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PubMed2006

[Comparison of the powered-assisted adenoidectomy with adenoid curette adenoidectomy].

OBJECTIVE: To compare the outcomes of powered-assisted adenoidectomy with adenoid curette adenoidectomy. METHOD: Thirty-four cases with adenoidal hypertrophy were retrospectively analyzed in Shanghai Sixth Peoples Hospital between June 2003 to June 2004. All the patients were followed up six to twelve months. Of 34 cases, 18 children underwent powered-assisted adenoidectomy, and the rest underwent conventional transoral adenoidectomy using a curette. The surgical results were assessed by acoustic rhinometry. RESULT: The averaged time for endoscopic powered-assisted adenoidectomy was 5 minutes and 15 seconds and the time for conventional adenoidectomy was 8 minutes and 22 seconds. There was a significant difference (P < 0.01) between them. The blood loss during powered-assisted and conventional adenoidectomy was 50 (10-125) ml and 75 (5-175) ml respectively, but there was no difference (P > 0.05). One case after powered-assisted adenoidectomy happened bleeding, and one case after conventional adenoidectomy happened dehydration. There were increases in the cross-sectional area at the adenoid, (0.75 +/- 0.58) cm2 preoperatively and (1.94 +/- 0.63) cm2 three months postoperatively, (1.99 +/- 0.44) cm2 one year after operation in powered-assisted group, and (0.80 +/- 0.53) cm2 preoperatively and (1.83 +/- 0.81) cm2 three months postoperatively, (1.89 +/- 0.37) cm2 one year after operation in conventional group. Comparing the preoperative and postoperative cross-sectional area in both groups by acoustic rhinometry, a significant difference (P < 0.01) was found. CONCLUSION: Powered-assisted adenoidectomy has the advantages of shorter surgical time, and less blood loss. Acoustic rhinometry is a kind of objective parameter for assessing the outcome of adenoidectomy.

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PubMed2005

Endoscopic-guided adenoidectomy using a classic adenoid curette: a simple way to improve adenoidectomy.

A total of 13 adenoidectomies using a nasal endoscopic-guided transoral adenoid curette (not yet a published standardised method) were performed to treat snoring. Nasal endoscopy allows easy assessment of the size of the adenoids and improves the accuracy of the adenoidectomy. This technique is particularly useful for paediatric patients who have small oral cavities. The assessment and excision of the adenoids in these cases are often difficult. Using the nasal endoscope, the curette can be accurately inserted at the superior border of the adenoid, allowing the complete transoral removal of the main bulk of the adenoid tissue. All 13 patients showed considerably decreased snoring and improvements in the quality of sleep as reported by the parents and the patients. We believe that nasal endoscopic-guided transoral adenoidectomy is a viable alternative to classic adenoidectomy. This technique also has the advantage of using commonly available simple ear, nose, and throat instruments.

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PubMed2000

Comparison of power-assisted adenoidectomy vs adenoid curette adenoidectomy.

OBJECTIVE: To compare the safety and efficacy of power-assisted adenoidectomy (PAA) vs adenoid curette adenoidectomy (ACA). DESIGN: A prospective randomized study. SETTING: Children's hospital of a tertiary care medical center. PATIENTS: Ninety patients (aged 1-13 years) underwent PAA, and 87 patients (aged 1-12 years) underwent ACA. MAIN OUTCOME MEASURES: The parameters evaluated were operative time, blood loss, completeness and depth of resection, injuries to surrounding structures, short- and long-term complications, surgeon satisfaction with the procedure, and parents' assessment of the patient's postoperative recovery period. RESULTS: The PAA was 20% faster (P<.001) and had 27% less blood loss (P<.001) than the ACA. It provided a more complete resection(P<.001) and better control of the depth of resection (P<.05). Surgeon satisfaction was greater with PAA (P<.001). There was no difference in the recovery period or parent satisfaction. One patient in the PAA group returned to the operating room for control of postoperative bleeding, and 1 child in the ACA group returned to the hospital for postoperative dehydration. CONCLUSION: The PAA provides a faster, dryer, more complete, and more surgically satisfying resection than the ACA.

