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PubMed2004

Efficacy of adenoidectomy in the treatment of nasal and middle ear symptoms in children with Down syndrome.

OBJECTIVE: To compare the efficacy of adenoidectomy in children with Down syndrome and control patients. METHODS: Medical records were reviewed for preoperative symptoms, ear complaints, date and reason for adenoidectomy, and postoperative symptoms in 27 children (mean age, 6.0 years; range, 1.6-14.5 years) with Down syndrome and 53 age- and sex-matched controls who had adenoidectomy between January 1978 and September 1997. Long-term follow-up was aided by telephone interviews. Improvement in nasal and middle ear symptoms after adenoidectomy was calculated as the percentage of patients symptom-free postoperatively among those with symptoms preoperatively. RESULTS: After adenoidectomy, more controls than patients with Down syndrome had improvement in symptoms, including nasal obstruction (86.7% versus 50.0%; P=0.005); snoring (73.2% versus 40.9%; P=0.01); mouth breathing (84.1% versus 40.9%; P<0.001); and middle ear disease (68.0% versus 23.1%; P<0.001). Patients with Down syndrome were 7.7 times (95% confidence interval, 2.3-25.3) more likely to have chronic ear drainage after adenoidectomy. CONCLUSIONS: The results of the study suggest that the efficacy of adenoidectomy in children with Down syndrome is significantly less than that in controls and should influence surgical decision making in these children.

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PubMed1998

Safety of powered instrumentation for adenoidectomy.

A recent study established the utility of an endoscopic shaver for adenoidectomy in children by the transoral approach and showed that power assisted adenoidectomy (PAA) was significantly faster with a trend toward decreased blood loss. The purpose of this study was to demonstrate the safety of power assisted adenoidectomy in a large cohort of patients. A retrospective review was performed of 329 patients who had adenoidectomy by powered instrumentation. Postoperative complications were documented and compared with a similar group that had curette adenoidectomy. Complications watched for included prolonged recovery, postoperative hemorrhage, readmission for dehydration, velopharyngeal insufficiency, and nasopharyngeal stenosis. No postoperative complications were seen in the power assisted adenoidectomy group. This review confirms the safety of power assisted adenoidectomy.

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PubMed1999

Endoscopic-assisted adenoidectomy.

Adenoidectomy is a commonly performed procedure. The advent of endoscopic sinus surgery has popularized the use of endoscopes. Endoscopic-assisted adenoidectomy (EAA) is a natural progression of this technology to allow a more complete adenoidectomy. Two hundred thirty-six patients undergoing adenoidectomy were evaluated with an endoscopic technique. A routine transoral adenoidectomy was performed first. Then a 4-mm 0 degrees telescope was used transnasally, and residual adenoid tissue was removed from the anterior superior nasopharynx. Invariably, residual adenoid tissue was found after transoral adenoidectomy. The EAA technique is minimally invasive, adds less than 5 minutes to the procedure, and is not associated with excessive bleeding. Readily available telescope and endoscopic equipment is used. The EAA technique is advocated for use as an adjunct to a more complete adenoidectomy.

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PubMed2002

Monopolar electrocautery in adenoidectomy as a possible risk factor for Grisel's syndrome.

OBJECTIVES/HYPOTHESIS: Grisel syndrome is a nontraumatic atlantoaxial subluxation after an inflammatory process in the upper cervical region. It results from a peripharyngeal infection as well as a rare complication following adenotonsillectomy. After the introduction of monopolar suction electrocautery in adenoidectomy, an increased incidence of Grisel's syndrome has been observed. The purpose of the study was to evaluate monopolar suction electrocautery as a possible risk factor. STUDY DESIGN: Retrospective chart review along with current measurements of monopolar and bipolar electrocautery during adenoidectomy. METHODS: The charts of 1431 consecutive cases of adenoidectomy were reviewed before (n = 710) and after (n = 721) the introduction of monopolar suction electrocautery for intraoperative hemostasis. Moreover, energy of delivered current of electrocautery was measured in 30 pediatric patients during adenoidectomy. RESULTS: Three cases of Grisel's syndrome occurred as a postoperative complication in 721 adenoidectomies (0.4%) after the introduction of monopolar suction electrocautery. In contrast, no Grisel's syndrome was observed in 710 procedures before the use of monopolar electrocautery. Current measurements demonstrate an almost fourfold higher level of electrical energy using monopolar electrocautery compared with bipolar coagulation for bleeding control in adenoidectomy. CONCLUSION: Monopolar suction cautery in adenoidectomy may be considered as a risk factor for Grisel's syndrome.

