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PubMed2002

Power-assisted adenoidectomy: total and partial resection.

OBJECTIVE: To describe the surgical technique for power-assisted adenoidectomy and review the safety and effectiveness of the procedure. STUDY DESIGN: Retrospective review. METHODS: Power-assisted adenoidectomy uses a curved microdebrider shaver blade that conforms to the nasopharynx. The action of the shaver is controlled through visualization using a laryngeal mirror. Power-assisted adenoidectomy is started high in the nasopharynx, with resection beginning in the most superior aspect of the adenoid pad and moving inferiorly to the base of the pad. The cutting edge of the microdebrider remains in view continuously. RESULTS: Between 1998 and 2001, we performed power-assisted adenoidectomy in 677 children and conducted both retrospective and prospective reviews of our experience. No instances of excess intraoperative blood loss (>150 mL), postoperative hemorrhage, velopharyngeal insufficiency, or other complication associated with adenoidectomy have occurred. CONCLUSION: We have consistently demonstrated that power-assisted adenoidectomy is precise, rapid, and safe.

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PubMed1989

Eustachian tube function following adenoidectomy: an evaluation by sniffing.

Recent investigations have demonstrated an association between sniff-induced negative middle ear pressure and otitis media with effusion. This is taken as evidence of Eustachian tube malfunction. Adenoidectomy is frequently performed as part of the surgical management for otitis media with effusion, but whether this affects Eustachian tube function is uncertain. The aim of this study was to investigate the hypothesis that if adenoidectomy improved Eustachian tube function, children who had undergone adenoidectomy would show less tendency to generate a high negative intratympanic pressure by sniffing. Eustachian tube function was studied actively in 40 children with otitis media with effusion. Twenty children, selected at random, underwent adenoidectomy and all 40 had a unilateral grommet inserted. Eighty-five percent of the children could create a negative middle ear pressure by sniffing, but there was no difference in the number of 'sniff + ve' children between the adenoidectomy and control groups (P greater than 0.5), or in the magnitude of the negative pressure induced. It is concluded that a high percentage of children with otitis media with effusion are capable of inducing a negative middle ear pressure by sniffing, but this parameter of Eustachian tube function is not affected by adenoidectomy.

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PubMed1993

A model to refine the selection of children with otitis media with effusion for adenoidectomy.

The selection of children with otitis media with effusion for adenoidectomy has been criticized on a number of grounds. In spite of the widespread popularity of the procedure there are few objective guidelines to help the otolaryngologist make a decision which is therefore usually subjective. We present a scientifically derived model using a Generalized Linear Interactive Modelling (GLIM) technique from a population of 122 children who underwent either adenoidectomy or no pharyngeal surgery. The outcome parameter studied was otoscopic clearance in an unoperated ear 1 year after treatment. This was related principally to the operation type (P < 0.001) and to the age at which the operation was performed (P < 0.005). Using a probability of clearance threshold of 50% the model was tested on a prospective population of 166 children and outcome was correctly predicted in over 72%. This model enables the surgeon to determine the probability of clearance of effusion following adenoidectomy in an individual child. At a probability threshold of 50% adenoidectomy would be offered to children with bilateral otitis media with effusion aged between 4.33 and 8.00 years. Over the age of 8 years the probability of clearance occurring spontaneously increases beyond 50%. By careful selection of the probability of clearance thresholds it was possible to produce otoscopic resolution in over 80% of those selected to undergo adenoidectomy. The model also enables the otolaryngologist to determine the proportion of children with established disease that require adenoidectomy at his own chosen probability thresholds which will ensure that a more effective resource allocation is achieved.

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PubMedDate not supplied

Role of tonsillectomy and adenoidectomy in the management of children with middle ear effusion.

Evidence for the clinical effectiveness of adenoidectomy or tonsillectomy and adenoidectomy in the management of children with persistent middle ear effusions is incomplete and what evidence there is the literature is not convincing. In the first year after tonsillectomy and adenoidectomy there is less otitis media. The beneficial effects of tonsillectomy and adenoidectomy on the incidence of otitis media declines in the second year after the operation. The prevailing opinion is that adenoidectomy is not indicated in the vast majority of children in whom a middle ear effusion has persisted for six weeks or more in spite of antibiotic therapy. Factors favoring an adenoidectomy would be persistent nasal obstruction, persistent purulent rhinorrhea and persistent adenoiditis. The role of tonsillectomy is even less clear, but the decision regarding tonsillectomy is made by most clinicians on the basis of the amount of intercurrent or chronic tonsillitis rather than on the basis of the middle ear effusion per se.

