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PubMed2004

Effect of adenoidectomy in children with complex problems of rhinosinusitis and associated diseases.

OBJECTIVES: The effectiveness of adenoidectomy in the management of pediatric sinusitis is still a controversial issue. The size of the adenoid and associated diseases are the factors for consideration. The adenoid has been studied and is proved to be a probable source of infection for the paranasal sinus. The purpose of this study is to evaluate the efficacy of adenoidectomy in reducing the frequency of sinusitis in children. METHODS: A prospective study was done in pediatric patients with rhinosinusitis admitted for adenoidectomy from January 2000 to January 2002. Pre-operative frequency of rhinosinusitis, underlying diseases and the diseases caused by the adenoid were recorded. The adenoid size was evaluated by lateral skull X-ray. The patients were followed after surgery and frequency of rhinosinusitis and associated diseases were compared with the pre-operative period. RESULTS: There were 37 patients with mean age of 6+/-2.8 years. Mean duration for pre-operative review was 436.7 days and mean duration for post-operative follow up was 450.2 days. Almost all (92%) of the patients had obstructive sleep disorder and 88.2% had adenoid-nasopharyngeal ratio >0.7. There was a statistically significant reduction of episodes per year of rhinosinusitis and obstructive sleep disorder after surgery (P-value < 0.001 and 0.008, respectively). CONCLUSIONS: Adenoidectomy was proved to be effective in the management of pediatric rhinosinusitis in this series. Adenoidectomy should be most beneficial as a surgical option before endoscopic sinus surgery (ESS), especially in younger children with obstructive symptoms.

Adenoidectomy↗

PubMed2006

Finnish adenoidectomy and tympanostomy rates in children; national variation.

OBJECTIVES: To assess upper respiratory surgery rates in Finnish children and compare the rates of adenoidectomy and tympanostomy tubes in 2002 with the 1987 cohort. METHODS: Descriptive study of national upper respiratory surgery in Finland in 1987 and 2002; adenoidectomies, tympanostomy tubes and combination of these two. Surgical rates were viewed in the light of child density and number of primary care physicians and otorhinolaryngologists. RESULTS: Rates of adenoidectomy and tympanostomy tubes were highest in Western Finland and lowest in Eastern Finland (p<0.00001). Peak-age for adenoidectomy and tympanostomy tubes was in the second year of life. Surgery was most common in boys (p<0.00001). Both the numbers of otorhinolaryngologists and operations increased from 1987 to 2002; the largest surgery increase, 7.3%, was found in Western Finland. CONCLUSION: Large national differences in rates of paediatric adenoidectomy and tympanostomy tubes in Finland propose that national guidelines have not had an impact on the selection of children for surgery.

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PubMed2004

Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in children undergoing adenoidectomy.

PROBLEM ADDRESSED: Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high-viscosity gel for hemostasis and has been clinically proven to control bleeding. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. METHODS AND MEASURES: Seventy patients (mean age 7.0 yrs, 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy with an adenoid curette and were then randomized to receive the hemostatic sealant (Floseal) or cautery to obtain hemostasis. Patients were crossed over to the other hemostatic technique if hemostasis was not achieved after more than 100 mL of blood loss or 15 minutes elapsed time. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal (0 = none, 3 = brisk) and ease of operation (1 = extremely easy, 6 = extremely difficult). Parents recorded diet on a journal and were contacted by phone at postoperative day 7 and questioned with regard to return to regular diet and use of narcotics. RESULTS: Compared to patients in the cautery group (n = 35), Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 +/- 1.3 minutes vs 9.5 +/- 5.4 minutes [mean +/- SD], P < 0.001), less blood loss (2.5 +/- 9.2 mL vs 29.4 +/- 27.1 mL, P < 0.001), less subjective bleeding (0.0 +/- 0.6 vs 2.0 +/- 0.7, [median 4-point VAS +/- SD], P < 0.001), and subjectively easier operations (2.6 +/- 1.0 vs 5.2 +/- 1.0 [mean 6-point VAS +/- SD], P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 +/- 0.7 vs 4.1 +/- 0.5 days [mean +/- SD], P < 0.001) and had less use of narcotics at 7 days postoperatively (40% vs 69%, P < 0.05). Lastly, three patients in the cautery group were crossed over to the Floseal group, but no Floseal subjects were crossed over to the cautery group. The retail cost of Floseal is US 85 dollars. Operating room costs are estimated at US 12 dollars/minute. Reducing the operative length by 8.9 minutes on average produces a cost savings of US 106.80 dollars per operation. There were no complications in either experimental group including postoperative hemorrhage, hospitalization, blood transfusion, or aspiration. CONCLUSIONS: Floseal matrix hemostatic sealant is a safe, efficacious, easy, and cost-effective technique for obtaining hemostasis in children undergoing adenoidectomy. Limitations of the study include the fact that it is nonblinded, which does allow for some bias in the subjective data recorded. However, utilizing 4 different operating surgeons, 3 of whom were not affiliated with the study, minimized this. CLINICAL SIGNIFICANCE OF STUDY: This study demonstrates the safety and efficacy of a novel hemostatic sealant in children undergoing adenoidectomy. Floseal matrix hemostatic sealant can be used as a first-line hemostatic agent, and it is a good tool in the armamentarium of otolaryngologists who encounter significant bleeding following adenoidectomy.

