Otitis media with effusion (OME) is a condition characterized by the accumulation of non-purulent fluid in the middle ear without signs of acute infection. It is commonly encountered in the pediatric population and is particularly prevalent in children aged between 2 and 7 years, often associated with upper respiratory tract infections and adenotonsillar hypertrophy [1]. Persistent OME can lead to significant hearing loss, speech delays, and academic difficulties if left untreated [2].

Adenotonsillar hypertrophy is recognized as one of the primary contributing factors to Eustachian tube dysfunction, which can predispose children to chronic middle ear effusions [3]. Therefore, adenotonsillectomy is frequently performed in children with upper airway obstruction and recurrent infections. However, when OME coexists, the optimal strategy for managing the middle ear effusion remains controversial.

Two main approaches are commonly employed: surgical intervention through tympanostomy tube insertion and conservative medical management using nasal corticosteroids, antihistamines, and decongestants. Tympanostomy tubes provide immediate ventilation to the middle ear and facilitate fluid drainage, often resulting in rapid hearing improvement [4]. On the other hand, medical therapy is less invasive but may require longer treatment duration and may not yield consistent results across all cases [5].

While adenotonsillectomy alone may improve Eustachian tube function and lead to spontaneous resolution of OME in some children, evidence suggests that combining it with myringotomy and tube placement offers better long-term outcomes in persistent or bilateral effusions [6]. Yet, some clinicians prefer an initial medical approach due to concerns about tube-related complications such as otorrhea, tympanosclerosis, or persistent perforation [7].

Given this clinical uncertainty, the present study aims to prospectively compare the efficacy of surgical versus medical intervention in managing concurrent OME in children undergoing adenotonsillectomy, with the goal of identifying the more effective treatment modality for long-term auditory and symptomatic improvement.

This prospective comparative study was conducted in the Department of Otolaryngology at a tertiary care hospital over a period of 15 months, from March 2024 to June 2025. After obtaining ethical clearance from the institutional review board and written informed consent from parents or guardians, a total of 80 children aged 5 to 15 years who were scheduled for adenotonsillectomy and diagnosed with concurrent bilateral otitis media with effusion (OME) were enrolled.

Children were included based on the following criteria: (1) age between 5 and 15 years, (2) indication for adenotonsillectomy due to adenotonsillar hypertrophy with symptoms of nasal obstruction, snoring, or recurrent tonsillitis, and (3) presence of bilateral OME confirmed by Type B tympanogram and fluid level or air bubbles visualized on otoscopy. Exclusion criteria included history of prior ear surgery, cleft palate, craniofacial anomalies, sensorineural hearing loss, or immunocompromised status.

Participants were randomly assigned into two equal groups using a simple randomization method:

• Group A (Surgical group): Underwent adenotonsillectomy with bilateral myringotomy and tympanostomy tube insertion.
• Group B (Medical group): Underwent adenotonsillectomy alone followed by a 6-week course of medical management, including intranasal corticosteroids (mometasone furoate nasal spray), oral antihistamines, and saline nasal irrigation.

All surgeries were performed under general anesthesia by experienced otolaryngologists. Tympanostomy tubes (grommets) were placed using standard myringotomy technique in the anteroinferior quadrant of the tympanic membrane. Patients in both groups were followed up at 1, 3, and 6 months postoperatively.

At each follow-up visit, clinical evaluation included otoscopic examination, tympanometry, and pure tone audiometry (PTA) to assess middle ear status and hearing thresholds. The primary outcome measure was resolution of OME (defined by Type A tympanogram and dry ear). Secondary outcomes included improvement in hearing thresholds and rate of recurrence or complications.

Statistical analysis was carried out using SPSS version 25. Continuous variables were compared using Student’s t-test, while categorical variables were analyzed using the Chi-square test. A p-value of less than 0.05 was considered statistically significant.

