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PubMed1998

Risk factors for permanent hypernasality after adenoidectomy.

OBJECTIVES: To investigate the causes of persistent, apparently permanent hypernasal speech following adenoidectomy in 10 subjects without overt cleft palates, and to establish a protocol to be followed before this operation is performed. DESIGN: Retrospective and descriptive design. PARTICIPANTS: Ten subjects, fulfilling the following criteria, were included: (i) subjects had undergone adenoidectomy which resulted in hypernasal speech that persisted for longer than 3 months (and was therefore considered to be permanent); (ii) subjects did not have a cleft lip or overt cleft palate; (iii) there was no hearing loss of sufficient magnitude to account for the hypernasal speech; and (iv) the hypernasality was rated as severe by a speech therapist, could not be remedied by speech therapy alone and required further management by a plastic surgeon through pharyngosplasty. Ten subjects were found through the clinical records of speech therapists and plastic surgeons working in hospitals and private practice. The following information was obtained through interviews or by reading the case files: (i) identifying information; (ii) the presence of any of the factors reported in the literature to be associated with the permanent hypernasality or nasal emission, as well as the method of identification; and (iii) whether these factors had been identified before or after the adenoidectomy. RESULTS: Nine out of a total of 10 subjects showed preoperative perceptual and structural characteristics and/or case history factors that have been documented to constitute risk factors for the development of nasal speech, should an adenoidectomy be performed. The methods used to investigate these factors pre-operatively appear to have been inadequate. CONCLUSION: This undesirable sequel to surgery can be prevented if certain case history and speech factors are investigated and followed up with radiographic procedures if necessary.

Adenoidectomy↗
PubMed1989

Adenoidectomy for secretory otitis media.

Thirty years of treating secretory otitis media by what is presently considered an alternate approach is discussed. Early experience with using a polyethylene tube in one ear only led to a formal study of the efficacy of polyethylene tube use when combined with adenoidectomy or adenotonsillectomy. This study included 31 children with chronic bilateral secretory otitis media treated by tonsillectomy and adenoidectomy. At the time of surgery, one ear was intubated and the other served as a control with no treatment. Using audiometric criteria, it was found that there was no significant difference between the intubated and control ears after a 6- to 8-week follow-up. Also documented is a series of 425 children suffering from chronic secretory otitis media, all of whom were resistant to prior ear, nose, and throat or pediatric treatment. Fifty-three children had tonsillectomies and adenoidectomies without tube insertion and were followed up for at least 1 year. Audiometry was used to measure the result of therapy that was successful in more than 90% of the patients.

Adenoidectomy↗
PubMed1997

Efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children.

OBJECTIVE: To determine the efficacy of adenoidectomy in relieving symptoms of chronic sinusitis in children. DESIGN: Retrospective case series. SETTING: Tertiary care center. PATIENTS: Symptoms of chronic sinusitis were studied in 48 consecutive patients who underwent adenoidectomy or adenotonsillectomy between October 1993 and May 1995. Children with cystic fibrosis or those who underwent concurrent endoscopic sinus surgery were excluded. Patient ages ranged from 1 to 12 years. Four patients were unavailable for follow-up and did not complete the study. MAIN OUTCOME MEASURES: Patients' charts were reviewed for the presence of preoperative symptoms, including rhinorrhea, nasal congestion, headache, postnasal drainage, cough, halitosis, and irritability. Also recorded were mouth breathing, fevers, and frequent antibiotic use. Telephone interviews with the patients' caregivers were conducted to collect information following the surgery regarding the presence of the same symptoms as well as an estimate of overall improvement. Follow-up ranged from 5 months to 2 years. RESULTS: The most frequently reported symptoms before surgery were rhinorrhea, nasal congestion, mouth breathing, and frequent antibiotic use (35, 37, 34, and 38 patients, respectively). These numbers decreased following surgery to 18, 20, 11, and 10 patients, respectively. The average number of symptoms experienced by each patient decreased from 5.3 to 2.9. Complete or near symptom resolution was reported in 25 (58%) of 43 patients. Some improvement was reported in another 9 patients (21%). Minimal or no improvement was reported in 9 patients (21%). To date, only 3 patients have gone on to have endoscopic sinus surgery. CONCLUSION: In the majority of cases, symptoms of chronic sinusitis in children are relieved by adenoidectomy.

