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PubMed2004

Adenoidectomy: selection criteria for surgical cases of otitis media.

OBJECTIVE: Nasopharyngeal adenoids may serve as a mechanical obstruction to the eustachian tube and contribute to the pathophysiology of otitis media (OM). The purpose of this study was to determine whether abutment of adenoids laterally against the torus tubaris affects the outcome of patients requiring pressure equalization tubes (PET) for OM. STUDY DESIGN: Randomized, controlled, prospective clinical trial. METHOD: Patients requiring PET for recurrent acute OM or OM with persistent effusion were randomized into two groups: 1) PET placement and 2) PET placement and adenoidectomy, regardless of whether the adenoids were abutting or not abutting the torus tubaris. Patients were followed for a minimum of 1 year to determine rate of treatment failure, defined as recurrence of acute OM (>3 times/year), OM with effusion, or reinsertion of PET. RESULTS: Of the 34 patients in the abutting group, 16 patients underwent only PET insertion, of whom 8 (50%) failed, whereas 18 patients had combined PET placement and adenoidectomy, of whom 3 (17%) failed. There was a statistical difference between these two groups (P < 05). Of the 29 patients in the nonabutting group, 24 patients underwent only PET insertion, of whom 9 (37.5%) failed, whereas 5 patients underwent combined PET placement and adenoidectomy, of whom 2 (40%) failed. There was no statistical difference between these two groups (P =.92). CONCLUSION: This study demonstrates that the position of hypertrophied adenoids may alter the final otologic outcome of patients requiring PET insertion for OM. Patients with adenoids abutting the torus tubaris may benefit most from an adjuvant adenoidectomy.

Acute Disease↗
PubMed1986

The effectiveness of adenoidectomy in the treatment of glue ear: a randomized controlled trial.

One hundred children with glue ear, in whom surgical treatment was indicated, were randomly allocated to 1 of 4 treatment groups. Children in 2 of the groups underwent adenoidectomy plus various combinations of ear operations while in the other 2 groups surgery was confined to the ears. The effect of adenoidectomy was assessed 6 weeks, 6 months and 1 year after surgery by means of audiometry, impedance tympanometry and parental opinion. Improvements in hearing were greater in those children who underwent an adenoidectomy than in those who did not (4.0 dB at 6 weeks; 2.4 dB at 6 months; 0.7 dB at 1 year). However, these differences are of little clinical significance and were only statistically significant (P less than 0.05) 6 weeks after surgery. Middle ear function, measured by tympanometry, revealed a similar pattern of response to treatment. Despite this, 6 months after surgery a higher proportion of parents were satisfied with their child's condition if an adenoidectomy had been performed. Possible explanations of this discrepancy between clinical and parental assessments of outcome are discussed.

Acoustic Impedance Tests↗
PubMed1994

Does adenoidectomy have an adjuvant effect on ventilation tube insertion and thus reduce the need for re-treatment?

Two hundred and twenty-two children with bilateral otitis media with effusion were followed for 5 years. A ventilation tube was inserted into one ear only and reinserted if the condition had not resolved. The need for reinsertion in 139 children in whom the adenoids were also removed was compared with the 83 children treated by tube insertion alone. In the combined group in year 1, 91% required one tube compared with 62% treated with only a tube. By year 5, 66% of the combined group required one tube compared with 32.5% in those without adenoidectomy. There was some relationship between tube reinsertion and age, and also with parental smoking. It is possible that the combination of adenoidectomy with tube insertion may prove more cost-effective than tube insertion in selected cases alone. In addition, once adenoidectomy becomes more established as a day case procedure, the cost benefit will be more advantageous in those children treated with adenoidectomy and a tube compared with those treated with only a tube.

Adenoidectomy↗
PubMed1995

A prospective study of day case adenoidectomy.

Adenoidectomy in this country is typically performed as an in-patient procedure requiring an overnight stay in hospital but experience from other countries shows that adenoidectomy can be safely performed as a day case procedure. In Leicester, a prospective study of day case adenoidectomy was initiated in 1991 under carefully monitored conditions. We report on 721 patients entered in the first 3 years. We have so far found day case adenoidectomy to be a safe procedure.

Adenoidectomy↗
PubMed1978

Allergy, otitis media and serum immunoglobulins after adenoidectomy.

