study initially had 4 or more annual AOM episodes, yet averaged 2.1 episodes during their first year as nonsurgical controls. Furthermore, only about one third remained susceptible to otitis (at least 3 annual episodes) and more than 20% had no AOM. Similarly, control groups in antimicrobial prophylaxis trials have a favorable prognosis. Children randomized to placebo in 13 randomized studies averaged 1.6 annual AOM episodes, a decrease from baseline of about 2.0 episodes per year.2 During a median period of 6 months only 13% had 3 or more AOM episodes and 51% had no further AOM.

These findings suggest a favorable prognosis for most children with recurrent AOM, provided that the patients do not have prior tympanostomy tubes or any of the usual criteria for exclusion from randomized trials (eg, immune deficiency, craniofacial anomalies, and Down or other syndromes). The term prognosis is preferred to natural history, because all children in the above studies received timely antimicrobial therapy for individual AOM episodes. Nonetheless, most children with recurrent AOM can expect marked improvement in the following year. The most likely explanations are continued growth of the child's immune system and a gradual improvement in eustachian tube function.

I would be appreciative if Paradise et al could provide additional data on control group outcomes in their study, stratified by age and middle-ear effusion (MEE). Did preschoolers (about 35% of the control groups) have a poorer prognosis than older children? Did children with persistent MEE at entry (about 11% of the control groups) have worse outcomes than those with recurrent AOM only? How does a history of a prior tympanostomy tube alter prognosis based on data from their earlier investigation?3

Paradise  JLBluestone  CDColborn  DK  et al.  Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes.  JAMA. 1999;282:945-953.Google Scholar
Rosenfeld  RM Natural history of untreated otitis media. In: Rosenfeld RM, Bluestone CD, eds. Evidence Based Otitis Media. Hamilton, Ontario: Decker Inc; 1999:157-178.
Paradise  JLBluestone  CDRogers  KD  et al.  Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement: results of parallel randomized and nonrandomized trials.  JAMA. 1990;263:2066-2073.Google Scholar