Adenoidectomy↗
PubMed2005

Effects of adenoidectomy in children with symptoms of adenoidal hypertrophy.

The purpose of this study was to compare the preoperative symptoms of children who had adenoid hypertrophy with postadenoidectomy symptoms. Sixty children undergoing adenoidectomy were included in this prospective uncontrolled study at the Farabi Hospital of Karadeniz Technical University, an academic tertiary medical center. The symptoms of each child were described by their parents. Adenoidectomy with myringotomy alone or with tympanostomy tube placement was performed in all children. Two months after the operation, the children were re-evaluated for remaining or residual symptoms. Nasal obstruction, mouth breathing, snoring, hearing loss and nasal discharge were present preoperatively in 55 (91.6%), 51 (85%), 50 (83%), 28 (46%) and 45 (75%), respectively. We found that 53 of 60 children (88.3%) completely recovered from their preoperative symptoms. Of the remaining seven patients, four had persistent nasal obstruction, five mouth breathing, three snoring and two hearing loss. We also noted that the parents of 53 of 60 children were satisfied after the operation. Adenoidectomy provided significant relief and improvement of preoperative presenting symptoms, and it also showed a high rate of parent satisfaction.

Adenoidectomy↗
PubMed1989

Rhinomanometry in the selection for adenoidectomy and its relation to preoperative radiology.

Recent work has shown that resolution of otitis media with effusion (OME) following adenoidectomy may be related to certain preoperative radiographic parameters. This study was performed to investigate the relationship between the total nasal resistance (TNR), adenoid volume and the radiographic palatal airway and adenoid depth in children with OME. Fifty-six children underwent anterior active rhinomanometry and 40 completed the investigation. There was a significant association between the Palatal Airway and the TNR, and in the 27 who subsequently underwent adenoidectomy this was nearly so with respect to adenoid volume and TNR. The relationship demonstrated was not strong enough for TNR to be of use in selection of children for adenoidectomy based on radiographic parameters. Rhinomanometry can be difficult and time-consuming to perform in children. In its present form it is unlikely to be of routine clinical use in this context.

Adenoidectomy↗
PubMed2006

Utility of prophylactic antibiotics in pediatric adenoidectomy.

OBJECTIVE: To determine the utility of prophylactic antibiotics in non-risk pediatric patients undergoing adenoidectomy. METHODS: We performed a prospective, controlled, randomized, and double-blind study on patients under 14 years of age, scheduled for adenoidectomy who accomplished the following criteria: absence of 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 for culture were obtained at 30s and 20 min after the curettage of adenoidal tissue. Likewise, immediate and delayed complications were registered in all cases. The usefulness of prophylaxis was analyzed according to three major standpoints: bacteremia, immediate complications, and delayed complications. RESULTS: One-hundred one patients fulfilled the inclusion criteria and were included in the study. Fifty-one children received prophylaxis and the remainder did not. In the non-prophylactic group incidence of bacteremia at 30s was significantly higher than in the prophylactic group (32.7% versus 4.0%) (p<0.001). Neither bacteremia at 20 min, nor immediate or delayed complications showed statistical differences between both treatment groups. CONCLUSIONS: Preoperative antimicrobial prophylaxis in pediatric adenoidectomy did not offer advantages preventing complications in non-risk patients. Only bacteremia that occurs 30s after the curettage of adenoid tissue is reduced with the employment of prophylactic antibiotics.

Adenoidectomy↗
PubMed2006

Endoscopic adenoidectomy in children with submucosal cleft palate.