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PubMed1998

Electrocautery versus curette adenoidectomy: comparison of postoperative results.

OBJECTIVE: Identify differences in adenoidectomy performed by curettage versus electrocautery ablation. DESIGN: To receive adenoidectomy by curettage or electrocautery ablation 38 patients undergoing adenoidectomy or adenotonsillectomy were prospectively randomized. The study was completed by 24 patients. All tonsillectomy patients received electrocautery dissection of the tonsils. Preoperative and at least 1 month postoperative video-nasopharyngoscopy was performed. Video tapes were reviewed by the authors blinded to patient identity and procedure to evaluate choanal obstruction. Preoperative and postoperative lateral neck radiographs were obtained. Blood loss and postoperative complications were recorded. SETTING: A single, tertiary care pediatric facility. INTERVENTIONS: Electrocautery ablation of the adenoid was performed with suction cautery. Curettage was performed with standard adenoid curettes. MAIN OUTCOME MEASURED: A grading system for adenoid size was developed using radiographs and endoscopic parameters. The grade of preoperative and postoperative adenoid tissue was compared between the curettage and electrocautery ablation groups. Operative blood loss was compared between the groups. The postoperative course and complications were compared. RESULTS: The preoperative grade of choanal obstruction in both groups was the same. No differences could be found in the postoperative grade between the curettage and the electrocautery ablation groups. No postoperative complications were recorded in either group. The estimated blood loss in the curettage group was 54.5 ml (S.D. 50.7) while the electrocautery ablation group averaged 3.75 ml (S.D. 6.4; p = 0.0053). CONCLUSION: There are no differences in the postoperative results of adenoidectomy performed by electrocautery ablation or curettage. There are no complications recorded in either group. Estimated blood loss was lower in the electrocautery ablation group. Decreased blood loss during the procedure makes the electrocautery ablation method of adenoidectomy attractive.

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PubMed1998

Acoustic rhinometric evaluation of nasal cavity and nasopharynx after adenoidectomy and tonsillectomy.

The occurrence of upper airway obstruction is frequently seen in patients with adenotonsillar hypertrophy. These patients usually also show hypertrophied inferior turbinates even without any other nasal or sinus disease. However, it is not known what the effect of adenoidectomy and tonsillectomy is on these hypertrophic turbinates. To determine the effect of these procedures on the nasal and nasopharyngeal geometry, we performed acoustic rhinometry previous to and 2 weeks following adenoidectomy and tonsillectomy, before and after spraying a decongestant in 31 children (19 males, 12 females; mean age, 8.03 years). After the adenoidectomy and tonsillectomy, there were increases in the cross-sectional area at the anterior end of the inferior turbinate (0.53+/-0.03 cm2 preoperatively, 0.65+/-0.21 cm2 postoperatively; P=0.01), the nasal volume (7.13+/-1.78 cm3 preoperatively, 9.38+/-1.65 cm3 postoperatively; P < 0.01), the cross-sectional area at the adenoid (0.80+/-0.53 cm2 preoperatively, 1.83+/-0.81 cm2 postoperatively; P < 0.01) before decongestion. However, 10 min after decongestion there was only a significant increase of the cross-sectional area at the adenoid (1.08+/-0.12 cm2 preoperatively, 1.80+/-0.20 cm2 postoperatively; P=0.01). We conclude that adenoidectomy and tonsillectomy reverse the congestion of the inferior turbinate which is observed in children with adenotonsillar hypertrophy and that acoustic rhinometry can be used to evaluate the effect of adenoidectomy and tonsillectomy on the nose and nasopharynx.

Acoustics↗

PubMed1995

Pediatric tympanoplasty: the role of adenoidectomy.

