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PubMed2003

Outcomes in suction coagulator adenoidectomy.

OBJECTIVES: To assess the feasibility of suction coagulator adenoidectomy relative to adenoid size and to document patient-based outcomes and satisfaction with surgery. DESIGN: Historical cohort study. SETTING: Referral-based academic pediatric otolaryngology practice. PARTICIPANTS: Consecutive series of 118 children older than 3 years (mean age, 6.5 years) undergoing adenoidectomy alone. INTERVENTION: Video nasopharyngoscopy followed by suction coagulator adenoidectomy as part of routine clinical care. An outcome survey was completed by telephone. OUTCOME MEASURES: Duration of surgery, estimated blood loss, complications, parent satisfaction, and clinical outcomes. RESULTS: The distribution of preoperative adenoid grades as determined by nasal endoscopy were as follows: grade 2 (>or=33% to <66% choanal obstruction), 7%; grade 3 (>or=66% to <90% obstruction), 48%; and grade 4 (90%-100% obstruction), 45%. The mean (SD) surgical time of 10.5 (3.0) minutes was unrelated to adenoid grade (R = 0.014; P =.88). All blood loss was less than 15 mL (<5 mL for 67%), and the only complication was a loose tooth. The parents of 98 patients (83%) were contacted a mean of 30.4 days after surgery: 95 (97%) reported less-labored breathing, and 94 (96%) were satisfied with the surgical results. Only 5 patients (5%) required a follow-up visit within 30 days of surgery. CONCLUSIONS: Suction coagulator adenoidectomy proved safe and rapid, regardless of the adenoid size. Surgical outcomes were very favorable, with nearly all parents reporting satisfaction with the procedure and improvement in their child's breathing.

Adenoidectomy↗
PubMed1999

Effect of treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy on obesity in children.

BACKGROUND: Obstructive sleep apnea is common in obese children who have enlarged tonsils and adenoids. OBJECTIVE: To determine if treatment of obstructive sleep apnea by tonsillectomy and/or adenoidectomy will result in normalization of an obese child's weight, as it does in underweight children, and as it does with other signs and symptoms. DESIGN: Retrospective cohort study. We recorded weight and height changes after tonsillectomy and/or adenoidectomy and compared changes of the obese and morbidly obese patients with those of the other patients. SETTING: A tertiary care inner-city hospital. PARTICIPANTS: Children (n = 45) who underwent tonsillectomy and/or adenoidectomy for obstructive sleep apnea in 1994-1995; their mean (+/-SD) age was 4.9+/-2.4 years at operation. RESULTS: At the time of surgery, 25 children were of normal weight; 3, underweight; 7, obese; and 10, morbidly obese. Postoperatively, 31 children (69%), including 10 of the 17 who were obese or morbidly obese, had substantial weight gain: the z score +/- SD for weight of the entire group increased from 1.37+/-2.49 to 2+/-2.27 (P<.001). The mean z score +/- SD for height increased from 0.03+/-1.08 to 0.58+/-0.94 (P<.001). The body mass index (BMI or Quetelet index): calculated as weight in kilograms divided by the square of the height in meters increased in 28 patients (62%) (P = .004). CONCLUSION: Treating obstructive sleep apnea by tonsillectomy and/or adenoidectomy is associated with increased gain in height, weight, and body mass index in most children, including the obese and morbidly obese.

Adenoidectomy↗
PubMed2006

[Histological examination following adenoidectomy and tonsillectomy in children. Surprising results are very rare].

