Quantitative Bacteriology in Adenoid Tissue

Over the past several years the indications for adenoidectomy have become increasingly controversial. Attempts to justify the operation in recurrent otitis media by correlating cultures of the nasopharynx with cultures of middle ear fluid have been inconclusive. Using quantitative bacteriologic techniques, we have studied the levels of aerobic and anaerobic bacteria per gram of tissue in adenoids removed from 48 patients. In seven patients, adenoidectomy was performed for nasal obstruction alone, in 17 patients for chronic serous otitis media, and in 24 patients for recurrent suppurative and serous otitis media. Using the criterion that greater than 10(5) organisms/gm of tissue constitutes infection, we found that 83% (20) of patients in the third group had infected adenoids, as opposed to only 15% (4) in the first and second group combined. Adenoid size measured radiographically did not correlate with the presence of infection. Adenoid size measured radiographically did not correlate with the presence of infection. When recurrent suppurative and serous otitis media are unresponsive to medical therapy including antibiotics and decongestants, adenoidectomy should be considered in addition to myringotomy and ventilation tubes.