A total of 80 children aged between 5 and 15 years were included in the study, with 40 participants in each group. Group A underwent adenotonsillectomy with tympanostomy tube insertion, while Group B received adenotonsillectomy followed by medical management. The demographic distribution between the two groups was comparable, with no significant difference in age or gender (Table 1).

At the 3-month follow-up, 34 children (85%) in Group A demonstrated complete resolution of otitis media with effusion, confirmed by Type A tympanogram and normal otoscopic findings, compared to 24 children (60%) in Group B (Table 2). The difference was statistically significant (p = 0.008).

Pure tone audiometry revealed that the mean hearing threshold improved from 30.4 ± 6.2 dB preoperatively to 14.5 ± 3.6 dB in Group A and from 29.7 ± 5.8 dB to 19.3 ± 4.2 dB in Group B at 3 months post-treatment. The hearing improvement was greater in the surgical group (p = 0.012) (Table 3).

At the 6-month follow-up, recurrence of effusion was noted in 4 children (10%) in Group A, compared to 10 children (25%) in Group B. Additionally, tympanometric findings showed that 80% of patients in Group A maintained a Type A curve, while this was observed in only 65% of patients in Group B (Table 4).

Only minor complications were reported, including transient otorrhea in 3 patients (7.5%) in Group A and nasal irritation in 5 patients (12.5%) in Group B. No major complications or persistent tympanic membrane perforations were observed.

Table 1: Demographic Distribution of Study Participants

Table 2: OME Resolution at 3-Month Follow-up

Table 3: Hearing Thresholds Pre- and Post-Treatment

Table 4: Tympanometric Findings at 6 Months

As seen in Tables 2 and 3, surgical intervention resulted in significantly better resolution of effusion and hearing improvement than medical therapy. Table 4 further supports the sustained benefit of tympanostomy tube insertion in long-term middle ear ventilation.

Otitis media with effusion (OME) is a common pediatric condition that often coexists with adenotonsillar hypertrophy, particularly in children between 5 and 15 years of age. The current study compared the outcomes of surgical and medical interventions in children undergoing adenotonsillectomy who presented with concurrent OME, focusing on effusion resolution and hearing improvement.

Our findings demonstrated that tympanostomy tube insertion in addition to adenotonsillectomy resulted in significantly higher rates of effusion resolution (85%) and improved hearing thresholds compared to medical management (60%) at the 3-month follow-up. These results are consistent with several previous studies that emphasized the effectiveness of tympanostomy tubes in promoting middle ear ventilation and reducing effusion-related hearing loss [1], [2], [3].

Tympanostomy tubes allow immediate normalization of middle ear pressure and facilitate drainage of fluid, leading to faster and more consistent recovery of auditory function [4], [5]. This is particularly beneficial in school-aged children in whom even mild hearing loss can impact language development and academic performance [6], [7]. In contrast, medical therapy may provide limited and slower resolution, particularly in cases with longstanding effusions or significant Eustachian tube dysfunction [8], [9].

Although adenotonsillectomy alone may improve Eustachian tube function by relieving nasopharyngeal obstruction, it may not always result in the resolution of existing middle ear effusion [10]. Studies have shown that combining adenotonsillectomy with tympanostomy tubes provides superior outcomes, especially in children with bilateral or persistent effusions lasting longer than three months [11], [12].

The recurrence rate of OME in our study was also lower in the surgical group (10%) compared to the medical group (25%) at 6 months, supporting the long-term efficacy of tube placement. These findings align with those of Maw et al., who reported a significantly reduced risk of recurrent effusion in children managed with tympanostomy tubes [13].

Complications in the surgical group were minimal, with only a few cases of transient otorrhea, and no instances of chronic tympanic membrane perforation or tympanosclerosis, which are known but uncommon complications of ventilation tube placement [14], [15]. This reinforces the safety of the surgical approach when performed by experienced clinicians and with appropriate follow-up care.