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PubMed2006

Pediatric adenoidectomy: what is the effect of obstructive symptoms on the likelihood of future surgery?

OBJECTIVE: Determine if pediatric patients undergoing adenoidectomy for obstruction have an increased likelihood of undergoing eventual tonsillectomy and/or second adenoidectomy over extended follow-up. METHODS: Retrospective cohort study within the ambulatory surgery component of a tertiary children's hospital. Exclusion criteria consisted of the presence of significant co-morbid conditions (obesity, craniofacial syndrome, cerebral palsy, etc.) and less than 1 year of post-adenoidectomy follow-up. The study population included 100 children (mean age=3.9 years, range 0.9-15 years) randomly selected from a financial billing database undergoing adenoidectomy either with pre-operative obstructive symptoms (OB n=52) or without pre-operative obstructive symptoms (NOB n=48) with a minimum of 1 year of retrospective follow-up. Electronic records were searched for subsequent surgery (tonsillectomy and/or revision adenoidectomy). RESULTS: Overall, 29 of 100 children (29%) underwent subsequent surgery (tonsillectomy and/or revision adenoidectomy) over an average of 3.46 years (range 1.0-6.59 years) retrospective follow-up. Children in the OB group were three times more likely (age, sex adjusted odds ratio=3.03, 95% confidence interval =1.18-7.78 p=0.021) than children in the NOB group to require tonsillectomy or second adenoidectomy. Age less than 2 years at time of initial adenoidectomy also suggested an increased likelihood of subsequent surgery. CONCLUSION: Children undergoing adenoidectomy with obstructive symptoms are more likely to require eventual tonsillectomy and/or second adenoidectomy than those undergoing adenoidectomy without obstruction. However, the low absolute likelihood of future surgery precludes a generalized recommendation for tonsillectomy in these children.

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PubMed2003

[Guidelines for inpatient adenoidectomy].

BACKGROUND: Adenoidectomy, with or without tonsillectomy, remains as one of the most common surgical procedures. This study was undertaken to determine whether or not the criteria for adenoidectomy based on an inpatient basis in our hospital have to be revised and to evaluate the incidence of postoperative bleeding. MATERIAL AND METHODS: The data of 470 patients who underwent adenoidectomy during 1 year were analyzed in a prospective study. Age <1 year; age >16 years; underlying diseases that put the patient at increased pre-or postoperative cardiopulmonary, metabolic or general risk; >20 minutes driving time between hospital and home, lack of compliance; request of the patients/parents were criteria for adenoidectomy to be performed as an inpatient procedure. Due to the rarity of postoperative bleeding the rate of post-adenoidectomy hemorrhage was calculated in a retrospective study on the basis of the data of 8131 patients who had undergone adenoidectomy. RESULTS: A total of 249 patients underwent adenoidectomy on an outpatient basis (53%). Two patients required surgical treatment for postoperative bleeding under general anesthesia (0.43%), one of whom was initially scheduled for outpatient surgery. The parents of 17 children initially scheduled for outpatient surgery refused to take responsibility of postoperative care on the day of surgery. These children were admitted. Inpatient observation was scheduled in most cases because of the distance to the hospital (115 patients) or underlying diseases (7 patients). The rate of post-adenoidectomy hemorrhage in our retrospective study was 0.23%. There was only one adult with repeated bleeding on the day of surgery and 6 days postoperatively. 15 of 19 episodes of bleeding occurred on the day of surgery, the latest episode 6 days postoperatively. There was no case with lethal outcome. No blood transfusions or major surgical procedures at the neck were required to stop the bleeding. CONCLUSIONS: Inpatient observation should be considered in patients with underlying general diseases, postoperative bleeding, poor compliance or request of the patients/parents. Age, general risk of post-adenoidectomy hemorrhage and distance to the hospital are not criteria significant enough to indicate inpatient observation in patients who undergo adenoidectomy.

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PubMedDate not supplied

Efficacy of adenoidectomy in recurrent otitis media. Historical overview and preliminary results from a randomized, controlled trial.