OBJECTIVE: To determine the safety and effectiveness of endoscopic partial adenoidectomy for the treatment of nasal obstruction in children with submucosal cleft palate. METHODS: The medical files of children with symptoms of nasal obstruction and submucosal cleft palate who underwent partial transnasal endoscopic adenoidectomy from January 1993 to December 2003 were reviewed. Operative complications, relief of nasal obstruction, presence of postoperative velopharyngeal insufficiency were recorded. RESULTS: There were no operative complications. All the children had relief of nasal obstruction. Velopharyngeal insufficiency was not observed during the postoperative follow-up. CONCLUSIONS: Endoscopic partial adenoidectomy is a safe and effective procedure for the treatment of nasal obstruction in children with submucosal cleft palate.

Adenoidectomy↗
PubMed2005

Hemorrhage following tonsillectomy and adenoidectomy in 15,218 patients.

OBJECTIVE: To evaluate potential risk factors and the incidence of bleeding following adenoidectomy or tonsillectomy, with or without adenoidectomy requiring surgical treatment under general anesthesia. STUDY DESIGN AND SETTING: Retrospective chart review of 15,218 patients who underwent surgery between January 1, 1988, and September 30, 2001, at our institution (St. Anna Hospital, Duisburg). RESULTS: A total of 229 patients experienced postoperative bleeding (1.5%). Patients of male gender and 70 years of age or older were significantly at risk for post-tonsillectomy hemorrhage. The incidence of bleeding increased with age. Of the bleeding episodes, 76% occurred on the day of surgery; immediate abscess-tonsillectomy was not associated with an increased risk of bleeding. CONCLUSIONS: Hemorrhage following tonsillectomy and adenoidectomy is rare and predominantly occurs early after surgery. Male patients, 70 years of age or older, infectious mononucleosis, and a history of recurrent tonsillitis were identified as risk factors for post-tonsillectomy hemorrhage. Delayed hemorrhage has the potential to be life-threatening.

Adenoidectomy↗
PubMed2006

Adenoidectomy: long-term follow-up.

OBJECTIVE: To assess the long-term (3-5 years) success of adenoidectomy and reasons for unsatisfactory results. STUDY DESIGN AND SETTING: The parents of all children who underwent adenoidectomy alone at a major tertiary center from 1998 to 2000 were asked to complete a questionnaire assessing their child's well-being and symptomatology 3-5 years after surgery; some were invited for follow-up. Symptom improvement, persistent symptoms, and adenoid regrowth were evaluated. RESULTS: Among the 206 parents who complied, 74%-87% reported improvement in all main symptoms: nasal obstruction, snoring, chronic rhinorrhea, hyponasal speech, and obstructive sleep disorder. At follow-up (n = 36), the symptomatic patients had significantly more anatomic nasal abnormalities (P = 0.01) and a higher rate of significant adenoid enlargement (P = 0.08), 3 patients (19%) vs none (0%). CONCLUSIONS AND SIGNIFICANCE: Adenoidectomy alone is satisfactory treatment for nasal obstruction and obstructive sleep apnea in selected children. Though some adenoid regrowth is not rare, clinically significant adenoid regrowth is infrequent. Persistent or recurrent symptoms are attributable mainly to nasal pathology.

Adenoidectomy↗
PubMed2006

[Indications for tonsillectomy and adenoidectomy: consensus document by the Spanish Society of ORL and the Spanish Society of Pediatrics].

Tonsillectomy and adenoidectomy are probably the commonest surgeries performed in the ENT field as well as the most controversial ones. There are very few consensus documents available for these two surgeries. In 1997 a document written by the two mentioned Societies was published, in order to update such document regarding tonsillectomy and adenoidectomy procedures we have met this year representatives from both scientific societies and a new document has been elaborated. We describe the diagnostic criteria of pharyngo-tonsillitis and adenoiditis as well as of obstructive sleep apnoea syndrome, with the aim of a better comprehension of these processes when a decision needs to be made regarding surgery. Indications and contraindications of tonsillectomy and adenoidectomy are here described.

Adenoidectomy↗
PubMed1996

Tonsillectomy and adenoidectomy. Changing indications.