In summary, the present study supports the combined use of tympanostomy tube insertion with adenotonsillectomy in managing children with concurrent OME, particularly those with significant hearing loss or bilateral effusions. While medical therapy remains an option in selected cases, surgical intervention offers more reliable and quicker recovery, which can be crucial in a child’s developmental window.

Tympanostomy tube insertion when combined with adenotonsillectomy, offers significantly better outcomes in managing OME in children compared to medical therapy alone. It leads to faster resolution of effusion, greater hearing improvement, and lower recurrence rates, making it a more effective treatment option for children with concurrent OME undergoing adenotonsillectomy.

1. Yousaf M, Inayatullah, Khan F. Medical versus surgical management of otitis media with effusion in children. J Ayub Med Coll Abbottabad. 2012;24(1):83–5.
2. Yousaf M, Malik SA, Haroon T. Laser myringotomy versus ventilation tubes in otitis media with effusion. J Ayub Med Coll Abbottabad. 2016;28(4):773–5.
3. Yousaf M, Malik SA, Zada B. Laser and incisional myringotomy in otitis media with effusion—a comparative study. J Ayub Med Coll Abbottabad. 2014;26(4):441–3.
4. Sedlmaier B, Jivanjee A, Gutzler R, Huscher D, Jovanovic S. Ventilation time of the middle ear in otitis media with effusion (OME) after CO2 laser myringotomy. Laryngoscope. 2002;112(4):661–8.
5. Popova D, Varbanova S, Popov TM. Comparison between myringotomy and tympanostomy tubes in combination with adenoidectomy in 3–7-year-old children with otitis media with effusion. Int J Pediatr Otorhinolaryngol. 2010;74(7):777–80.
6. Lous J, Burton MJ, Felding JU, Ovesen T, Rovers MM, Williamson I. Grommets (ventilation tubes) for hearing loss associated with otitis media with effusion in children. Cochrane Database Syst Rev. 2005;(1):CD001801.
7. Tanpowpong K, Saisukul I, Kittimanont H, Rattanasiri S. Outcome of myringotomy with ventilation tube for otitis media with effusion in Thai children: Ramathibodi experiences. J Med Assoc Thai. 2007;90(9):1866–71.
8. Rovers MM, Straatman H, Ingels K, van der Wilt GJ, van den Broek P, Zielhuis GA. The effect of ventilation tubes on language development in infants with otitis media with effusion: a randomized trial. Pediatrics. 2000;106(3):E42.
9. Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA, et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. 2004;130(5 Suppl):S95–118.
10. MRC Multicentre Otitis Media Study Group. Adjuvant adenoidectomy in persistent bilateral otitis media with effusion: hearing and revision surgery outcomes through 2 years in the TARGET randomized trial. Clin Otolaryngol. 2012;37(2):107–16.
11. American Academy of Family Physicians; American Academy of Otolaryngology–Head and Neck Surgery; American Academy of Pediatrics Subcommittee on Otitis Media With Effusion. Otitis media with effusion. Pediatrics. 2004;113(5):1412–29.
12. Khodaverdi M, Jørgensen G, Lange T, Stangerup SE, Drozdziewizc D, Tos M, et al. Hearing 25 years after surgical treatment of otitis media with effusion in early childhood. Int J Pediatr Otorhinolaryngol. 2013;77(2):241–7.
13. Zielnik-Jurkiewicz B, Olszewska-Sosińska O, Rakowska M. [Results of treatment with tympanostomy tubes in children with otitis media with effusion]. Otolaryngol Pol. 2006;60(2):181–5. Polish.
14. Wolter NE, Dell SD, James AL, Campisi P. Middle ear ventilation in children with primary ciliary dyskinesia. Int J Pediatr Otorhinolaryngol. 2012;76(11):1565–8.
15. Döner F, Yariktas M, Demirci M. The role of allergy in recurrent otitis media with effusion. J Investig Allergol Clin Immunol. 2004;14(2):154–