Adenoidectomy is well established as a procedure for treating children with recurrent or persistent otitis media. Many physicians also believe that when adenoidectomy is undertaken for otitis media, tonsillectomy also should be done routinely. Thus otitis media serves as the justification for a substantial proportion of the tonsil and adenoid operations carried out on children. Nonetheless, evidence supporting the efficacy of adenoidectomy, or tonsillectomy and adenoidectomy (T&A), for otitis media is scant and inconclusive. Only six prospective studies have been reported, and in all but two of them, the combination of adenoidectomy with tonsillectomy, rather than adenoidectomy alone, was tested. The results were contradictory, perhaps because of all the studies contained flaws in design or methodology or both. Whether adenoidectomy or T&A are efficacious remains entirely uncertain. We are attempting to address the question currently in a prospective study in which children considered at high risk for otitis media are entered into a randomized, controlled clinical trial of adenoidectomy. The trial is complicated by the need to take adequate account of subject variables such as age, sex, adenoid size, and the presence or absence of allergy, and of the important treatment variables of concomitant myringotomy with tympanostomy tube insertion. Outcome measurements employed in the trial include the number of episodes per year of acute otitis media, the persistence of middle ear effusion, and the frequency of subsequent myringotomy. Data thus far collected in the study are not sufficient to reach a conclusion for or against the efficacy of adenoidectomy for otitis media, but it is apparent that adenoidectomy by no means eliminates the problem.

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PubMed2002

Obstructive adenoid tissue: an indication for powered-shaver adenoidectomy.

OBJECTIVES: To quantify the incidence of intranasal extension of adenoid tissue and residual adenoidal obstruction of the posterior choanae following traditional curette adenoidectomy to determine the efficiency of adenoid curettage and the usefulness of intraoperative endoscopic examination and powered-shaver adenoidectomy in achieving better postnasal patency. DESIGN: Prospective intraoperative endoscopic evaluation of the posterior choanae and nasopharynx of a case series of 130 patients before and after curette and powered-shaver adenoidectomy. SETTING: Tertiary referral center. PATIENTS: One hundred thirty consecutive pediatric patients with obstructive adenoidal hypertrophy undergoing adenoidectomy. MAIN OUTCOME MEASURES: The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically (grades 0-3) after curette and adjuvant powered-shaver adenoidectomy. The presence of intranasal adenoid tissue was also recorded. RESULTS: Following traditional curette adenoidectomy, 51 (39%) of 130 patients had residual obstructive adenoid with 42 patients (32%) having occlusive intranasal adenoid tissue. Having determined the presence of remaining obstructive tissue with intraoperative nasal endoscopy in these 51 patients, complete airway patency was achieved with powered-shaver adenoidectomy. CONCLUSION: The presence of intranasal extension of adenoids obstructing the posterior choanae is common in children with adenoid hypertrophy. Traditional adenoidectomy is ineffective in removing this tissue and may also leave obstructive tissue high in the nasopharynx. Intraoperative nasal endoscopy allows assessment of the completeness of surgery. Powered-shaver adenoidectomy enables complete removal of obstructive adenoid tissue thereby ensuring postnasal patency.

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PubMed1992

Adenoidectomy and otitis media.

Adenoid enlargement has traditionally been considered a factor in otitis media; adenoid size, however, does not appear to be correlated with otitis media occurrence. Presence of pathogenic bacteria in the adenoids of children with otitis media has been shown, and adenoidectomy appears to affect the middle ear primarily by removal of the source of infection in the nasopharynx. Three recent randomized, controlled studies showed the efficacy of adenoidectomy in the treatment of chronic secretory otitis media. In one study comparing no treatment, adenoidectomy, and adenotonsillectomy, a significant benefit was seen with adenoidectomy that was not enhanced by tonsillectomy. Another study that compared adenoidectomy, tympanostomy tubes, and a combination of the two showed a significant reduction in effusion time and less surgical retreatment over 2 years in the two adenoidectomy groups. The third study demonstrated the effect of adenoidectomy in children with recurrent chronic otitis media with effusion after failure of tympanostomy tube insertion. All three studies showed that the effect of adenoidectomy was independent of adenoid size. This review discusses current concepts of adenoid physiology and pathology, the major adenoidectomy studies, and indications for the procedure.

