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.