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PubMed2005

Telescopic-assisted radiofrequency adenoidectomy: a prospective randomized controlled trial.

OBJECTIVES/HYPOTHESIS: The objective was to conduct a prospective randomized controlled trial describing and investigating the efficacy and safety of transoral telescopic-assisted radiofrequency adenoidectomy in young children. STUDY DESIGN: Prospective randomized controlled trial. METHODS: One hundred twenty patients who were 36 months of age or less and planned to undergo adenoidectomy or adenoidectomy with insertion of tympanostomy tubes were included in the study. Children were prospectively and randomly assigned into two equal treatment groups: the telescopic-assisted adenoidectomy using radiofrequency curette and the conventional adenoid-curette adenoidectomy. The main parameters included visual analogue scale score for nasal breathing, amount of blood loss, operating time, completeness of adenoid resection, smoothness of postoperative recovery, and complications. RESULTS: Both groups had a significant improvement in the visual analogue scale score after surgery with no evidence for a significant difference between the conventional adenoid-curette and radiofrequency groups. The amount of blood lost during radiofrequency adenoidectomy was minimal, with a mean difference of 31 mL and a median difference of 26 mL. There was a tendency for shorter operative time in the radiofrequency group, but this did not reach a statistical significance. No evidence for a significant difference was noticed in the smoothness of postoperative recovery or complication rate. CONCLUSION: Telescopic-assisted radiofrequency-curette adenoidectomy allows removal of huge adenoids completely in a precise, easy, and cost-effective procedure, with minimal blood loss and short operating time. The use of transoral telescopes provides a clear visualization that helps complete removal of the adenoids, reduction of unnecessary trauma, and effective control of bleeding.

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PubMed2005

Rates and risk factors for subsequent tonsillectomy after prior adenoidectomy: a regression analysis.

OBJECTIVE: To determine the role of adenoidectomy without concurrent tonsillectomy in the treatment of upper airway obstruction, by determining rates and risk factors for subsequent tonsillectomy. DESIGN: Retrospective cohort study with nested case-control study. Data were evaluated using Kaplan-Meyer curves with Cox proportional hazards regression analysis, as well as contingency table and logistic regression analysis. SETTING: Tertiary care pediatric hospital with satellite clinics and surgical centers. PATIENTS: A total of 2462 patients aged 5 months to 18 years undergoing adenoidectomy without concurrent tonsillectomy. MAIN OUTCOME MEASURES: A 5-year database was searched for birth dates, dates of initial surgery, and dates of subsequent tonsillectomy (if performed) or latest follow-up. Cases (tonsillectomies) were then matched 1:1 by age with controls (no subsequent tonsillectomy). Medical charts were reviewed to identify potential predisposing factors, including sex, tonsil size, and adenoidectomy or tonsillectomy indication. RESULTS: Within 5.4 years, 108 patients underwent subsequent tonsillectomy. The relative risk of subsequent tonsillectomy decreases by 0.83 (95% confidence interval, 0.78-0.88) for each increasing year of age at adenoidectomy. The odds of undergoing a future tonsillectomy significantly increase with increasing tonsil size at the time of adenoidectomy. There was a trend toward doubling the risk of subsequent tonsillectomy when the adenoids were removed for upper airway obstruction (including obstructive sleep apnea) compared with other indications (P = .06). CONCLUSION: Knowledge of the rates and risk factors for subsequent tonsillectomy will allow more informed counseling of parents regarding whether tonsillectomy should be performed or deferred at the time of an indicated adenoidectomy.