A chronic dry perforation in a child presents a dilemma with regard to timing of intervention or whether intervention is appropriate at all. Many studies have looked at elements associated with eustachian tube function in hopes of finding prognostic factors. Adenoidectomy has been shown to be very effective in the treatment of chronic and recurrent otitis media. Intuitively, it would seem to play a role in pediatric tympanoplasty; however, no study has thoroughly investigated this issue to date. To evaluate the role of adenoidectomy in pediatric tympanoplasty, we performed a retrospective review of all patients younger than 18 years who had a simple dry perforation and underwent a Wullstein's type I tympanoplasty. Thirty-six patients were identified for review during the 7-year study period. The patients were grouped into those who had previous adenotonsillectomy (n = 12), those who had prior adenoidectomy alone (n = 10), and those who had neither (n = 14). Initial success of tympanoplasty was noted to be high in all three groups. However, at 6-month follow-up, the success for the group who had not had prior adenoidectomy or tonsillectomy dropped dramatically (14.3%), whereas the other two groups maintained success rates in excess of 75% (p = 0.002). This relationship remained fairly constant throughout the 2 years of follow-up. Although our population under study is somewhat small, the results support a potentially advantageous role of adenoidectomy for pediatric tympanoplasty. These results and their implications will be discussed.

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PubMed2000

Adenoidectomy with laser or incisional myringotomy for otitis media with effusion.

OBJECTIVE: To compare the effectiveness of CO2 laser myringotomy to incisional myringotomy at the time of adenoidectomy for refractory otitis media with effusion (OME). STUDY DESIGN: Controlled retrospective consecutive case series. METHODS: All children undergoing myringotomy and adenoidectomy for OME in the spring of 1999 had 1.7-mm-diameter perforations created in their tympanic membranes using a CO2 laser and conventional microslad. Their ears were evaluated at first postoperative visit (mean, 16.65 days after surgery) by a validated otoscopist to determine the presence or absence of perforations and middle ear effusions. These patients were compared with historical controls comprising all children undergoing incisional myringotomy and adenoidectomy in 1998. A chi2 analysis was performed to compare the results of these two myringotomy techniques. RESULTS: Twenty-three children (39 ears) underwent laser myringotomy and adenoidectomy in 1999, compared with 26 children (48 ears) who underwent incisional myringotomy and adenoidectomy in 1998. In the laser myringotomy group, 8 of the 39 ears had a persistent opening at first follow-up; 4 of the 39 ears showed evidence of effusion. In the incisional myringotomy group, all 48 ears had healed; 7 of these ears showed evidence of effusion. CONCLUSION: Myringotomies created using the CO2 laser are more likely to be patent at first postoperative visit than those made with incisional technique (P < .01). However, this prolonged middle ear ventilation does not significantly decrease the prevalence of effusion (P > .1).

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PubMed2006

Adenoidectomy and/or tonsillectomy in childhood is not associated with atopic disease later in life.

OBJECTIVE: To investigate the association between adenoidectomy and/or tonsillectomy in childhood and asthma, allergic rhinitis (AR), and eczema in adolescence. METHODS: Longitudinal birth cohort study of 1328 members born in the city of Nijmegen. Information on ear-nose-throat surgery was documented at 2, 4, and 8 years of age. In 1055 cohort members the incidence of asthma, AR, and eczema at 21 years of age was determined using the International Study of Asthma and Allergic disease in Childhood Core Questionnaire. To analyse the association between adenoidectomy and/or tonsillectomy in childhood and asthma, AR, and eczema at age 21 years, relative risks (RR) were calculated. RESULTS: Six hundred and ninety-three (66%) members completed the questionnaire at age 21 years, of whom 104 (15%) had undergone adenoidectomy and/or tonsillectomy and 262 (38%) reported atopic disease. Children who underwent adenoidectomy and/or tonsillectomy before the age of 8 years were not more likely to develop asthma, AR, or eczema at the age of 21 years than children who did not; RR 0.93 (95% confidence limits (CL) 0.52-1.64), RR 0.94 (CL 0.68-1.30), and RR 1.00 (CL 0.59-1.68), respectively. CONCLUSIONS: Our data show no association between adenoidectomy and/or tonsillectomy in childhood and the incidence of atopic disease in young adults.

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PubMed1993

Spontaneous resolution of severe chronic glue ear in children and the effect of adenoidectomy, tonsillectomy, and insertion of ventilation tubes (grommets).

