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Adenoidectomy: Anatomical Versus Clinical Success
Paresh P Naik1, V M Lakshanadeve2, Mary Kurien2
1University Hospital of Northamptonshire, Northampton, UK.
Insights
Conventional adenoid curettage is as effective as endoscopic adenoidectomy for managing adenoid enlargement in children. Complete adenoid removal is not essential for symptom relief, suggesting other factors influence persistent sleep issues.
Area of Science:
- Otolaryngology
- Pediatric Surgery
Background:
- Adenoidectomy is a common procedure for adenoid enlargement.
- Endoscopic techniques are increasingly used, posing challenges in resource-limited settings.
Purpose of the Study:
- To compare the efficacy of conventional curettage versus endoscopic-assisted adenoidectomy for adenoid enlargement in children.
- To assess the impact of residual adenoid tissue on clinical outcomes.
Main Methods:
- A randomized controlled double-blinded study involving 71 children (3-15 years) undergoing adenoidectomy.
- Patients were randomized to conventional curettage or endoscopic-assisted adenoidectomy.
- Outcomes assessed via symptom questionnaires and fiberoptic nasal endoscopy pre- and post-operatively.
Main Results:
- Both methods achieved significant symptom relief, except for sleep-related issues.
- Residual adenoid tissue (up to Grade II) was observed in both groups post-surgery.
- No significant complications were reported in either group.
Conclusions:
- Conventional adenoid curettage is comparable to endoscopic adenoidectomy in children aged three and above.
- Complete adenoid clearance ('anatomical success') is not always necessary for clinical success.
- Persistent sleep issues may indicate non-obstructive causes in some patients.
Abstract:
Endoscopic adenoidectomy with powered instruments,a challenge in resource-constraint developing countries, has been on the rise. To evaluate conventional curettage as compared to endoscopic assisted adenoidectomy in the successful management of adenoid enlargement. A randomized controlled double-blinded study among children undergoing adenoidectomywas done. Primary outcomes were assessed by pre- and postoperative evaluation with a symptoms questionnaire and fiberoptic nasal endoscopy. There were 71 children aged 3-15 years, majority having grade III adenoids. Conventional adenoidectomy was done by the surgeon who was blinded to preoperative adenoid status. Patients were randomized to two groups, 35in conventional curettage where no further on-table intervention was done. Check endoscopyof the remaining 36 patients, formingthe second group, revealed residual grade III adenoidsin 5.6%. They underwentcompletion adenoidectomyendoscopically. By the 12th postoperative week, nasal endoscopy noted that 39.3% had grade I/II and 8.8% had grade I in the conventional and endoscopic groups respectively. Thoughstatistically significant, all pre-op symptoms settled except sleep-related ones which persisted in both groups (25% versus 14.7) with no complications in either group. Relief of all symptoms other than sleep-related ones, was achieved despite residual adenoids being up to grade II in both conventional and endoscopic group. This suggests non-obstructive causes in a subset of these patients. Conventional adenoid curettage is comparable to endoscopic adenoidectomy by cold method among children aged three and above. Complete adenoidclearance for achieving 'anatomical success' appears not to be necessary for 'clinical success'.