The incidence of atopic disease and of episodes of otitis media, respiratory tract infections as well as levels of serum immunoglobulins were followed during 16 months after adenoidectomy in a consecutive group of 274 children. The total incidence of atopic disease was high (23.6%) at the start of the study and increased further to 39.0% during the study. Increased serum IgE levels, positive RAST tests and/or positive provocation tests were found before the onset of atopic symptoms in 13 out of the 19 children developing such symptoms during the observation period. Otitis media continued to occur in 42.9% of the children. The incidence of episodes of otitis media after the adenoidectomy was higher with lower age, a high number of episodes of otitis media before the operation and/or a history of atropic disease. None of the laboratory tests could predict subsequent episodes of otitis media. Protracted respiratory tract infections developed only in children with laboratory findings indicative of atopy. Serum IgE and IgM levels decreased significantly. No serious infections and no dysgammaglobulinaemias developed. Adenoidectomy seems to be a rather minor trauma from an immunological point of view, but further and controlled studies are needed concerning the possible clinical benefit of adenoidectomy in children with recurrent otitis media.

Adenoidectomy↗
PubMed2006

Topical adrenaline in the control of intraoperative bleeding in adenoidectomy: a randomised, controlled trial.

OBJECTIVES: To evaluate the efficacy of topical racemic adrenaline (RA) (Micronefrin; Bird Products, Palm Springs, CA, USA) in the control of intraoperative bleeding and the prevention of postoperative bleeding, laryngeal spasm and postoperative pain in adenoidectomy among children <6 years of age. DESIGN: Prospective, randomised, blinded and placebo-controlled trial. SETTING: Kanta-Hame Central Hospital, a district referral center in Finland. PATIENTS: A consecutive sample of 93 children undergoing outpatient adenoidectomy. INTERVENTION: Patients were randomised to receive topical gauze sponges soaked in either 1:500 RA or 0.9% sodium chloride (physiological saline) for 3 min after adenoidectomy. MAIN OUTCOME MEASURES: Amount of intraoperative bleeding (surgeons' subjective estimate), need for additional packings, need for electrocautery, laryngeal spasm, postoperative bleeding and pain, duration of procedure and duration of patients' stay in the operation room (OR). RESULTS: Adrenaline significantly decreased surgeons' subjective estimate of the amount of intraoperative bleeding (proportion of patients with significant decrease 67 versus 21%, P < 0.001), reduced the mean number of packings needed (0.6 versus 1.2, P < 0.001) and use of electrocautery (22 versus 45%, P = 0.015), and shortened the mean duration of the procedure (13 versus 18 min, P = 0.043) and the mean stay in the OR (31 versus 35 min, P = 0.058). The impact of adrenaline was even more pronounced among patients with extensive adenoids and/or profuse intraoperative bleeding. A slight elevation of heart rate was observed more often in the adrenaline group (P = 0.043). CONCLUSIONS: Use of topical adrenaline can be recommended in adenoidectomy among children. It helps control the intraoperative bleeding, reduces the use of electrocautery and shortens the durations of procedure and stay in the OR.

Adenoidectomy↗
PubMed2004

Adenoidectomy versus chemoprophylaxis and placebo for recurrent acute otitis media in children aged under 2 years: randomised controlled trial.

OBJECTIVE: To evaluate the efficacy of adenoidectomy compared with long term chemoprophylaxis and placebo in the prevention of recurrent acute otitis media in children aged between 10 months and 2 years. DESIGN: Randomised, double blind, controlled trial. SETTING: Oulu University Hospital, a tertiary centre in Finland. PARTICIPANTS: 180 children aged 10 months to 2 years with recurrent acute otitis media. INTERVENTION: Adenoidectomy, sulfafurazole (sulphisoxazole) 50 mg/kg body weight, given once a day for six months or placebo. Follow up lasted for two years, during which time all symptoms and episodes of acute otitis media were recorded. MAIN OUTCOME MEASURES: Intervention failure (two episodes in two months or three in six months or persistent effusion) during follow up, number of episodes of acute otitis media, number of visits to a doctor because of any infection, and antibiotic prescriptions Number of prescriptions, and days with symptoms of respiratory infection. RESULTS: Compared with placebo, interventions failed during both the first six months and the rest of the follow up period of 24 months similarly in the adenoidectomy and chemoprophylaxis groups (at six months the differences in risk were 10% (95% confidence interval -9% to 29%) and 18% (-2% to 38%), respectively). No significant differences were observed between the groups in the numbers of episodes of acute otitis media, visits to a doctor, antibiotic prescriptions, and days with symptoms of respiratory infection. CONCLUSIONS: Adenoidectomy, as the first surgical treatment of children aged 10 to 24 months with recurrent acute otitis media, is not effective in preventing further episodes. It cannot be recommended as the primary method of prophylaxis.