OBJECTIVE: To measure the time to spontaneous resolution of severe chronic otitis media with effusion (glue ear) in children and study the effects of adenoidectomy, adenotonsillectomy, and ventilation tubes (grommets). DESIGN: Randomised controlled study over 12 years. SETTING: Paediatric otorhinolaryngology clinics and in-patient unit. SUBJECTS: 228 children aged 2-9 years with pronounced hearing loss from glue ear and persistent bilateral middle ear effusions confirmed on three occasions over three months. INTERVENTIONS: Children were randomly allocated to adenotonsillectomy, adenoidectomy, or neither procedure. In all groups a Shepard type ventilation tube was inserted in one randomly chosen ear. Follow up was annually for five years and then less often for up to seven years four months. For analysis the two operated groups were combined. MAIN OUTCOME MEASURES: Otoscopic clearance of fluid, change in tympanogram, and improvement in mean audiometric hearing threshold. RESULTS: Survival analysis showed appreciable otoscopic and tympanometric resolution of fluid with ventilation tubes alone and adenoidectomy alone compared with no surgery. Further improvement was seen after combination of both treatments. Mean audiometric hearing thresholds improved with fluid resolution. Resolution was delayed in younger children and in those whose parents smoked, irrespective of treatment. Whereas a single insertion of a Shepard tube resolved the glue for a mean (SD) period of 9.5 (5.2) months, the effect of adenoidectomy was sustained throughout follow up. CONCLUSIONS: Treatment of glue ear considerably shortened the time to fluid resolution, combined adenoidectomy and tube insertion being better than either procedure alone. Resolution was longer in younger children and those whose parent(s) smoked, irrespective of treatment.

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PubMed2003

Value-based approach to power-assisted adenoidectomy.

A recognized disadvantage of power-assisted adenoidectomy (PAA) is the increased patient charge associated with the disposable instrumentation. The elimination of pathological review of routine adenoid specimens may provide a means of offsetting the increased charge, as 1) unsuspected findings are rare, and 2) PAA specimens are too traumatized to provide the microscopic detail necessary to make an unsuspected diagnosis. The pathology reports of all adenoidectomy specimens removed over a 10-year period were reviewed and combined with previously published reviews in order to estimate the prevalence of unsuspected disease. The estimated prevalence of unsuspected diagnoses found by routine pathological review of adenoid specimens is 37 per 100,000 cases (95% confidence interval, 26-51). In a separate analysis, a pathologist blinded to the technique of adenoid removal assessed the tissue effects of curette adenoidectomy versus PAA. Significant tissue damage at the microscopic level was identified in 6 of 11 specimens removed with the power-assisted technique as compared to 0 of 11 specimens removed by curette (p = .03). Eliminating histopathologic review of routine adenoidectomy specimens can potentially offset the increased patient charge of PAA by 62%. Power-assisted adenoidectomy, however, should be avoided in nonroutine cases in which the potential for occult disease exists.

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PubMed1995

Velopharyngeal incompetence and persistent hypernasality after adenoidectomy in children without palatal defect.

Persistent hypernasal speech after adenoidectomy has been reported in children with palatal deficiency. Hypernasality after adenoidectomy can also occur in children with normal palatal function. The aim of the present study was to identify the cause of velopharyngeal incompetence and hypernasality after adenoidectomy in children who did not have palatal defect as a predisposing factor. Sixteen children who developed hypernasality after adenoidectomy were included in the present study. Standard lateral cephalometry, videofluoroscopy, and nasopharyngoscopy were performed to visualize the velopharynx and its function during speech. The results showed that enlarged tonsils and prominent remaining adenoid tissue on the posterior pharyngeal wall were the causes of hypernasality in these children. Incomplete removal of the adenoid tissue should be avoided and enlarged tonsils should be removed at the time of adenoidectomy to prevent the risk for postoperative hypernasality.

Adenoidectomy↗

PubMed2002

Endoscopic partial adenoidectomy for children with submucous cleft palate.

