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Adenoidectomy in Children: What Is the Evidence and What Is its Role?
Alexander J Schupper1, Javan Nation2,1, Seth Pransky2,1
12UC San Diego School of Medicine, San Diego, CA USA.
Insights
Adenoidectomy is a safe pediatric procedure for sleep-disordered breathing and nasal obstruction. Current guidelines advise against it for otitis media in young children unless other symptoms are present.
Area of Science:
- Pediatric Otolaryngology
- Surgical Procedures
- Respiratory Medicine
Background:
- Adenoid hypertrophy significantly impacts children's health, causing sleep-disordered breathing, nasal obstruction, and recurrent ear infections.
- Management strategies range from watchful waiting to surgical intervention.
Purpose of the Study:
- To review current indications, surgical techniques, adverse events, and non-surgical options for pediatric adenoidectomy.
- To discuss future directions in adenoid hypertrophy management.
Main Methods:
- Literature review of recent studies and updated clinical recommendations.
- Analysis of operative techniques, including conventional and endoscopic-assisted adenoidectomy.
- Evaluation of outcomes and adverse events associated with the procedure.
Main Results:
- Adenoidectomy is indicated for sleep-disordered breathing, nasal obstruction, recurrent acute otitis media, and chronic rhinosinusitis.
- 2016 guidelines recommend against adenoidectomy for otitis media in children under 4 unless other indications exist.
- Endoscopic-assisted adenoidectomy shows safe and effective outcomes; immunotherapy is being explored as a non-surgical option.
Conclusions:
- Adenoidectomy is a safe and effective procedure for pediatric patients with specific indications.
- Adverse events are infrequent, and hospitalizations are rare.
- Children experiencing sleep disturbance due to nasal obstruction, ear issues, or chronic rhinosinusitis are ideal candidates.
Purpose Of Review:
Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions.
Recent Findings:
Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscope-assisted removal of the adenoids has proven to be a safe technique, with good short- and long-term outcomes. Novel non-surgical therapies including immunotherapy have been evaluated.
Summary:
Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.
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