BACKGROUND: The histological examination of lymphatic tissue resected in children during adenoidectomy or tonsillectomy has to be considered as a screening method. Its purpose is to detect rare diseases that differ from "chronic inflammation" or "lymphatic hyperplasia". That this examination is economically reasonable in relation to the frequency of surprising results with therapeutic consequences is doubtful. The aim of this study was to define the frequency of surprising or clinically relevant results in histological reports following adenoidectomy and/or tonsillectomy in children. METHODS: From both 1999 and 2004, 200 patients were identified, 10 years old or less, who underwent adenoidectomy/tonsillectomy due to recurrent throat infections or stenotic symptoms of the upper airways or upper swallowing path. The histological reports on these 400 children were evaluated. RESULTS: At the date of surgery, the median age was 4 years. In 140 children, an adenoidectomy-tonsillectomy was performed, 26 underwent tonsillectomy alone and 234 adenoidectomy alone. No reports with a histological diagnosis other than "lymphatic hyperplasia" or "chronic tonsillitis" were found. DISCUSSION: A histological report that is surprising or might influence the further treatment of the patient is rare. From the literature, an unusual diagnosis in children occurs in less than 1 per 1,000. The routine histological examination of adenoidectomy/tonsillectomy tissue cannot nowadays be economically justified. On the other hand, the ethical aspects of the abolition of this inefficient but established method should be discussed. If routine histological examination is abandoned, the surgeon would be responsible for the decision of whether a histological examination is necessary for each individual case (asymmetry of tonsils, extraordinary cervical lymph node status, striking history e.g.).

Adenoidectomy↗
PubMed1980

Velopharyngeal insufficiency starting at puberty without adenoidectomy.

At the Cleft Palate Unit of The Montreal Children's Hospital a number of patients are seen each year who developed velopharyngeal insufficiency after adenoidectomy. Each time one of these patients is seen, the question is asked: "What would have happened to the speech if adenoidectomy had not been done, and the adenoid had been allowed to undergo the normal process of atrophy at puberty?" We had not seen a patient develop velopharyngeal insufficiency at puberty without adenoidectomy until recently, when an 11.5-year-old boy presented with a history of hypernasality for 1.5 years. Physical examination revealed the soft palate to be slightly short but with good mobility. The voice was mildly hypernasal but there was no nasal escape. Radiologic investigation revealed a very deep nasopharynx with virtual absence of adenoid tissue and a slight shortness of the palate. The child had been on speech therapy and the recommendation was that the therapy be stopped. When the child was seen 2.5 months after cessation of speech therapy, the hypernasality had cleared completely. Speech Pathologists at other Cleft Palate Units were contacted and no similar cases were known. The literature also did not reveal any similar cases of velopharyngeal insufficiency developing after puberty in the absence of adenoidectomy and without a cleft palate.

Adenoidectomy↗
PubMedDate not supplied

Effect of adenoidectomy on otitis media with effusion, tubal function, and sinusitis.

Three clinical studies were performed to investigate the effects of adenoidectomy on otitis media with effusion (OME), especially with regard to eustachian tube (ET) disfunction and sinusitis, which often accompanies OME. In the first study, the audiograms, tympanograms, and ET ventilatory functions of 78 adenoidectomized patients (121 ears) and 54 non-adenoidectomized patients (63 ears) were compared over 6 months. The audiograms and tympanograms of the adenoidectomized group showed significant improvement; however, no difference in passive tubal opening pressure was noted despite an improvement in positive pressure equalizing function observed in the adenoidectomized group at 6 months after the operation. In the second study, tubal passive resistance (PR) and the ratio of passive resistance to active resistance (PR/AR) were compared before and 1 month after adenoidectomy using the forced response test (12 subjects, 12 ears). Neither PR nor PR/AR had significantly improved after the operation. In the third study, sinusitis improvement in 45 adenoidectomized patients 6 months after the operation was evaluated in comparison with 33 non-adenoidectomized patients. This condition was found to have improved significantly in the adenoidectomized group. Overall, adenoidectomy appeared effective in reducing the incidence of OME and sinusitis, and in improving the active ventilatory function of the ET without causing changes in the tubal passage. It is conceivable that tubal active ventilatory function was improved due to a reduction of inflammation and pollution around the nasopharynx by adenoidectomy, and that the effect of adenoid mass on the ET is minimal.

Adenoidectomy↗
PubMedDate not supplied

Cochlear implant integrity after adenoidectomy with Coblation and monopolar electrosurgery.