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PubMed1994

Adenoidectomy for otitis media with effusion.

The efficacy of adenoidectomy in the surgical treatment of children with otitis media with effusion (OME) persisting after adequate medical therapy has been established in three independent randomized clinical trials. Although each of these studies used a different experimental design, all showed significant reductions in morbidity from OME after adenoidectomy as compared to the control groups. Subsequent application of these findings in formulating clinical guidelines for the use of adenoidectomy has yet to be realized, and recommendations to parents for or against the procedure appear to vary more with the surgeon's philosophy than with the condition of the child. This discussion examines the effectiveness and cost of adenoidectomy for the treatment of children with chronic OME and addresses the question of whether adenoidectomy should be used as a primary or a secondary surgical therapy. The argument is made to use adenoidectomy as a primary therapy in selected cases on the basis of patient age, type of OME, and patient preference, and to base the decision not on the size of the adenoid, but on its known pathophysiology.

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PubMed1975

Certain effects of adenoidectomy of Eustachian tube ventilatory function.

In an effort to develop a simple and accurate method to identify children in whom adenoidectomy might prevent otitis media, the ventilatory function of the Eustachian tube was assessed by a manometric technique. Nasal pressures during swallowing were also determined in some. The study group consisted of 23 children with otitis media in whom tympanostomy tubes had been inserted. All were judged clinically and roentgenographically to have prominent adenoids. Inflation-deflation Eustachian tube ventilation studies were obtained in 36 ears that remained intubated, aerated and dry both before and eight weeks after adenoidectomy. Fifteen of the 36 (42 percent) ears had improvement in Eustachian tube ventilatory function postadenoidectomy which was attributed to relief of extrinsic mechanical obstruction of the tube. In the remaining 21 (58 percent) ears in which Eustachian tube function was not improved, mechanical obstruction was not apparent preoperatively. The effect of nasopharyngeal pressures on a pliant Eustachian tube (Toynbee phenomenon) due to obstruction of the posterior nasal choanae by the adenoid mass was suggested as a possible cause of functional Eustachian tube obstruction. In several instances in which preadenoidectomy mechanical obstruction of the Eustachian tube was not demonstrated, the tube appeared to have been made more pliant by the operation. This increase in compliance of the Eustachian tube was attributed to loss of adenoid support of the tube in the fossa of Rosenmuller. From this study, preliminary recommendations for selection of patients for adenoidectomy are the following: 1. Eustachian tube ventilation function tests in a dry, intubated middle ear; 2. if extrinsic mechanical obstruction of the Eustachian tube is present and chronic inflammation is absent, adenoidectomy will probably improve Eustachian tube function. The surgical technique should include adequate removal of the adenoid tissue in the fossa of Rosenmuller; 3. if the Eustachian tube does not appear to be mechanically obstructed, the adenoids should not be removed unless functional obstruction is suspected due to obstruction of the posterior nasal choanae. Adenoid tissue within the fossa of Rosenmuller should not be removed when such circumstances exist; and 4. in the abscence of obstructive adenoids to the nasal choanae or Eustachian tube, adenoidectomy probably will not improve Eustachian tube function and could make it worse. A more rational and effective approach to adenoidectomy for the prevention of otitis media in children may be possible through this type of preoperative evaluation.

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PubMed2005

Adenoidectomy does not significantly reduce the incidence of otitis media in conjunction with the insertion of tympanostomy tubes in children who are younger than 4 years: a randomized trial.