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PubMed2006

Tubal tonsil hypertrophy: a cause of recurrent symptoms after adenoidectomy.

OBJECTIVES: To assess the incidence of symptomatic tubal tonsil hypertrophy (TTH) after adenoidectomy and to attempt to differentiate the clinicoradiographic presentation of TTH from that of recurrent or residual adenoid. DESIGN: Retrospective case series review. SETTING: Pediatric otolaryngology practice in a tertiary care hospital. PATIENTS: The charts of all patients scheduled to undergo revision adenoidectomy or nasopharyngeal examination under anesthesia over a 5-year period in 1 pediatric otolaryngologist's practice were reviewed. MAIN OUTCOME MEASURE: Presence of TTH in patients with recurrent symptoms after previous adenoidectomy. RESULTS: Forty-two patients were identified, 24 of whom satisfied the established criteria of recurrent symptoms after previous adenoidectomy. Ten (42%) of these patients were identified as having TTH. The average age at presentation was 7 years 2 months, at an average time interval of 4 years 2 months after adenoidectomy. The comparative incidence of recurrent or residual adenoid was 54%. The symptomatic manifestations of TTH included nasal obstruction, obstructive sleep disorder, rhinosinusitis, recurrent otitis media, and otitis media with effusion. Preoperative radiographic evaluation was not useful in distinguishing TTH from recurrent or residual adenoid; nasopharyngoscopy appears to have better diagnostic potential. Thermal ablation with suction cautery was therapeutically effective. CONCLUSIONS: Tubal tonsil hypertrophy is a significant clinical entity as a cause of recurrent symptoms after adenoidectomy. The study patients demonstrated the entire spectrum of signs and symptoms seen in patients with adenoid hypertrophy. Operative nasopharyngeal examination is required to definitively distinguish TTH from recurrent or residual adenoid.

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PubMed1982

Partial adenoidectomy.

Adenoidectomy in the presence of an inadequate palate may result in velopharyngeal insufficiency. When an adenoidectomy is indicated in a child whose palate is not fully adequate, a partial adenoidectomy may be considered. Partial adenoidectomy involves removing the upper part of the adenoid for relief of nasal obstruction while leaving the lower portion of the adenoid intact to ensure velopharyngeal competence. Fifty-eight children underwent partial adenoidectomy over a 4-year period; 55 of these children had preoperative nasal obstruction; 49 had a tonsillectomy done at the same time; and 2 had had a previous T&A. The rationale for retaining the lower portion of the adenoid includes a short soft palate, decreased palatal mobility, a mild submucous cleft palate, huge tonsils pushing the palate anteriorly, and a short hard palate. The relief of nasal obstruction was excellent. There were no primary postoperative hemorrhages, and none of the 58 children developed velopharyngeal insufficiency following partial adenoidectomy.

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PubMed2002

Electrocautery adenoidectomy compared with curettage and power-assisted methods.

OBJECTIVE: To compare electrocautery adenoidectomy with conventional (curettage) and power-assisted (endoscopic shaver) methods. STUDY DESIGN: Comparative review. METHODS: Prospective and retrospective studies comparing electrocautery adenoidectomy and conventional curettage or power-assisted methods were reviewed to provide direct comparisons regarding specific outcome variables. RESULTS: Electrocautery adenoidectomy is a precise, effective technique for removing adenoid tissue. Compared with curettage techniques, electrocautery involves less blood loss and shorter operating times. Power-assisted adenoidectomy also offers shorter operating times and less blood loss, but the necessary equipment is more expensive and more experience is required to attain proficiency with the technique. CONCLUSION: Electrocautery adenoidectomy provides the benefits of minimization of operating time and blood loss at a lower cost than power-assisted adenoidectomy.

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PubMed2002

Power-assisted partial adenoidectomy.