PURPOSE: Conventional electrosurgical adenoidectomy has been deemed contraindicated in subjects with cochlear implants (CIs) because of risk to the CI and the auditory neurons. No published studies have evaluated the safety of electrosurgical adenoidectomy techniques with CIs. The goal of this study was to compare the impact of monopolar electrosurgery and Coblation radiofrequency bipolar electrosurgery on CI integrity. METHODS: Twelve fresh, cadaveric pigs received unilateral CIs, then the nasopharynx was treated for 15 to 30 minutes with continuous monopolar electrosurgery or Coblation. CIs were tested by the manufacturer for device integrity before and after treatment. RESULTS: Integrity was maintained in all CIs treated with either monopolar or Coblation electrosurgery. CONCLUSIONS: Although the safety of electrosurgical adenoidectomy after CI placement remains unproven, these observations suggest that judicious use of conventional monopolar and Coblation electrosurgery in adenoidectomy does not convey a serious risk to CI integrity. Theoretical considerations favor the use of Coblation over monopolar electrosurgery in CI recipients.

Adenoidectomy↗
PubMed2004

Safety of electronic molecular resonance adenoidectomy.

Adenoidectomy is one of the most frequent operations in children. In order to reduce hospital stay costs, today, this procedure is performed as day surgery. Even though adenoidectomy is not considered risky, some minor complications may occur, the most important being bleeding (0.5-8% incidence). The surgical technique used can influence considerably postoperative pain and time to recovery. This aspect is essential in the management of day surgery patients, for whom the need of safe and rapid maneuvers associated with early recovery determines the choice of the surgical procedure. Recently, we developed a surgical technique based on the use of an electronic molecular resonance tool associated with bendable suction electrocautery. This study was carried out on 600 patients, divided into two groups, the first undergoing ablation using the molecular resonance tool and the second undergoing curette adenoidectomy. The two groups were homogeneous for age, sex, surgical indications, and grade of adenoid hypertrophy. The following parameters were considered: duration of surgery, importance of intraoperative bleeding, time to cicatrization, incidence of bleeding complications. Duration of surgery and intra- and postoperative bleeding were much lower in the first group than in the group undergoing traditional adenoidectomy. In addition, rhinopharyngeal complete cicatrization, defined as absolute absence of pseudomembrane, was much quicker in the first group, as assessed by postoperative endoscopy. Another major advantage offered by the molecular resonance tool is the accuracy of surgery performed under visual control in a practically bloodless field. To sum up, this method, thanks to its technical features and safety, is particularly indicated in children and in patients with coagulation disorders.

Adenoidectomy↗
PubMed2005

Bacteremia following pediatric adenoidectomy.

OBJECTIVE: Adenoidectomy is frequently performed in children. The goals of this work were to determine the incidence of bacteremia during the adenoidectomy, to identify the microorganisms implicated, and to analyze the possible association of bacteremia with postoperative complications. METHODS: One hundred pediatric patients operated of adenoidectomy without preoperative antibiotic prophylaxis were prospectively included in this study. They had no immunosuppressive and/or cardiovascular risk factors, no antimicrobial therapy for at least 15 days prior to operation, and no fever 1 week before surgery. Venous blood samples were obtained 30 s and 20 min after the curettage of adenoidal tissue. RESULTS: The 33 and 14% of the samples were positive at 30 s and 20 min. The organism more commonly isolated was the streptococcus viridans. Bacteremia was only related to postoperative acute otitis media (p=0.012). CONCLUSIONS: Bacteremia exists after pediatric adenoidectomy, although it seldom correlates with clinical signs or symptoms. Postoperative acute otitis media is the only complication related to postsurgical bacteremia.

Acute Disease↗
PubMed2005

A mean red blood cell volume loss in tonsillectomy, adenoidectomy and adenotonsillectomy.