OBJECTIVE: To evaluate the efficacy of adenoidectomy in reducing the incidence of otitis media among children who are younger than 4 years and receive tympanostomy tubes. METHODS: A randomized trial was conducted at a tertiary center clinic. A total of 217 children who were aged 12 to 48 months and had recurrent acute otitis media (>3 episodes during the past 6 months) or chronic otitis media with effusion, no obstructive symptoms as a result of adenoid enlargement, and no previous surgical intervention were enrolled in the study. Adenoidectomy in conjunction with the insertion of tympanostomy tubes or insertion of tympanostomy tubes without adenoidectomy was studied. The number of otitis media episodes during the follow-up period of 12 months was measured. RESULTS: During the follow-up, the mean number of otitis media episodes was 1.7 among children who underwent adenoidectomy with concurrent insertion of tympanostomy tubes and 1.4 among children who received tympanostomy tubes only. The risk for recurrent otitis media (>or=3 episodes) could not be reduced by adenoidectomy (odds ratio: 1.66; 95% confidence interval: 0.80-3.46). CONCLUSION: Adenoidectomy does not significantly reduce the incidence of acute otitis media in otitis prone children who are younger than 4 years and receive tympanostomy tubes.

Acute Disease↗

PubMed2005

Association between tonsillectomy, adenoidectomy, and appendicitis.

INTRODUCTION: Tonsillectomy, with or without adenoidectomy, is one of the most frequent surgical procedures generally performed, especially in young patients. Several studies suggest that there is a relationship between tonsillectomy and altered MALT immune system. OBJECTIVE: To examine the possible association between tonsillectomy or adenoidectomy and the risk of subsequent appendicitis. MATERIAL AND METHOD: A cross-sectional study was performed in 650 patients admitted to the emergency department of a general hospital in Valencia, Spain. Previous history of tonsillectomy and/or adenoidectomy was related to a history of appendectomy. A descriptive study and an analysis of the relationship between previous operations and appendicitis was performed. A multivariable analysis controlled for age and sex was also performed, including the possible interaction of the gender variable. The independent effect of each of the procedures (tonsillectomy, adenoidectomy) was tested. RESULTS: The 25.5% of patients had undergone tonsillectomy and 11.5% adenoidectomy; 17.5% had had an appendectomy. On average, women were operated on more frequently than men. In the bivariate analysis, both tonsillectomy and adenoidectomy were significantly associated with subsequent appendectomy. In the multivariate analysis, this association was only maintained for tonsillectomy (OR: 3.23; 95% CI: 2.11-4.94). A stratified analysis controlling for sex showed a modification of this effect, with a higher association in women (OR: 5.20; 95% CI: 2.91-9.28) than in men (OR: 1.74; 95% CI: 0.90-3.39). CONCLUSIONS: A clear association has been found, especially in women, between previous tonsillectomy and subsequent acute appendicitis. Due to a lack of data on acute appendicitis there should be further studies to explain the findings of this study, as this could be the first described risk factor of acute appendicitis.

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PubMed1991

Daycare tonsillectomy and/or adenoidectomy at the British Columbia Children's Hospital.

The fact that tonsillectomy (T), or tonsillectomy with adenoidectomy (T & A) or adenoidectomy (A) can be performed safely in selected children on a daycare or outpatient basis is well proven. This article illustrates the approach that the British Columbia Children's Hospital (B.C.C.H.) took to confirm that the procedures were safe locally. A pilot project was started in June of 1984 to perform daycare adenoidectomies only, using two full-time pediatric otolaryngologists. When this proved successful, other otolaryngologists were encouraged to use the program. In June of 1988, a second pilot project was started for daycare tonsillectomies (or tonsillectomy and adenoidectomy). Criteria were established for patient selection, preparation, anesthesia, post-anesthetic recovery (PAR), Daycare Unit (DCU) nursing, and discharge. Follow-up information was obtained. Daycare tonsillectomy with or without adenoidectomy and daycare adenoidectomy are now routine procedures at B.C.C.H.

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PubMed1990

Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials.