Adenoidectomy↗
PubMed2003

Effect of modern fibrin glue on bleeding after tonsillectomy and adenoidectomy.

We performed a prospective randomized study in 179 patients to examine the second-generation surgical fibrin sealant Quixil as an effective substitute for different types of electrocautery in tonsillectomy and adenoidectomy. We compared the rates of hemorrhagic complications in a group with bipolar or needle point electrocautery and in a group in whom fibrin glue was used to stop intraoperative bleeding and to prevent postoperative bleeding. The operations were performed under general anesthesia in typical fashion with sharp dissection. For the control group, hemostasis was achieved by bipolar or needle point electrocautery. For the fibrin glue group, hemostasis was achieved by spraying Quixil fibrin glue approximately 0.5 mL to each tonsillar fossa and 0.5 mL to the nasopharynx (in adenoidectomy). The results were excellent in all the patients of the fibrin glue group, with complete hemostasis and resolution of the major symptoms. In this group, the intraoperative blood loss averaged 15 mL in tonsillectomy and 9 mL in adenoidectomy. There were no cases of postoperative hemorrhage or any other complications. The electrocautery group required a longer time for healing, and its intraoperative blood loss (tonsillectomy) averaged 29 to 33 mL. The incidence of posttonsillectomy bleeding in this group was 4.35% (4 patients). Three patients (3.26%) had primary hemorrhage (bleeding that occurs within the first 24 hours of surgery), and 1 patient (1.09%) had secondary hemorrhage (bleeding that occurs after the first 24 hours). We conclude that Quixil fibrin glue application to the operative sites in tonsillectomy and adenoidectomy provides effective hemostasis and sealing with good systemic and local compatibility. With the help of Quixil, we minimized surgical trauma and achievedabsolute hemostasis at the same time. We found this fibrin glue to be a more convenient and effective hemostatic sealant than bipolar or needle point coagulation.

Adenoidectomy↗
PubMed2004

Indications and outcomes of adenoidectomy in infancy.

Adenoid hypertrophy is one of the most common causes of pediatric obstructive sleep apnea. Although adenoidectomy is the only effective treatment for adenoid hypertrophy, it is rarely performed in infants less than 1 year old. This study reports on the successful use of adenoidectomy in 24 infants less than 1 year old with a triad of upper airway obstruction symptoms, findings of obstructing adenoids, and obstructive sleep apnea (but no other anomalies). This is a retrospective case series reviewing each infant's clinical data, including presenting symptoms (with special emphasis on apnea episodes), physical examination findings, and results of other investigations such as polysomnography, endoscopy, pH-metry, and echocardiography. With careful preoperative and postoperative monitoring, the 24 infants underwent adenoidectomy without complications. After the procedure, all showed marked improvement with complete disappearance of symptoms of upper airway obstruction, failure to thrive, and gastroesophageal reflux disease. Adenoidectomy was found to be sufficient and curative for such infants.

Adenoidectomy↗
PubMed1992

Current indications for tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy are currently the most common pediatric surgical procedures performed in the United States. Tonsillectomy may be effective in recurrent acute throat infection (acute tonsillitis), chronic tonsillitis, tonsillar hypertrophy, and peritonsillar abscess. Antimicrobial therapy may also be beneficial. Clinical trials evaluating children with obstructive adenoids are currently being evaluated; anecdotal evidence points to improvement in development and quality of life after surgery. The efficacy of adenoidectomy in paranasal sinusitis has not been evaluated in clinical trials; antimicrobial therapy or the possibility of upper respiratory tract allergy should be considered in such cases. For acute otitis media, recommendations range from no treatment in cases that will abate with time, to anti-microbial prophylaxis, to myringotomy with tympanostomy tube insertion, adenoidectomy with or without tonsillectomy, or a combination of adenoidectomy with myringotomy and/or tympanostomy tubes. The decision for or against otic and/or pharyngeal surgery should be individualized on the basis of severity, duration, and frequency of illness; previous treatment; and risk.

Adenoidectomy↗
PubMed1988

Effect of adenoidectomy upon children with chronic otitis media with effusion.

To investigate the mechanism whereby adenoidectomy influences the subsequent course of patients with chronic otitis media with effusion, we analyzed, on the basis of adenoid size, the outcomes of 476 children randomly assigned to receive, after paracentesis and aspiration of the middle ear, either no treatment, tympanostomy tubes, adenoidectomy, or both. The two groups receiving adenoidectomy did significantly better than those who did not, and the effect was independent of adenoid size. This suggests that reduction of the adenoidal bacterial reservoir may be the mechanism whereby adenoidectomy is effective.