OBJECTIVE: To calculate a mean red blood cell volume (RBCV) loss per kilogram (kg) in adenoidectomy, tonsillectomy, and adeno-tonsillectomy. MATERIALS AND METHODS: Pre- and post-operative complete blood cell count, and pre-operative clotting studies of 144 patients were measured. Total blood volume (75 or 70 ml/kg), pre- and post-operative RBCV (hematocritxtotal blood volume), RBCV loss, per kg RBCV loss and per cent RBCV loss were calculated. RESULTS: There was significant differences between pre- and post-operative RBCV, Hb, and Htc values for tonsillectomy, adenoidectomy and A&T groups, respectively (p<0.001 for all groups). We found a mean RBCV loss of 33 ml (5.56% of total RBCV) for adenoidectomy, 128 ml (10.63% of RBCV) for tonsillectomy and 60 ml (10.71% of RBCV) for A&T. RBCV loss per kg was 1.57+/-1.29 for adenoidectomy, 2.96+/-1.91 for adeno-tonsillectomy, and 3.02+/-1.66 for tonsillectomy. CONCLUSION: According to us, for management of the patients, knowledge of a mean nature loss of RBCV per kg is important because bleeding seems to be unavoidable in the intra-operative or maybe post-operative period in these operations.

Adenoidectomy↗
PubMed1986

Otoscopic, impedance, and audiometric findings in glue ear treated by adenoidectomy and tonsillectomy. A prospective randomised study.

150 children aged between 2 and 9 years (mean 5.25 years) with chronic bilateral otitis media with effusion were randomly allocated to three groups who, in addition to unilateral myringotomy and grommet insertion, would have an adenotonsillectomy, an adenoidectomy, or neither. The contralateral ear was assessed. Otoscopic, impedance, and audiometric findings were recorded preoperatively and at six and twelve months postoperatively. Subtraction of the no-surgery results indicates that at twelve months adenoidectomy produces otoscopic resolution of OME in 41.7% and no-peak/peak conversion of impedance in 29.8%. The hearing gain from adenoidectomy alone was similar to that resulting from insertion of a grommet alone, but the children having adenoidectomy required fewer reinsertions to maintain adequate subjective hearing thresholds in the treated ear (26% versus 54%). Tonsillectomy conferred no additional benefit. Without treatment there was a small but significant improvement in all indices at twelve months but not at six months postoperatively.

Acoustic Impedance Tests↗
PubMedDate not supplied

Age and adenoid size in relation to adenoidectomy in otitis media with effusion.

A previously reported study showed that adenoidectomy resolved effusions in chronic bilateral otitis media with effusion in 36 to 46 per cent of 103 children. This work includes 52 additional cases and assesses the effect of age and adenoid size in relation to adenoidectomy. Pre-operative lateral cephalometric radiographs showed the adenoid size and postnasal space airway. Surgery was allocated randomly into three groups: adenotonsillectomy, adenoidectomy, and no surgery. In addition, in all cases a unilateral myringotomy and ventilating tube insertion were performed. The ear not operated upon was assessed for clearance of the effusion at 3, 6, 9, and 12 months postoperatively. Following adenoidectomy the effusion resolved in the ear not operated upon in 31 to 45 per cent of cases assessed after 1 year. Tonsillectomy conferred no additional benefit. There was a trend for improved clearance of effusions in children more than 6 years of age, compared with those less than 6 years of age. There was also a trend for improved clearance after removal of larger adenoids from children with smaller postnasal space airways, but this was only significant for 3 months postoperatively.

Adenoidectomy↗
PubMed1993

Normalization of incisor position after adenoidectomy.

Changes in incisor inclination and position in both jaws of children during the first 5 years after adenoidectomy were studied. The main change is a significant increased labial inclination of the incisors for the adenoidectomy groups. All variables that measure the labiolingual position of the mandibular incisors confirm a significant labial incisor positioning for both sexes. Stepwise regression analysis shows that 41% to 44% of the incisor proclination after adenoidectomy is accounted for by two regressors--sex (female) and increase in the sagittal size of the nasopharynx. The study supports the hypothesis that a changed mode of breathing after adenoidectomy is associated with significant labial positioning of the incisor teeth.

Adenoidectomy↗
PubMed1998

Admission and discharge policy for paediatric adenoidectomy and tonsillectomy--a rural perspective.