We studied the efficacy of adenoidectomy in 213 children who had received tympanostomy-tube placement because of persistent and/or recurrent otitis media and had again developed otitis media after tubal extrusion. Ninety-nine of the children were assigned randomly to either an adenoidectomy group or a control group; in a separate trial, 114 children whose parents withheld consent for randomization were assigned according to parental preference. In both trials, control group outcomes appeared to have been biased favorably by the withdrawal of certain severely affected subjects from control status to receive adenoidectomy. Nonetheless, in both trials, adenoidectomy group outcomes were more favorable than control group outcomes during the first 2 follow-up years. Statistically significant differences were found mainly in the randomized trial, where during the first and second years, respectively, adenoidectomy subjects had 47% and 37% less time with otitis media than control subjects and 28% and 35% fewer suppurative (acute) episodes than control subjects. We conclude that adenoidectomy is warranted on an individualized basis for children who develop recurrent otitis media after extrusion of tympanostomy tubes.

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PubMed1999

Adenoidectomy vs endoscopic sinus surgery for the treatment of pediatric sinusitis.

OBJECTIVE: To compare endoscopic sinus surgery with adenoidectomy for the treatment of refractory chronic sinusitis in children. STUDY DESIGN: Prospective nonrandomized study in a pediatric otolaryngology service of a university teaching hospital. PATIENTS AND METHODS: Sixty-six children consecutively referred to the pediatric otolaryngology service between 1994 and 1997 with computed tomographic documentation of sinusitis subsequently underwent endoscopic sinus surgery or adenoidectomy. Their ages ranged from 2 to 14 years. Sixty-one children received follow-up. Two main outcomes were documented: (1) symptom status at least 6 months after the intervention and (2) requirement of the alternate procedure or a revision procedure. RESULTS: Twenty-four (77%) of 31 children who underwent endoscopic sinus surgery had improved symptoms, compared with 14 (47%) of 30 children who underwent adenoidectomy (odds ratio [OR], 3.9; P = .01). Multivariable analysis demonstrated that endoscopic sinus surgery was significantly better than adenoidectomy after age, sex, allergy, asthma, day care attendance, and computed tomographic stage were adjusted for (OR, 5.2; P = .03). The diagnosis of asthma also appeared to be an independent predictor of success (OR, 4.37; P = .03). CONCLUSION: Endoscopic sinus surgery is better than adenoidectomy for the treatment of refractory chronic sinusitis in a select group of children.

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PubMed2002

Postoperative behavioral changes in children after adenoidectomy.

BACKGROUND: Pain is a common complaint after adenoidectomy. Behavioral changes after adenoidectomy in children have been reported, and it has been concluded that postoperative pain significantly affects the occurrence of behavioral changes. Behavioral changes, when a proactive pain treatment has been used, have not been systematically studied. OBJECTIVE: To assess postoperative behavioral changes in children who have undergone day-case adenoidectomy with proactive pain treatment. DESIGN: Prospective, longitudinal, randomized clinical trial. SETTINGS: Ambulatory Care Unit, Department of Otorhinolaryngology, Kuopio University Hospital, Kuopio, Finland. PATIENTS: Three hundred consecutive children, aged 1 to 10 years, who underwent day-case adenoidectomy during 1999 through 2000. INTERVENTION: In the hospital, 213 children received the first dose of ketoprofen before surgery and 87 children received the first dose at discharge. For pain treatment after discharge, patients were given ketoprofen tablets or suppositories on a regular basis for 72 hours. MAIN OUTCOME MEASURES: The number of postoperative behavioral changes were evaluated with 3 consecutive questionnaires, at baseline before surgery, 1 week after surgery, and 3 weeks after surgery. RESULTS: A total of 294 questionnaires (98%) were returned after 1 week and 255 questionnaires (85%) after 3 weeks. Most children (91%) had pain after discharge and the mean for pain cessation was 3 days (range, 0-8 days). The mean of ketoprofen doses after discharge was 6 (range, 1-24 doses). Most of the children showed no or only trivial postoperative behavioral changes, and, furthermore, at 3 weeks, more positive than negative changes were reported. The child's age was a significant factor (P<.05) in affecting behavioral changes for all domains. Other significant factors were the worst pain at rest (P =.04) and during swallowing (P =.02) for daytime function disturbances, and fear of separation from parents (P =.03) for sleep disturbances. CONCLUSION: Day-case adenoidectomy with proactive pain treatment seems to result in a negligible incidence of behavioral troubles in children.

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PubMed1997

Power-assisted adenoidectomy.