Adenoidectomy↗
PubMed2005

[Effects of orthodontic treatment after adenoidectomy on jaw relations in the sagittal plane].

AIM: To evaluate the orthodontic treatment effects, performed immediately after adenoidectomy, on lips relation, overjet and class (Angle). METHODS: Three groups of patients, aged 6-17 years, were observed: group K--patients with oral respiration caused by adenoidal enlargement; group 1--patients with adenoidectomy performed five and more years previously; group 2--patients with one year of orthodontic treatment performed immediately after adenoidectomy. Lips and overjet status and class (Angle) was measured in the examined patients. RESULTS: In all of the three examined groups, there was a statistically highly significant increase (p<0.01) of competent lips. In the patients of group K, the overjet values ranged from 1 mm up to 12 mm where 90% of them had overjet > 4 mm and 6% < 1 mm. The front open bite, low overbite and reversed overjet was found in the patients with low overjet in this group, as well. Overjet values in the patients of group 1 ranged from -2 mm up to 12 mm where 86% had overjet > 4 mm and 10% < 1 mm. Significantly higher increase (p<0.01) of overjet values (1-4 mm in 94% of patients) was observed in the patients of group 2 in comparison to the values found in the patients from groups 0 and 1. Class II (Angle) was recorded in 81% of the patients in group 0, and 79% in group 1, while class I (Angle) was observed 100% only in the patients of group 2. CONCLUSION: Orthodontic treatment immediately after adenoidectomy was necessary for achieving the competition lips relation, normal overjet and class I (Angle).

Adenoidectomy↗
PubMed2005

[Effect of nasal endoscopy-assisted adenoidectomy on the development of pediatric chronic sinusitis and otitis media with effusion].

OBJECTIVE: To discuss the effect of nasal endoscopy-assisted adenoidectomy with debrided on the development of pediatric chronic sinusitis and otitis media with effusion. METHOD: Fifteen cases of hypertrophied adenoid with pediatric chronic sinusitis and/or otitis media with effusion were treated with nasal endoscopy-assisted adenoidectomy and medicines followed. RESULT: No remainder of adenoid was left, no complication occurred and snoring disappeared in all patients. Pediatric chronic sinusitis and/or otitis media with effusion recovered with medicines after adenoidectomy. CONCLUSION: Nasal endoscopy-assisted adenoidectomy with debrided was an minimally invasive and effective treatment for hypertrophied adenoid, as well as contributed to the development of pediatric chronic sinusitis and otitis media with effusion.

Adenoidectomy↗
PubMedDate not supplied

[Epidemiology of tonsillectomy and/or adenoidectomy in Italy].

OBJECTIVES AND METHODS: Aim of the study was to describe frequency, causes, regional variations, setting and risk of mortality of tonsillectomy and adenoidectomy in Italy. The study is based on hospital discharge data for the years 1998-2000 provided by the Ministry of Health. RESULTS: During the year 2000, 61.280 tonsillectomy with or without adenoidectomy and 32.655 adenoidectomy alone were performed in Italy. ICD-9-CM codes reported on discharge abstracts indicated that the most frequent causes of tonsillectomy were chronic tonsillitis (45%) and hypertrophy of tonsils and adenoids (43%). The total tonsillectomy rate was 10.6 x 10.000 (CI 10.5-10.7) in 2000, and it was stable throughout the study period. We observed a wide geographical variability of regional tonsillectomy rates, standardised by age and sex. They ranged from 3.5 x 10.000 (CI 3.1-4.0) in Basilicata to 19.0 (CI 18.6-19.5) in Piemonte. We found an inverse correlation (r = -0.50) between regional tonsillectomy rates for tonsillitis and minimum temperatures recorded in capitals of the regions. Most operations were performed in the acute setting with a hospital stay longer than one day. The mortality risk associated to surgery was estimated to be at least of one case over 95.000 operations. CONCLUSIONS: The observed variability of regional tonsillectomy rates, only partly explained by weather differences, may be ascribed to disagreement among physicians. Inappropriate variations and setting were the two main reasons conducive to the development of the guidelines "Clinical and organisational appropriateness of tonsillectomy and/or adenoidectomy in Italy", in the frame of LINCO project and of the Italian National Program for Guidelines.

Adenoidectomy↗
PubMed2004

Effects of adenoidectomy and changed mode of breathing on incisor and molar dentoalveolar heights and anterior face heights.