Adenoidectomy and tonsillectomy are amongst the most common surgical procedures carried out in children. We undertook a prospective audit in the Highlands of Scotland to document the views of general practitioners, parents, nursing staff and anaesthetists on admission and discharge policy. Of responses from 149 general practitioners, 119 (80 per cent) were in favour of change to same day admission and 22 (15 per cent) were not in favour. For change to same day discharge for adenoidectomy, 55 (37 per cent) were in favour and 81 (54 per cent) were not in favour. For change to next day discharge for tonsillectomy, the figures were 51 (34 per cent) and 89 (60 per cent) respectively. Responses from 14 trained paediatric nurses comprised 13 not in favour of same day admission, six in favour and seven not in favour of same day discharge for adenoidectomy and all 14 not in favour of same day discharge for tonsillectomy. All eight Consultant anaesthetists approached were happy with a change in policy to same day admission for children who were otherwise fit and well. Thirty-seven parents (70 per cent) preferred previous day admission and 14 (29 per cent) were happy with same day admission for their children. On the basis of these results, day-case adenoidectomy or tonsillectomy is not being considered in this area. Moves have been made, however, toward a policy of same day admission and next day discharge.

Adenoidectomy↗
PubMed2003

Vertical growth changes after adenoidectomy.

The purpose of this retrospective investigation is to compare vertical growth component of craniofacial structure of subjects with early and late adenoidectomy history. The study consisted of 93 lateral cephalometric radiographs of three groups of randomly selected patients. The first group was made up of 12 patients (10 male and two female) with an average age of 11.16 +/- 2.08 years, who had been operated upon between 1.5-4 years of age. The second group was made up of 54 patients (25 maleand 29 female) with an average age of 12.18 +/- 2.6 years, who had been operated upon after four years of age. The third group of 27 patients (7 male and 20 female) with clear airway with an average age of 11.18 +/- 2.35 years was used as the control. The data obtained from two adenoidectomy groups were compared and because no statistically significant difference was found except for ANSMe/NMe, the two groups were pooled and compared with the growth pattern in the control sample. There were statistically significant differences in the following parameters: SNGoMe, PPGoMe angle, Gonial angle, Gonial ratio, sigma of inner angles, ANSMe/NMe ratio, Jarabak ratio, PNS-adl distance, PNS-ad2 distance, OAW1 distance. When compared with the control group, the adenoidectomy group showed a more vertically directed growth pattern, however, there were no vertical growth pattern differences between the two groups of children who had adenoidectomy before and after four years of age.

Adenoidectomy↗
PubMed2002

Altered speech following adenoidectomy: a 20 year experience.

Altered speech related to velopharyngeal insufficiency is a rare but well-recognised complication of adenoidectomy. Over a 20 year period, 42 patients were referred to the Edinburgh cleft team for investigation of altered speech persisting for more than 12 months after adenoidectomy. We studied the cases to ascertain the incidence, clinical features and causes of altered speech in these patients and to assess the efficacy of a selective treatment policy. All data were prospectively collected when the patients were assessed in a multidisciplinary clinic and investigated by videofluoroscopy. Nasopharyngoscopy was also possible in half of the patients. Overall, 27 patients were male and 15 were female, and their mean age was 6.5 years. The incidence was one in 1200 adenoidectomies. Diagnoses included five submucous cleft palates, six occult submucous cleft palates, 22 cases of velopharyngeal disproportion, seven developmental or neurological causes, one iatrogenic palatal injury and one case that defied diagnosis. In six patients treatment was not required, 13 responded to speech therapy and 23 required surgical intervention. The choice of operation was based on the findings at investigation. Ten patients were treated by a superiorly based pharyngeal flap, 10 underwent a sphincteric pharyngoplasty and three had an intravelar veloplasty. Speech outcome was assessed in 36 cases. Treatment resulted in significantly improved speech in all but one patient and normal speech in 16 patients. Persistently altered speech is a rare complication of adenoidectomy. Preoperative screening by clinical examination will prevent some but not all of such problems. When patients present they should undergo multidisciplinary assessment and multi-modality investigation. A good outcome can be anticipated in most patients.

Adenoidectomy↗
PubMed2001

The role of adjuvant adenoidectomy and tonsillectomy in the outcome of the insertion of tympanostomy tubes.