OBJECTIVE: Children with submucous cleft palate who suffer from chronic nasal obstruction because of hypertrophic adenoids usually are not subjected to adenoidectomy because of the fear of postoperative velopharyngeal insufficiency. These patients present a therapeutic challenge because we are aware more than ever of the importance of normal nasal breathing and nocturnal respiration, especially during childhood. Our hypothesis was that transnasal endoscopic horizontal limited adenoidectomy may relieve nasal obstruction while preserving the function of the velopharyngeal valve. The objective of this study was to evaluate the efficacy of transnasal endoscopic horizontal partial adenoidectomy in patients with submucous cleft palate and adenoidal hypertrophy. SETTING: Patients were either referred to the outpatient clinic of the Palate Surgery Unit (seven patients) or were patients referred to the senior author's (Y.F.) private clinic. All the patients had been operated on by this senior author (Y.F.). PATIENTS: Ten children aged 3.5 to 13 years (six girls and four boys) with submucous cleft palate and hypertrophic adenoids were included in the study. All the patients were hyponasal and suffered nasal obstruction, loud snoring, and episodes of apnea. INTERVENTIONS: Endoscopic partial adenoidectomy was accomplished to open the lower third of the choanae. Nasal breathing was achieved in all the patients, and only mild snoring remained in two patients. The hyponasality disappeared and speech intelligibility normalized. Mild hypernasality developed in two patients but was still perceived as an overall improvement in speech. CONCLUSIONS: Transnasal endoscopic horizontal partial adenoidectomy may be an effective surgical method for relief of nasal obstruction while preserving velopharyngeal valve function in patients with submucous cleft palate who suffer from obstructive adenoids.

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PubMed2000

Superior adenoidectomy in children with palatal abnormalities.

When treating a child with a palatal abnormality for otitis media or a nasal obstruction, otolaryngologists often face the question of whether the benefits of adenoidectomy are worth the risk of the development of velopharyngeal insufficiency. Treatment options for these patients include a complete adenoidectomy, a partial adenoidectomy, or no surgical intervention. In this retrospective study, we describe the outcomes of 22 such patients who were treated with a superior adenoidectomy performed with a St. Clair adenoidforceps under indirect vision with a laryngeal mirror. All patients experienced a complete or near-complete resolution of their nasal obstruction, and none developed permanent velopharyngeal insufficiency. Only three patients experienced a recurrence of otitis media. Our experience suggests that superior adenoidectomy is a safe and effective procedure.

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PubMedDate not supplied

[Endoscopic adenoidectomy; use or abuse of the technology?].

OBJECTIVE: To evaluate efficacy of the conventional technique of adenoidectomy by means of transoperative endoscopic revision of the nasopharynx and to evaluate the need for including telescopes as part of usual instruments used in adenoidectomy. MATERIAL AND METHODS: Prospective, open, comparative, and transversal study. We included the first 150 patients with absolute indication for adenoidectomy. We did 150 adenoidectomy procedures by conventional technique using Beckman adenotomes, and La Force adenotomes, using a laryngeal mirror to observe condition of nasopharynx once the surgeon thought the procedure was completed, we did a revision of adenoid area with Hopkins telescopes of 0 and 30; if we founded residues of adenoids, these were eliminated with Guggenheim forceps, adenotomes, or curved 40 degrees microdebrider tip, all after endoscopic viewing, which also helped in control of area bleeding. MEASURED PARAMETERS: Presence or absence of adenoids residue location, and presence or absence of active bleeding. RESULTS: Total removal of adenoids was carried in 43 patients, our finding adenoid residues in 107 of cases. Of these, 45.3% were occluding pharyngeal part of Eustachian tubes. CONCLUSIONS: Conventional technique for adenoidectomy was effective in < 30%; therefore, it is imperative to use endoscopic revision in each case.

Adenoidectomy↗

PubMed2005

[Analysis of postoperative hemorrhage after adenoidectomy and tonsillectomy in children in own material].

Hypertophy of pharyngeal tonsil and palatine tonsils is the most common cause of nasal obstruction in children. When the obstruction of the nasopharynx causes recurrent infections of upper respiratory tract, chronic otitis media secretoria or sleep apnoea, then adenoidectomy with or without tonsillectomy is indicated. The purpose of the study was analysis of postoperative hemorrhage after adenoidectomy with or without tonsillectomy. The influent of frequent infections of upper respiratory tract, disorders of blood clotting, chronic diseases, seasons of the year, operation time and general anesthesia on postoperative hemorrhage was estimated. A group of 1184 children after adenoidectomy with or without tonsillectomy was studied. Postoperative hemorrhage occurred in 59 children (4.98%). Early bleeding was frequently occurred after adenotonsillectomy and late bleeding after adenoidectomy. There was relationship between the time of general anesthesia and incidences of postoperative bleeding. Food or inhalation allergy, recurrent infections of upper respiratory tract and male sex are risk factors of postoperative hemorrhage after adenoidectomy with or without tonsillectomy.

Adenoidectomy↗

PubMedDate not supplied

[Tonsillectomy and adenoidectomy in children of 1 and 2 years].