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PubMed2005

Incidence of unexpected pathology in routine adenoidectomy specimens.

OBJECTIVE: The aim of this study was to determine the incidence of unexpected pathologies in adenoidectomy specimens and necessity for histopathologic evaluation of adenoid tissue. MATERIALS AND METHODS: All patients younger than 16 years who underwent routine adenoidectomy were reviewed. Patients were excluded if the primary surgery was other than routine adenoidectomy such as nasopharyngeal biopsy for suspicion of malignancy or other pathology. RESULTS: One thousand one hundred eighty-four patients (683 males, 501 females) were involved in this study. The mean age was 7.53+/-3.24 years, ranging between 2 and 16 years. There was no patient with unexpected pathology among 1184 routine and primary adenoidectomy procedures. However, one patient had unexpected pathology among 33 revision adenoidectomy procedures (3%). CONCLUSIONS: There was no occult pathology in routine primary adenoidectomy. The incidence of unexpected pathology in revision adenoidectomy was 3%. Microscopic evaluation of adenoid tissue gives some knowledge about histological properties and rarely some unexpected pathologies. Searching for malignancy is unnecessary in routine primary adenoidectomy cases without any other clinical, radiological and laboratory findings.

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PubMed2005

Does increased electrocautery during adenoidectomy lead to neck pain?

OBJECTIVES: The objective was to assess the impact of electrocautery on complications in adenoidectomy. We sought to quantify cautery-related temperature changes in prevertebral fascia that may occur during the procedure, retrospectively evaluate the incidence of cautery-related complications, and prospectively assess the role of cautery in postoperative neck pain. METHODS: Three consecutive related trials were performed. Initially, adenoidectomy was performed on 20 fresh cadavers, using a thermister to evaluate temperature changes in the prevertebral fascia after electrocautery (30 watts over a 30-second period). Next, retrospective analysis of adenoidectomy complications in 1206 children over a 5-year period was performed. Based on these findings, a prospective study of the incidence of neck pain following adenoidectomy was performed in a cohort of 276 children. Adenoidectomy technique, wattage, and duration of electrocautery were recorded for each child. Children with significant neck pain were evaluated with MRI. RESULTS: Peak thermister readings averaged 74 degrees C, for a mean change of 51.8 degrees C. Complications observed in retrospective analysis included neck pain (3), Grisel's syndrome (1), prolonged velopharyngeal insufficiency (1), retropharyngeal edema (1), and severe nasopharyngeal stenosis (1). The incidence of neck pain in the prospective study was 12% (33 pts), and was independent of adenoidectomy technique, cautery wattage, or duration of cautery use. MRIs revealed edema without abscess. CONCLUSIONS: Cautery can result in substantial temperature changes in the surgical adenoid bed. Despite this, the incidence of complications, specifically neck pain, associated with adenoidectomy is low, although underreported. Complications appear to be independent of adenoidectomy technique and cautery use.

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PubMed2000

Consequences of adenoidectomy in conjunction with tonsillectomy in children.

OBJECTIVE: The purpose of this prospective study was to investigate the role of adenoidectomy in children undergoing elective adenotonsillectomy. PATIENTS AND METHODS: All consecutive children less than 15 years of age operated on over a 12-month period were included. Adenoidectomy was done with curettes and forceps under mirror visualization and tonsillectomy with a unipolar electrodissection technique. Duration of the operation, intra-operative blood loss, and post-operative complications were recorded. RESULTS: Adenotonsillectomy was done in 98 children with a mean age of 7.8 years. The mean duration of adenoidectomy was 10.3 min (S.E. 0.7), 51.8% of the time used for adenotonsillectomy and 25. 9% of the total operating room time. The blood loss was 43.6 ml (S.E. 5.4) and 7.8 ml (S.E. 2.5) for adenoidectomy and tonsillectomy, respectively. Both the duration (P=0.04) and blood loss (P=0.0005) of adenoidectomy increased significantly with the increasing age of children. Post-adenoidectomy complications did not occur. CONCLUSION: Even though adenoidectomy prolonged the operating time and increased the intra-operative blood loss, especially in older children the procedure in general remained relatively short and safe. However, adding adenoidectomy to tonsillectomy should always be carefully considered, particularly in children 10 years or older operated on principally because of palatine tonsil disease.