Obstructive sleep apnea and upper airway obstruction (even without complete apnea) from adenotonsillar hypertrophy is either occurring more frequently or is becoming better recognized. Tonsillectomy or adenoidectomy is indicated for these children. Most patients who would benefit from surgery can be identified by a thorough history and physical examination. Occasionally, additional methods of evaluation, such as lateral neck radiographs or polysomnograms, are helpful. The indications for tonsillectomy and adenoidectomy are varied. No review can cogently encompass all clinical scenarios. Tonsillectomy and adenoidectomy remain valuable procedures for carefully selected patients.

Adenoidectomy↗
PubMed2000

On the decision of outpatient adenoidectomy and adenotonsillectomy in children.

OBJECTIVE: Outpatient tonsillectomy and/or adenoidectomy is the procedure of choice in the US, whereas in Europe, the transition from the traditional duration of hospital stay to same day discharge slowly increases. This trial was conducted to find factors, which influence surgery on an outpatient basis and to find possible positive and negative predictive conditions in patients. METHODS: Most trials, which argue for a same day discharge take the low percentage of postoperative hemorrhage into account. Hemorrhage, apnea and infections are complications and have to be distinguished from sequelae such as poor oral intake (with consecutive i.v. fluid supply), fever and protracted vomiting, that also should be considered as discharge criteria. Complications as well as sequelae were measured in 114 consecutive children, and the patients divided into an adenotonsillectomy group and an adenoidectomy group. RESULTS: Patients from both groups that underwent surgery because of severe obstructive symptoms had significantly more sequelae than those indicated because of chronic or recurrent infections. They could not have been discharged in an acceptable condition. Due to the fact that most children after adenoidectomy recovered well 8 h postoperatively, they could have been discharged on the same day. Children after adenotonsillectomy had significantly more sequelae. There was a tendency that adenotonsillectomy children with only mild obstructions could have been discharged either 8 or at least 24 h postoperatively. It still remains the surgeon's decision when a child can be discharged safely.

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PubMed1985

The long term effect of adenoidectomy on established otitis media with effusion in children.

Adenoidectomy is a recommended treatment for otitis media with effusion (OME). This work up-dates a previous report and includes a larger number of 155 cases. Surgery has been allocated at random with a control non-adenoidectomy group. The study is prospective and allows for a wide variety of variables. These include age, sex, adenoid size, seasonal variation, observer accuracy, and spontaneous resolution. Adenoidectomy results in clearance of OME even one year following operation in 31-45% of cases. Clearance is related to the duration of history of hearing loss though this may reflect on age effect. Tonsillectomy provides no additional benefit.

Adenoidectomy↗
PubMed2006

Histological analysis of tonsillectomy and adenoidectomy specimens--January 2001 to May 2003.

UNLABELLED: Palatine and nasopharyngeal tonsils are nonencapsulated nodular masses of lymphoid tissue of the respiratory and digestive tract epithelium. STUDY DESIGN: Retrospective clinical study based on the revision of medical records of patients who underwent tonsillectomy and adenoidectomy at Hospital das Clínicas, Medical School, Marília in the period between January 2001 and May 2003. AIM: Analysis of patients' profile and main pathological changes in 250 patients with palatine and nasopharyngeal tonsil hypertrophy, recurrent infections or both. MATERIAL AND METHOD: Histological review of 250 patients who underwent tonsillectomy and adenoidectomy among adults and children. RESULTS: Out of 250 subjects, 117 (46.8%) were female and 133 (53.2%) were male patients. Mean age was 7.3 years, ranging from 2 to 34 years. Main surgical indication was concomitant presence of recurrent infections and hypertrophy of nasopharyngeal and palatine tonsils. Among these patients, 160 (64%) were classified as grades III to IV hypertrophy. Lymphatic or follicular lymphatic hyperplasia was observed in 205 patients (82%); focal inflammation was verified in 45 (18%) subjects. Among those, 2 patients presented squamous cell cysts, 2 had Actinomyces sp colonies and 1 cat scratch disease. DISCUSSION: The results presented in this study suggested a possible correlation between recurrent tonsillitis and palatine tonsil hypertrophy. CONCLUSION: Routine histological study of tonsillectomy and adenoidectomy specimens has a low cost-benefit rate, although, due to legal and ethical issues, physicians may request this type of examination.