OBJECTIVE: To quantify that the use of powered instrumentation for adenoidectomy is an improvement over traditional techniques. DESIGN: Retrospective case series of 40 consecutive children undergoing power-assisted adenoidectomy compared with 40 consecutive children undergoing conventional transoral adenoidectomy with a curet. SETTINGS: Tertiary care center. MAIN OUTCOME MEASURES: Operative time, blood loss, length of hospitalization, and complications. RESULTS: With power-assisted adenoidectomy, the mean operative time was significantly faster (11 minutes vs 19 minutes for the conventional method), mean blood loss was not significantly different (22 mL vs 32 mL for the conventional method), mean length of hospitalization after the procedure was not significantly different (2.95 hours vs 2.8 hours for the conventional method), and there were no surgical complications with either technique. CONCLUSION: In comparison with conventional techniques, power-assisted adenoidectomy provides significant advantages that are subjectively apparent but can also be objectively measured.

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PubMed1999

Adenoidectomy and adenotonsillectomy for recurrent acute otitis media: parallel randomized clinical trials in children not previously treated with tympanostomy tubes.

CONTEXT: Adenoidectomy and adenotonsillectomy are commonly performed in US children to reduce the occurrence of persistent or recurrent otitis media, but evidence supporting the efficacy of the operations is limited. OBJECTIVES: To test the efficacy of adenoidectomy and adenotonsillectomy in children with persistent or recurrent otitis media who had not previously undergone tube placement and to compare the relative efficacy of adenoidectomy alone vs adenotonsillectomy in such children. DESIGN: Two parallel randomized clinical trials. SETTING AND PARTICIPANTS: A total of 461 children aged 3 to 15 years were enrolled at Children's Hospital of Pittsburgh, Pa, between April 1980 and April 1994. Four hundred ten children were observed for up to 3 years. INTERVENTIONS: Children without recurrent throat infection or tonsillar hypertrophy (304 enrolled; 266 followed up) were randomized to either an adenoidectomy, adenotonsillectomy, or control group; children who had such conditions (157 enrolled; 144 followed up) were randomized to an adenotonsillectomy or control group. MAIN OUTCOME MEASURES: Occurrence rate of episodes of acute otitis media by treatment group and estimated proportion of time with otitis media. RESULTS: In both trials, most subjects were eligible because of recurrent acute otitis media, with or without persistent otitis media with effusion. A total of 47 children assigned to surgical treatment groups had no surgery. The efficacy of surgery in both trials was modest and limited mainly to the first follow-up year. The largest differences in that year were found in the 3-way trial between the adenotonsillectomy group and the control group: mean annual rate of episodes of acute otitis media, 1.4 vs 2.1 (P<.001); and mean estimated percentage of time with otitis media, 18.6% vs 29.9% (difference, 11.3%; 95% confidence interval, 4.4%-18.2%; P=.002). Perioperative and postoperative complications or other adverse events occurred not infrequently, especially among subjects undergoing adenotonsillectomy (14.6%). CONCLUSIONS: Our study showed limited and short-term efficacy of both adenoidectomy and adenotonsillectomy; given the risks, morbidity, and costs of these procedures, these data suggest that neither operation should ordinarily be considered as a first surgical intervention in children whose only indication is recurrent acute otitis media.

Acute Disease↗

PubMed2002

Indications for tonsillectomy and adenoidectomy.

OBJECTIVE: To review recent clinical trials that provide a foundation on which clinicians can base decisions regarding adenotonsillar surgery for their patients. STUDY DESIGN: Review. METHODS: An evidence-based approach was used to review recent clinical trials addressing indications for adenotonsillectomy, tonsillectomy, and adenoidectomy. RESULTS: Absolute indications for tonsillectomy and adenoidectomy include adenotonsillar hyperplasia with obstructive sleep apnea, failure to thrive, or abnormal dentofacial growth; suspicion of malignant disease; and (for tonsillectomy) hemorrhagic tonsillitis. Relative indications for both procedures are adenotonsillar hyperplasia with upper airway obstruction, dysphagia, or speech impairment, and halitosis. Otitis media and recurrent or chronic rhinosinusitis or adenoiditis are relative indications for adenoidectomy but not tonsillectomy. Recurrent or chronic pharyngotonsillitis, peritonsillar abscess, and streptococcal carriage are relative indications for tonsillectomy but not adenoidectomy. CONCLUSION: Good clinical evidence regarding indications for tonsillectomy and adenoidectomy is available. Clinicians should make recommendations for surgery on the basis of this evidence.