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PubMed2003

Adenoidectomy during early life and the risk of asthma.

The objective of the study was to evaluate the risk of asthma in children who had undergone an adenoidectomy, an operation frequently performed on children with glue ear or recurrent otitis media. Two surveys were carried out, a nation-wide questionnaire returned by 483 individuals (survey A) and a survey of hospital discharge records involving 1616 children who had undergone an adenoidectomy and 161 control children who had undergone probing of the nasolacrimal duct due to congenital obstruction (survey B). The questionnaire (survey A) showed that an adenoidectomy before the age of 4 years was associated with asthma (OR 3.19, 95% CI 1.25; 8.13) and with allergy to animal dust (OR 2.50, 95% CI 1.27; 4.95). In survey B, asthma diagnosis was retrieved from the national asthma register. It showed also that adenoidectomy at an early age was associated with an increased risk of asthma (OR 6.74, 95% CI 2.99; 15.2). There was an association between asthma and adenoidectomy, even before adenoidectomy had actually been performed. The risk of asthma was highest among children who had had adenoidectomy because of recurrent otitis media. The observed association between an adenoidectomy and asthma may be explained by an underlying factor predisposing to both recurrent otitis media and asthma.

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PubMed2001

Pediatric adenoidectomy under vision using suction-diathermy ablation.

OBJECTIVES: To compare adenoidectomy using suction-diathermy ablation with adenoidectomy by way of curettage in a pediatric tertiary care setting. STUDY DESIGN: A prospective series of 68 children undergoing adenoidectomy (without tonsillectomy) under vision using a suction-diathermy ablation technique over 2 years was compared with an historical control group of 58 children undergoing adenoidectomy (without tonsillectomy) by way of curettage over 2 years. METHOD: Intraoperative blood loss was recorded and compared. Efficacy in improving nasal symptomatology was compared between the two groups using an ordinal "nasal symptom score" preoperatively and postoperatively. Complications were recorded and compared. Analysis was performed using two-tailed t tests. RESULTS: The two groups were well matched for age, weight, and adenoid size (P > .4). Follow-up ranged from 4 to 48 months. Adenoidectomy using suction-diathermy resulted in significantly less blood loss (P < .001). The technique was no less efficacious in terms of reducing the nasal symptom score than conventional adenoidectomy by way of curettage (P = .07). Complication rates were no different. No recurrences were identified and no instances of nasopharyngeal stenosis were recognized. CONCLUSIONS: Routine use of suction-diathermy ablation for adenoidectomy converts a difficult, often bloody procedure into a surgically precise operation. It is especially applicable to children. It may have additional advantages in aiding the prevention of the spread of the human form of bovine spongiform encephalopathy (variant Creutzfeldt-Jakob disease [CJD]). Compared with other recently introduced techniques for adenoidectomy, it is considerably less expensive.

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PubMed2005

[Effects of adenoidectomy and immediate orthodonthic treatment on jaw relations and naso-respiratory rehabilitation].

AIM: To determine if adenoidectomy itself could provide spontaneous relation of the transverse growth of jaws as well as an adequate mode of breathing or if there is a need for an additional orthodontic treatment to solve the problem. METHODS: The study included one hundred and one patients aged 6-17 yrs., divided into three groups: group K--patients with oral respiration caused by adenoidal enlargement; group 1--patients with adenoidectomy done 5 or more years before; group 2--patients with orthodontic treatment done immediately after adenoidectomy. Transverse occlusion relation, the frequency of crossbite, and the intensity of nasal respiration were measured in all three groups of patients. RESULTS: The obtained results have shown that in the patients with adenoidal enlargement and oral respiration, there was an evidence of maxillary width reduction as opposed to mandibular width. Of the patients, 14% were with unilateral or bilateral crossbite. In the patients with adenoidectomy done 5 or more years before, transverse maxillary growth compared to mandibular one in the region of the front width, showed statistically significant increase (p < 0.05) as opposed to the patients with adenoidal enlargement. The effect of adenoidectomy on transverse maxillary growth was not satisfactory anyway, which was also indicated by the increase of frequency of crossbite in 24% of the patients with adenoidectomy done 5 or more years before. In operated on and in the patients one month after orthodontic treatment, transverse maxillary growth compared to mandibular growth in all the regions of both front and back width, there was statistically highly significant increase (p < 0.01) as opposed to the patients with adenoidal enlargement and adenoidectomy done many years before. Significant maxillary and mandibular transverse relation was obtained without the presence of crossbite. Nasal respiration prevailled. CONCLUSION: Orthodontic therapy one month after adenoidectomy was necessary for solving the orthodontic problems caused by adenoidal enlargement and significantly contributed to the rehabilitation of nasal respiration.