Adenoidectomy↗
PubMed1987

The effect of tonsillectomy and adenoidectomy on the intra-tympanic pressure.

A group of 67 children were studied (mean age 7 years, 2 months) who underwent adenoidectomy and/or tonsillectomy because of either recurrent otitis media or upper respiratory tract infection. The mean pre-operative intratympanic pressure was -67.3 mmH2O (SD 65.1); three months post-operatively it was -21.9 mmH2O (SD 32.4), a highly significant improvement (p less than 0.001). The size of the adenoids had a nearly significant effect on the pre-operative intratympanic pressure (p less than 0.05). In children with large vs small adenoids the difference was highly significant (p less than 0.001). In a group of five children, tonsillectomy alone (adenoidectomy performed earlier) did not have any effect on the intratympanic pressure. No change in intratympanic pressure was seen in children with nasal allergy as compared with non-allergic children after adenoidectomy.

Acoustic Impedance Tests↗
PubMed1989

Treatment of glue ear in relation to radiographic palatal airway size: a predictor for outcome following adenoidectomy?

Adenoidectomy performed for 'glue ear' accounts for many of the admissions for surgery in childhood. In spite of this there are no objective guidelines to enable the clinician to select those cases in whom a definite benefit is likely, or in whom such procedures might best be avoided. A total of 147 children with established bilateral glue ear randomized to adenoidectomy (A) or no pharyngeal surgery (NS) treatment groups were examined for clearance of effusion in an unoperated ear after one year. Outcome was analysed with respect to the pre-operative Radiographic Palatal Airway size in three groups in relation to mean measurements obtained from matched populations of normal children and those with established disease. Those with small airways had significantly increased clearance following A when compared with NS between the ages of 3-7 years. Adenoidectomy should probably not be performed in those children with large airway measurements, although the outcome may ultimately be related to the age at which surgery is performed.

Adenoidectomy↗
PubMed1990

Enlarged adenoid and adenoidectomy in adults: endoscopic approach and histopathological study.

Adenoid enlargement is uncommon in adults and because examination of the nasopharynx by indirect posterior rhinoscopy is inadequate, many cases of enlarged adenoid in adults are misdiagnosed and accordingly maltreated. This study was conducted on 35 cases of enlarged adenoid aged between 20 and 42 years. The nasal endoscope was utilized to identify the adenoid mass. Adenoidectomy under transnasal endoscopic control was performed and all the excised material was sent for histopathological examination. Adenoidectomy resulted in marked improvement in 94 per cent of cases without major complications. Histopathological examination revealed non-specific inflammatory reaction in 15 cases (43 per cent), pure reactive changes, predominantly follicular hyperplasia, in two cases (6 per cent) and mixed pattern in 18 cases (51 per cent). Endoscopic follow-up for an average 17 months identified recurrence in only two patients. It was concluded that enlarged adenoid tissue in adults has some histopathological differences from that in children and adenoidectomy under transnasal endoscopic control is safe and reliable.

Adenoidectomy↗
PubMed1994

Day-case adenoidectomy, parental opinions and concerns.

Day-case surgery has been urged on the National Health Service by the Audit Commission in the last decade despite concerns about safety. A questionnaire was posted to the parents of 109 children who had recently undergone day-case adenoidectomy, addressing parental concerns and opinions. Eighty per cent of the questionnaires were returned. A high level of satisfaction with day-case adenoidectomy was expressed by the parents. All the children were observed for six hours after surgery prior to discharge. One child was visited at home by his general practitioner in the first 24 hours of discharge but there were no serious post-operative complications and none of the children required re-admission to hospital. Day-case adenoidectomy is safe, very acceptable to parents and does not result in a greatly increased workload for general practitioners.

Adenoidectomy↗