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PubMed1986

Mandibular growth direction following adenoidectomy.

The purpose of this article is to test the hypothesis that the establishment of nasal respiration in children with severe nasopharyngeal obstruction can be eliminated as a factor in determining mandibular growth direction. The article describes the changes in mandibular growth direction (MGD) in a 5-year period after adenoidectomies and the establishment of nasal breathing in a population of Swedish children. Measurements of mandibular growth directions were obtained from serial cephalometric radiographs after adenoidectomies in 38 Swedish children aged 7 to 12 years with previous nasopharyngeal obstructions. These were compared with the growth directions in a control sample of 37 Swedish children with clear airways and matched for age and sex. The adenoidectomy sample initially showed significantly longer lower face heights, steeper mandibular plane angles, and more retrognathic mandibles than the matched controls. Analysis showed that during the 5 years after adenoidectomies, the girls had a more horizontal MGD (P less than 0.02) than did the female controls. A corresponding but not significant trend was found for the boys. The individual growth directions that were obtained following adenoidectomies were more variable than those found in the controls.

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PubMed1995

Tonsillectomy and adenoidectomy in patients with Down syndrome.

Tonsillectomy and adenoidectomy in patients with Down syndrome usually relieves symptoms of upper airway obstruction due to adenotonsillar hypertrophy. A retrospective review of 16 patients with Down syndrome who underwent a tonsillectomy and adenoidectomy was conducted to define early postoperative morbidity, and to evaluate the results of the procedure. Fifteen of 16 patients had upper airway obstruction manifest by adenotonsillar hypertrophy. One had adenoid hypertrophy only. Tonsillectomy and adenoidectomy (13), adenoidectomy (1), tonsillectomy (1), and UP3/adenoidectomy (1) were performed on these patients. Four patients (25%) required observation in an intensive care setting the first night. An average hospital stay of 2.1 days was noted with a range of 0 to 7 days. Significant postoperative apnea was common, and oxygen was used in over 60% of patients. Symptoms were resolved in 69% of patients at last follow up. In conclusion, tonsillectomy and adenoidectomy can be a useful procedure for children with Down syndrome and obstructive sleep apnea, however overnight hospitalization for observation and treatment of persistent apnea is appropriate.

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PubMed1996

Ondansetron decreases postoperative vomiting in pediatric patients undergoing tonsillectomy and adenoidectomy.

One of the most frequently performed pediatric surgical procedures is tonsillectomy and adenoidectomy. Nausea and vomiting and the inability to tolerate oral fluids lead to unplanned hospitalizations. Despite treatment with metoclopramide and droperidol, nausea and vomiting continue to be high after this procedure. We designed this investigation to compare currently utilized antiemetics to ondansetron, a new serotonin antagonist, in hopes of decreasing the occurrence of nausea and vomiting in patients undergoing tonsillectomy and adenoidectomy. This prospective, randomized, double-blinded clinical trial compared ondansetron, droperidol, and placebo administered at the induction of general anesthesia and the incidence of vomiting postoperatively. One-hundred sixty-five children between the ages of 2 and 12 years undergoing ambulatory adenotonsillectomy were enrolled and completed this investigation. The primary outcome measure was the elimination of vomiting during the 24-h investigative period following surgery. Both ondansetron and droperidol significantly lowered the incidence of postoperative emesis after tonsillectomy and adenoidectomy (P < 0.012) compared to placebo. Ondansetron was significantly more effective than droperidol in reducing emesis after discharge (P < 0.025). Both ondansetron and droperidol are effective in decreasing emesis when given before surgical incision in pediatric patients undergoing tonsillectomy and adenoidectomy. Ondansetron's antiemetic effect persists for up to 24 h following surgery with significant reductions in emesis. Ondansetron's effectiveness in eliminating vomiting without sedation or other side effects suggests that it should be considered as part of the standard management in pediatric patients undergoing tonsillectomy and adenoidectomy.

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