Search results
The number of unique items retrieved from each database is available in Supplemental Table 1. Among the 321 unique research items initially identified, a total of 18 articles were selected for full-text evaluation and 7 further were retrieved from citations and reviews. Among the 25 articles undergoing full-text evaluation, 3 studies were retained for further analysis (see Supplemental Figure 1 for the selection process details and Supplementary Table 2 for details on the articles excluded during the full-text evaluation).
Two articles were case series[16,17] and one was a retrospective cohort study [18], all published from the mid-Sixties to the early Seventies. The resulting levels of evidence according to the OCEBM scale were rated 4 for two studies and 3 for the remaining one. According to the NHI-SQAT, all articles were judged of fair quality. Most articles lacked ample information to support the comparability of patients. No significant bias emerged from the evaluation of the articles. The pooled population from the three studies was 136 patients. Table 1 reports the characteristics of the included studies, their demographics, and the type of cleft included. Sex distribution among the samples was not reported in any of the articles.
Table 2 reports data in terms of procedures performed (adenoidectomy or adenotonsillectomy), indications to surgery, diagnostic and outcome assessment methods, and outcomes.
In one study all patients underwent adenotonsillectomy, in another, all patients underwent isolated adenoidectomy and, in a third study, patients underwent either adenoidectomy or adenotonsillectomy. Two out of three studies included patients with OMAR or ORCHL and one exclusively included patients with OME. The diagnosis was otoscopy-based in all studies but employed also audiometry for the two studies treating patients with ORCHL. In the single study on OME, the diagnosis was confirmed with myringotomy in all but 2 patients. No study employed tympanograms. The outcomes were positive in all three articles in terms of improvement of ORCHL[16,17], reduction of acute otitis media episodes[16,17], and OME resolution [18], though this last result was not statistically significant when compared to no treatment in a control group of cleft palate children. Besides primary outcomes, two papers [16,17] reported positive outcomes in subjective perceptual speech. A single study[17] reported outcomes in terms of hypernasality, which was improved in 3 out of 15 patients and unchanged in the remaining 12 patients. The speech evaluation was performed either: via an informal unspecific qualitative interview with parents and speech therapist [16] or via a non-further-specified speech therapist evaluation for hypernasality and general speech quality [17].
Finally, no reviewed study performed concurrent tympanostomy prior to or concurrent with adenoidectomy. A single study [18] performed tympanotomy in a number between 81 and 83 patients, but the timing of the procedure with regards to adenoidectomy was unclear.
Due to the heterogeneity and paucity of data, a meta-analysis could not be performed.