OBJECTIVE: To describe partial adenoidectomy using a powered microdebrider and review the experience with the procedure. STUDY DESIGN: Prospective study and review. METHODS: To perform a power-assisted partial adenoidectomy, the surgeon directs the window in the microdebrider blade tip toward the tissue, which is drawn in by suction; the rotating blade then shaves the tissue. Studies have compared this adenoidectomy technique with curette procedures. RESULTS: In a comparative prospective study, we found that operating time and time required for hemostasis were significantly shorter (P =.001) with power-assisted partial adenoidectomy than with curettage. There was no significant difference between the two procedures in blood loss or complication rate. These results were similar to those of previous studies. Overall, we have performed more than 1000 power-assisted partial adenoidectomies. No long-term complications have occurred, blood loss remains low, and surgeons are satisfied with the technique because of its speed, improved visibility during resection, and precision. CONCLUSION: We and other authors have found power-assisted partial adenoidectomy to provide a faster, more precise operation than curette techniques, with benefits for both patient and surgeon.

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PubMed2002

Craniofacial characteristics and velopharyngeal function in cleft lip/palate children with and without adenoidectomy.

The association between velopharyngeal function, craniofacial morphology and adenoidectomy was investigated using 27 craniofacial and nasopharyngeal variables taken from lateral cephalograms. The sample consisted of 96 boys with cleft palates with or without cleft lips. They were examined at 6 years of age when cephalograms were obtained and perceptual speech assessments were performed. The subjects were divided into three groups: (1) velopharyngeal competence (VPC, n = 45); (2) mild incompetence not requiring velopharyngoplasty (VPI, n = 36); and (3) previous incompetence operated on with velopharyngoplasty ad modum Hoenig (VPP, n = 15) before the 6-year examination. The groups were further divided into two subgroups according to previous adenoidectomy (Ad+, Ad-). The cranial base, size and interrelationship of the maxilla and mandible and their relationship to the cranial base or the bony nasopharynx did not differ among the VPC, VPI and VPP groups. The sagittal depth of the nasopharyngeal airway (Pm-ad1, Pm-ad2, Pm-ad3) was significantly wider in the VPP group than in the the VPC and VPI groups. The previous adenoidectomy decreased the thickness of the posterior pharyngeal wall (ad1-Ba, ad2-so) and thus increased airway size. The length of the velum did not differ between the three groups or their subgroups with and without adenoidectomy. The results showed that adenoidectomy is a risk to velopharyngeal function by widening the nasal airway, but velopharyngeal incompetence cannot definitely be attributed to adenoidectomy.

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PubMed2005

Day-case adenoidectomy: outcomes are improved using suction coagulation and prophylactic anti-emetic treatment.

In 2004, the Department of Health published 10 High Impact Changes across the NHS. Of these, the first was treating day surgery as the norm for elective operations, releasing up to half a million in-patient beds each year. Adenoidectomy is an operation commonly performed in children for upper respiratory tract obstruction and as part of the surgical management of otitis media with effusion. Many surgeons consider the traditional curettage adenoidectomy as an unsatisfactory operation because it is performed blind, and is associated with varying reported levels of post-operative bleeding. Concern about the risk of bleeding and the frequent occurrence of post-operative nausea and vomiting have discouraged many surgeons from adopting adenoidectomy as a day-case procedure. We have audited the management and discharge of a cohort of 72 children undergoing traditional curettage adenoidectomy. Based on the results, we have completed the audit loop, by managing a second cohort of 77 children by suction coagulation adenoidectomy. An anaesthetic protocol has been designed to reduce post-operative nausea and vomiting, and facilitate same day discharge from hospital. The rate of post-operative nausea and vomiting fell from 21 to 1.3%, and the post-operative bleeding from 9.7% to nil. Discharge on the day of operation rose from 40.3 to 100%. Our audit confirms that these measures permit safe, day-case adenoidectomy.