The aim of this paper is evaluate the risk and the benefit to tonsillectomy and adenoidectomy in very young children. Between January 1989 and May 1993 we have operated on 166 children less than 3 years old (98 adenoidectomies and 68 adenotonsillectomies). 19 one year old children were submitted to adenoidectomy and 7 to tonsillectomy, the youngest was 7 months old. The indication for adenoidectomy were prevalent mouth breathing, snoring and recurrent otitis media; the criteria for tonsillectomy have been obstructive sleep problems, history of snoring, eating and swallowing disorders (97% of cases) and recurrent viral tonsillitis (3% of cases). All operation were performed under general anesthesia with children in Rose position. Postoperatively no antibiotics were given and only one dose of analgesic drug. We have never used aspirin either before or after surgery. No child had postoperative bleeding. No child has been readmitted for dehydration. We conclude after this study that tonsillectomy and adenoidectomy can be a safe procedure also in very young children.

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PubMed1998

Postoperative complications after tonsillectomy and adenoidectomy in children with Down syndrome.

OBJECTIVE: To compare the postoperative course and complications after tonsillectomy or tonsillectomy and adenoidectomy in children with Down syndrome (group 1) with the postoperative course and complications in children in a control group (group 2). DESIGN: Retrospective review of medical records for the period January 1, 1986, through March 30, 1996. SETTING: Tertiary care children's hospital. PATIENTS: The study included 87 children in group 1 and 64 children in group 2 matched for age, sex, and year of surgery. INTERVENTION: Tonsillectomy and adenoidectomy (group 1, 79 children; group 2, 57 children) and tonsillectomy (group 1, 8 children; group 2, 7 children). MAIN OUTCOME MEASURES: Length of hospitalization and postoperative complications. RESULTS: The length of hospitalization was significantly increased for the children in group 1 compared with that of children in group 2 (1.6 vs 0.80 days; P=.001, Mann-Whitney U test). Twenty-two children (25%) in group 1 required airway management or observation in the pediatric intensive care unit compared with no children in group 2 who required such care (P<.001, Fisher exact test). None of the children in either group required reintubation, continuous positive airway pressure, or tracheotomy. Respiratory complications requiring intervention were 5 times more likely in group 1 (22 [25%] vs 3 [5%]; P<.001, Fisher exact test). The median time until intake of clear liquids and duration of intravenous therapy were significantly increased in group 1 compared with group 2 (5.0 vs 4.0 hours, P=.03; 23.5 vs 16.0 hours, P=.001, respectively; Mann-Whitney U test). CONCLUSIONS: Although tonsillectomy and adenoidectomy can be performed safely in children with Down syndrome, the rate of postoperative respiratory complications is higher and the duration until adequate oral intake is resumed is longer. We therefore recommend that children with Down syndrome be admitted to the hospital overnight after undergoing tonsillectomy and adenoidectomy.

Adenoidectomy↗

PubMed2003

Prevention of otitis media by adenoidectomy in children younger than 2 years.

OBJECTIVES: To test the effect of adenoidectomy in connection with tympanostomy compared with tympanostomy only in preventing otitis media in children younger than 2 years. DESIGN: Prospective trial with randomized and nonrandomized arms. SETTING: Primary care study clinics. PARTICIPANTS AND INTERVENTIONS: The study participants were selected from 2497 children who had been enrolled in the Finnish Otitis Media Vaccine Trial at the age of 2 months. A total of 306 children, aged 1 to 2 years, who had experienced recurrent episodes of otitis media were randomized into 2 treatment groups: tympanostomy with or without adenoidectomy. Of the 306 children, 137 were operated on according to random basis (randomized trial). The 169 children whose parents declined participation in the randomized trial were operated on according to the parents' preferences (nonrandomized trial). All children were followed up until 2 years of age. The mean follow-up time was 7 months. MAIN OUTCOME MEASURE: The rate of acute otitis media episodes. RESULTS: The average reduction in the rate of all acute otitis media episodes in the adenoidectomy group was 19% (95% confidence interval [CI], -14% to 43%) among children enrolled in the randomized trial and 25% (95% CI, -13% to 50%) in the nonrandomized trial. The reduction in the randomized trial was mainly due to reduction in the rate of pneumococcal otitis media (58%, 95% CI, 16%-79%). CONCLUSION: In children younger than 2 years, concurrent adenoidectomy during the insertion of tympanostomy tubes does not seem to have a major advantage over the insertion of tympanostomy tubes alone in preventing otitis media.

Adenoidectomy↗