BACKGROUND: Otitis media is the most common medical problem in young children. The usual surgical treatment is myringotomy with insertion of tympanostomy tubes. There is debate about the usefulness of concomitant adenoidectomy or adenotonsillectomy. We examined the effects of these adjuvant procedures on the rates of reinsertion of tympanostomy tubes and rehospitalization for conditions related to otitis media. METHODS: Using hospital discharge records for the period 1995 through 1997, we examined the results of surgery for all 37,316 children (defined as persons 19 years of age or younger) in Ontario, Canada, who received tympanostomy tubes as their first surgical treatment for otitis media. We determined the time to the first readmission for conditions related to otitis media and the time to the first reinsertion of tympanostomy tubes. RESULTS: As compared with treatment involving the insertion of tympanostomy tubes alone, adjuvant adenoidectomy was associated with a reduction in the likelihood of reinsertion of tympanostomy tubes (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001) and the likelihood of readmission for conditions related to otitis media (relative risk, 0.5; 95 percent confidence interval, 0.5 to 0.6; P<0.001). The risk of these outcomes was further reduced if an adjuvant adenotonsillectomy was performed. The effect was age-related. Children as young as one year appeared to benefit from adjuvant adenotonsillectomy; the benefit of an adjuvant adenoidectomy was apparent in two-year-olds and was greatest for children three years of age or older. CONCLUSIONS: Performing an adenoidectomy at the time of the initial insertion of tympanostomy tubes substantially reduces the likelihood of additional hospitalizations and operations related to otitis media among children two years of age or older.

Adenoidectomy↗
PubMed1982

Influence of premedication on plasma ACTH and cortisol concentrations in children during adenoidectomy.

The endocrine response to stress, as reflected by the plasma concentrations of ACTH and cortisol, was investigated in 14 children receiving two different premedications during halothane anaesthesia for adenoidectomy. Seven children (group A) were premedicated with diazepam 5 mg rectally and atropine 0.3-0.4 mg sublingually and seven (group B) received a rectal combination of diazepam 0.5 mg kg-1, morphine 0.15 mg kg-1 and hyoscine 0.01 mg kg-1. Before and after surgery plasma concentrations of ACTH and cortisol were lower in group B than in group A. In group A mean values for ACTH increased from 40.7 ng line-1 before adenoidectomy to 352.9 ng litre-1 (P less than 0.001) after adenoidectomy. The corresponding increase in group B was from 12.1 ng litre-1 to 82.1 ng litre-1 (P less than 0.01). In group A mean cortisol concentrations increased from 235.7 nmol litre-1 to 655.7 nmol litre-1 after adenoidectomy (P less than 0.01) and in group B from 121.4 nmol litre-1 to 427.9 nmol litre-1 (P less than 0.01). End-tidal carbon dioxide tension was approximately the same in both groups. It was concluded that the combination of diazepam, morphine and hyoscine decreased the endocrine response to stress.

Adenoidectomy↗
PubMed2001

Incidence of reflux in young children undergoing adenoidectomy.

OBJECTIVE: To compare the incidence of gastroesophageal reflux disease (GERD) in children under 2 years of age who have symptomatic adenoid hypertrophy requiring surgical removal or who have otitis media with effusion requiring ventilation tube insertion without adenoidectomy. STUDY DESIGN: Retrospective chart review. SETTING: An academic pediatric otolaryngology unit. PATIENTS: All children under age 2 undergoing adenoidectomy (Ad group) between January 1998 and May 2000 were compared with children in the same age range having ventilation tube insertion without adenoidectomy (VT group). MAIN OUTCOME MEASURES: Whether a diagnosis of GERD was made, how it was made, GERD treatment, and resolution of symptoms were compared. RESULTS: There were 95 children in the Ad group and 99 in the VT group. GERD incidence was significantly higher in the Ad group where it was 42% versus 7% in the VT group (P < .001). In the Ad group, 88% of children age 1 or less had GERD, and 32% of those older than 1 had GERD diagnosed. In the VT group, 14% of patients age 1 or less and 2% of those older than 1 had a diagnosis of GERD. CONCLUSIONS: Children under age 2 with symptomatic adenoid enlargement requiring adenoidectomy have a significantly higher incidence of GERD than children in the same age group presenting with otitis media requiring ventilation tube insertion.

Adenoidectomy↗