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PubMed2005

Pathologic evaluation of routine tonsillectomy and adenoidectomy specimens in the pediatric population: is it really necessary?

OBJECTIVE: To evaluate the necessity of histopathologic examination for routine tonsillectomy and/or adenoidectomy in terms of unexpected malignancy by evaluating a large group of pediatric patients retrospectively with review of the literature. MATERIALS AND METHODS: A retrospective chart review of all patients under the age of 19 who underwent tonsillectomy and/or adenoidectomy between January 1990 and January 2005 was carried out. The records were analyzed concerning each patient's age, sex, indication for surgery, type of surgical procedure and the result of histopathologic examination of the specimen. The patients operated for chronic or recurrent infections and obstructive hypertrophy were included in the study. Moreover, the English literature was searched in Medline for articles published between 1949 and March 2005 and the studies dealing with pathologic analysis of tonsillectomy and/or adenoidectomy specimens were reviewed. RESULTS: The total number of patients was 2826. After excluding 83 patients because of insufficient data, 2743 patients with an age distribution from 1 to 18 years (mean: 7.53) were reviewed. There were 1534 males (56%) and 1209 females (44%). Tonsillectomy and adenoidectomy were performed together on 1930 patients (70%) while tonsillectomy and adenoidectomy alone were performed on 287 (10%) and 526 (20%) patients, respectively. Evaluation of the pathology reports revealed no malignancies. Review of the literature identified 14 articles and 5 of them included only pediatric patients. The rate of unexpected malignancies observed in these pediatric series varied between 0 and 0.18%. CONCLUSION: After being evaluated by an experienced otolaryngologist, pathologic evaluation of all specimens may not be necessary if a child undergoing routine tonsillectomy and/or adenoidectomy is not found to have certain preoperative risk factors.

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PubMed2001

Can nasal endoscopy be used to predict residual symptoms after adenoidectomy for nasal obstruction?

BACKGROUND: the efficacy of adenoidectomy in relieving nasal symptoms has been questioned. Although enlarged adenoids are often blamed for nasal obstruction, other causes can be missed if examination is not thorough. We suggest that endoscopy at the time of adenoidectomy may be useful to confirm large adenoids and exclude other causes, and the findings may help predict residual symptoms 2 years after adenoidectomy. METHOD: a prospective study of a consecutive series of children undergoing adenoidectomy for nasal obstruction was performed. All underwent endoscopy with a 4-mm rigid endoscope without decongestants under GA immediately prior to adenoidectomy. Two years later a postal symptom questionnaire was sent, with telephone follow up for non-responders. The findings on endoscopy were compared with residual symptoms at 2 years. RESULTS: Forty-eight children aged 2-9 (mean 4) years were enrolled, 26 of them female. At 2 years follow up, data were available for 34 children (71%). Complete obstruction of the posterior choanae of the nose by adenoids was seen in 21 (62%). Additional findings (e.g. septal deviation, hypertrophic mucosa on the turbinates) were present in 22 (65%). Of them 9 (26%) had residual nasal symptoms. Of the children with less than occlusive adenoids, six (50%) out of 12 had residual symptoms, compared with three (14%) out of 21 with occlusive adenoids (chi(2)=4.91, P<0.05). Although residual symptoms were more common in those with additional findings on the original endoscopy (32 vs. 17%), this did not reach statistical significance. CONCLUSIONS: residual nasal symptoms are common when children are followed up in the medium term. The findings on endoscopy may predict the success of adenoidectomy in relieving the symptoms, and may help to guide further treatment.

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PubMed2002

Bacteremia during adenoidectomy.