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PubMed1983

Current thinking on tonsillectomy and adenoidectomy.

Tonsillectomy and adenoidectomy, though less frequently performed now than in the 1930s, remain among the most common surgical procedures in the United States. The need for and benefits of tonsillectomy and adenoidectomy have been a source of controversy for several decades. Nonetheless, there are situations in which these procedures definitely are beneficial. Tonsillectomy and adenoidectomy are two distinct procedures with separate indications, and they are performed concurrently only when the specific indications for each coexist. Tonsillectomy is indicated by recurrent tonsillitis, peritonsillar abscess, chronic tonsillitis, tonsillar neoplasm, or tonsillar hypertrophy that is obstructive to the upper aerodigestive tract (respiratory distress, dysphagia, or interference with performance of an adenoidectomy). Adenoidectomy is indicated for nasal airway obstruction due to adenoidal enlargement from hypertrophic or inflammatory processes. Although correlation exists among obstructive adenoids, mouth breathing, and dentofacial anomalies, present evidence is not sufficient to justify adenoidectomy solely on the basis of craniofacial or dentofacial abnormalities. Today, elimination of an occult source of infection (once called focal infection) in patients with disorders such as rheumatic fever or serous otitis media is not a valid indication for either operation. Contraindications to tonsillectomy and adenoidectomy include bleeding disorders, familial anesthetic intolerance, velopharyngeal insufficiency, and concurrent disease that may enhance operative risks. Like all surgical procedures, tonsillectomy and adenoidectomy entail morbidity and risk of mortality. The most frequent complication of these operations is hemorrhage. Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with endotracheal anesthesia, and meticulous surgical technique.

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PubMed2002

Powered partial adenoidectomy.

OBJECTIVE: To confirm our clinical impression that the powered microdebrider is superior to curettes for performing partial adenoidectomy (removal of the superior one half to three fourths of the adenoid pad). DESIGN: Observational study of 100 children undergoing partial adenoidectomy with the powered microdebrider compared with 40 children undergoing conventional partial adenoidectomy with curettes. SETTING: Private and public tertiary care centers. PATIENTS: All patients younger than 20 years undergoing partial adenoidectomy at the respective institutions during the study period. INTERVENTIONS: Partial adenoidectomy as indicated for chronic otitis media, airway obstruction, or chronic or recurrent tonsillitis with either the powered microdebrider or curettes. MAIN OUTCOMES MEASURES: Operative time (with specific quantification of the time required for tissue removal and hemostasis), blood loss, complications, and subjective ease of use. RESULTS: Operative time was 59% shorter for the microdebrider group (mean, 3 minutes 22 seconds; range, 1 minute 6 seconds to 12 minutes 45 seconds) than for the conventional group (mean, 8 minutes 8 seconds; range, 1 minute 2 seconds to 22 minutes 0 seconds) (P<.001). Blood loss was comparable for both groups (powered group: mean, 2.0 mL/kg; range, 0.4 to 9.4 mL/kg; conventional group: mean, 2.0 mL/kg; range, 0.3 to 6.7 mL/kg; P=.34). There were no intraoperative or postoperative complications in either group. Surgeon satisfaction with the microdebrider was high. CONCLUSIONS: The powered microdebrider for partial adenoidectomy is quicker and is not associated with blood loss or complications above that of conventional partial adenoidectomy. The degree of control afforded by the microdebrider technique is of utmost value in preventing complications such as velopharyngeal insufficiency, and this is now our procedure of choice.

Adenoidectomy↗