BACKGROUND: Mouth breathing may affect facial form and the positions of the teeth. OBJECTIVES: To determine whether the increased dentoalveolar and facial heights found in mouth breathing children with enlarged adenoids are maintained following adenoidectomy and changed mode of breathing from mouth to nose. METHODS: The subjects were Swedish children, either mouth breathers with nasal obstruction caused by large adenoids, or nose breathers. The children in the mouth breathing group were adenoidectomized at seven years of age and changed from mouth breathing to nose breathing. The unoperated subjects were age and sex matched to the operated subjects, and both groups were followed up again at 12 years of age. The incisor and molar dentoalveolar heights and anterior face heights, measured on lateral cephalometric radiographs, were compared prior to adenoidectomy and at 12 years of age. RESULTS: Significant intra-group increases were found for all dentoalveolar heights and 5 out of 6 facial heights. Only the ratio of upper anterior to lower anterior face height in the controls was not different statistically. Upper posterior dentoalveolar height was significantly larger (p < 0.05) in the adenoidectomized group compared with the controls at follow up, but not before adenoidectomy. Lower face height was significantly longer (p < 0.001) in the adenoidectomized group compared with the control group initially, and at follow up (p < 0.01). Initially, the ratio of upper face height to lower face height was significantly larger (p < 0.001) in the control group than the adenoidectomized group, but the groups were similar at follow up. Small, but statistically significant, correlations were found between the changes in upper molar dental height and the mode of breathing (p < 0.05) in the adenoidectomized group, and between the change in the ratio of upper to lower face heights and the mode of breathing (p < 0.01). CONCLUSION: The changes in the dentoalveolar heights of the maxillary molars, and the ratio of the upper and lower anterior face heights seem to be associated with the change in mode of breathing from mouth to nose breathing after adenoidectomy.

Adenoidectomy↗
PubMed1991

Changes in vocal resonance and nasalization following adenoidectomy in normal children: preliminary findings.

The purpose of this study was to evaluate changes that occur in certain aspects of vocal resonance and nasalization following adenoidectomy. Fourteen normal children were assessed prior to adenoidectomy and then at one month, three months, and six months following surgery. A unique combination of aerodynamic, acoustic, and perceptual measures were made. The aerodynamic component of the evaluation involved the use of posterior rhinomanometry to calculate nasal airway resistance (Rnaw) during relaxed nasal breathing. Acoustical measures consisted of "nasalance" scores (oral/nasal acoustic ratio) obtained during production of various speech stimuli. In addition, perceptual measures of change in vocal quality included listener judgments of severity and categorical ratings of nasality. Consistent patterns of change in vocal resonance and nasalization following adenoidectomy were identified. Clinical implications of these preliminary findings suggest that the maximum increase in nasality after tonsillectomy and adenoidectomy occurs at about one month, and referral to a speech-language pathologist should be considered if the hypernasality persists beyond three months.

Adenoidectomy↗
PubMed1978

Tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy is the definitive treatment for chronic tonsillitis and adenoid hypertrophy. It is most important to determine if the patient has chronic tonsillitis--a diagnosis that can only be made between acute attacks when the patient is clinically well. Decisions regarding the need for a tonsillectomy and adenoidectomy should be made only at this time and never during an episode of acute tonsillitis. Frequency of acute attacks should not by itself be the indication for surgery. The family physician who performs tonsillectomy and adenoidectomies has an opportunity to correlate the preoperative and postoperative clinical course of the patient with the findings at the time of surgery. In my experience, patients carefully selected for tonsillectomy and adenoidectomy on the basis of these criteria do benefit from the surgery, and the clinical improvement is sustained in the long-term follow up of these patients.

Adenoidectomy↗
PubMed1994

Adenoidectomy: indirect visualization of choanal adenoids.

A retrospective review of adenoidectomies was carried out at the Montreal Children's Hospital, Montreal, Quebec. From April 1, 1990, to November 14, 1992, the senior author (JJM) was involved in 330 adenoidectomies with or without concurrent tonsillectomy or pressure equalization tube (PET) insertion. In all cases, adenoid surgery was performed with proper soft palate retraction and indirect visual inspection using laryngeal mirrors. A subgroup of 31 patients (9.4%) was identified as having adenoid tissue extending from the nasopharynx into the choanae and posterior nasal cavity: "choanal adenoids." The characteristics of this subgroup are outlined in the hope that features may be useful in identifying potential choanal adenoids preoperatively. Furthermore, the use of indirect visualization, as opposed to the traditional "blind adenoidectomy," is proposed so that no significant residual adenoid tissue remains post-adenoidectomy.

Adenoidectomy↗