OBJECTIVE: Although adenoidectomy is one of the most commonly performed surgical procedures in children, there is no satisfactory information about the risk of bacteremia during adenoidectomy and necessity of antibiotic use. The aim of this study was to determine the incidence of bacteremia during adenoidectomy and identify the organisms leading to bacteremia. METHODS: Thirty two patients who had undergone adenoidectomy at ENT Clinic of Sutcu Imam University were included in the study. They had received no antimicrobial therapy for at least 20 days before surgery. Adenoidal surface and deep tissue cultures were taken and venous blood samples were obtained for cultures before and immediately after adenoidectomy in which adenoid was removed with a curette. RESULTS: While none of the blood cultures taken preoperatively was positive for any organisms, the cultures obtained postoperatively were positive in only two of 32 patients included in the study. CONCLUSION: The results of this study suggest that there is an extremely low incidence of bacteremia during adenoidectomy. As a result, it may be concluded that the use of prophylactic antibiotics to prevent bacteremia or its complications is unnecessary unless the patient has a predisposing factor for cardiac infection like prosthetic valve replacement.

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PubMed1997

Day-case adenoidectomy: how popular and safe in a rural environment?

In spite of previously favourable reports on day-case adenoidectomy, there are still worries amongst otolaryngologists that such practice is unsafe, especially in a rural environment. A national survey was therefore carried out which shows that only 41 per cent of respondents perform adenoidectomy routinely as day-case, and even fewer in rural areas. A regional audit on day-case adenoidectomy, covering five hospitals, was conducted in East Anglia. Between 1994 to 1995, 73 day-case adenoidectomies were performed and the outcome was compared to those of 183 in-patient adenoidectomies during the same period. The children in the day-case group recovered post-operatively even better than the in-patient group. None of them stayed overnight or required re-admission. There was no increased in post-operative consultation to the general practitioner. The parents in the day-case group were mostly in favour of the day-case arrangement (88 per cent). The results suggest that day-case adenoidectomy is safe and popular with parents even in a rural environment.

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PubMed2006

Role of revision adenoidectomy in paediatric otolaryngological practice.

OBJECTIVES: We aimed to determine the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation. METHODS: Within a district general hospital, we undertook a retrospective study of 3231 children who underwent adenoidectomy between 1996 and 2003, 53 of whom required revision adenoidectomy. The main outcome measure was the number of children needing revision adenoidectomy. RESULTS: A total of 53 children required a repeated operation for recurrence of symptoms (1.6 per cent); of these, 42 were for treatment of glue ear, five were for nasal symptoms and six were for adenoidal infection. CONCLUSION: Adenoidectomy performed without vision may be one of the reasons for recurrence of symptoms. Residual adenoids are acknowledged in the literature as one of the complications of the traditional technique. We highlight the fact that the need for revision adenoidectomy is not uncommon and suggest that we should improve our surgical technique in the UK by visualization of the postnasal space either by a mirror or an endoscope.

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PubMed1987

Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion.

To study the effectiveness of adenoidectomy and of the placement of tympanostomy tubes in the treatment of chronic otitis media with effusion, we randomly assigned 578 children, aged four through eight years, to receive bilateral myringotomy and no additional treatment (Group 1), placement of tympanostomy tubes (Group 2), adenoidectomy (Group 3), or adenoidectomy and placement of tympanostomy tubes (Group 4). The 491 children who underwent one of these treatments were examined at six-week intervals for up to two years. The mean time spent with effusion of any type in either ear over the two-year follow-up in the four groups was 51, 36, 31, and 27 weeks, respectively (P less than 0.0001), comparing Group 1 with each of the other groups. Hearing was equivalent in Groups 2, 3, and 4, and was significantly better than in Group 1. The most frequent sequela, purulent otorrhea, occurred one or more times in 22, 29, 11, and 24 percent of the subjects in Groups 1, 2, 3, and 4, respectively (P less than 0.001). Adenoidectomy plus bilateral myringotomy lowered the overall post-treatment morbidity (as measured by hearing acuity in the most severely affected ear [P = 0.0174] and the number of surgical retreatments required [P = 0.009]) more than did tympanostomy tubes alone and to the same degree as did adenoidectomy and tympanostomy tubes. We conclude that adenoidectomy should be considered when surgical therapy is indicated in children four to eight years old who are severely affected by chronic otitis media with effusion.

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