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Effects of visual guidance and instrument choice on symptom recurrence following adenoidectomy: a systematic review
Martin Mølhave1, Therese Ovesen1,2, Adnan Madzak1
1University Clinic for Flavour, Balance and Sleep, Department of Otorhinolaryngology, Head and Neck Surgery, Gødstrup Hospital, Herning, Denmark.
Insights
This systematic review found insufficient evidence on whether visual guidance impacts adenoidectomy outcomes for obstructive sleep apnea (OSA) and otitis media with effusion (OME). More high-quality studies are needed to determine the effectiveness of visual guidance in reducing symptom recurrence.
Area of Science:
- Otolaryngology
- Pediatric Surgery
- Evidence-Based Medicine
Background:
- Adenoidectomy is a common procedure for pediatric obstructive sleep apnea (OSA) and otitis media with effusion (OME).
- The techniques used, including visual guidance and instrument choice, may influence surgical outcomes.
- Current evidence on the comparative effectiveness of different adenoidectomy techniques is limited.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) assessing the impact of visual guidance and instrument choice on adenoidectomy outcomes.
- To evaluate the effect on symptom recurrence and reoperation rates for OSA and OME in pediatric patients.
- To synthesize current evidence and identify gaps for future research.
Main Methods:
- Systematic review of RCTs identified through comprehensive database searches (Embase, PubMed/Medline, Cochrane Library, Scopus).
- Inclusion criteria: RCTs from 2000 onwards, ≥25 pediatric patients, adenoidectomy for OSA or OME, comparing visually guided vs. blinded or cold vs. hot techniques.
- Outcomes assessed: OSA and OME symptom recurrence, reoperation rates. Risk of bias and evidence quality evaluated using Cochrane Risk of Bias tool and GRADE.
Main Results:
- Four studies (373 participants) met inclusion criteria, all comparing hot and cold adenoidectomy techniques (hot techniques were visually guided).
- One study suggested lower OSA recurrence with hot (visually guided) technique but had a high risk of bias; other studies found no significant differences.
- No studies reported reoperation rates, and significant heterogeneity precluded meta-analysis. Overall risk of bias and evidence quality were moderate.
Conclusions:
- There is currently insufficient evidence to conclude whether visual guidance improves outcomes after pediatric adenoidectomy for OSA or OME.
- High-quality RCTs are necessary to provide definitive conclusions on the effectiveness of visual guidance and instrument choice.
- Further research should focus on standardized reporting of recurrence and reoperation rates.
Objectives:
To assess the impact of visual guidance and instrument choice on obstructive sleep apnea (OSA) and otitis media with effusion (OME) symptom recurrence and reoperation rates following adenoidectomy in pediatric patients.
Design:
Systematic review of randomized controlled trials (RCTs).
Setting:
A comprehensive literature search was conducted in Embase, PubMed/Medline, the Cochrane Library, and Scopus, with the final search on September 23, 2024. Reference lists were also screened.
Participants:
Eligible studies included RCTs published from 2000 onwards, with ≥25 pediatric patients undergoing adenoidectomy for OSA or OME. Comparisons included visually guided versus blinded and cold versus hot adenoidectomy techniques. Studies involving concurrent procedures, craniofacial abnormalities, or non-primary adenoidectomy cases were excluded.
Main Outcome Measures:
The primary outcomes were OSA and OME symptom recurrence and reoperation rates following adenoidectomy. Risk of bias was assessed using Cochrane Risk of Bias tool, and evidence quality was evaluated using Grading of Recommendations Assessment, Development and Evaluation.
Results:
Of 2302 screened articles, 35 underwent full-text review, and 4r studies (373 participants) met inclusion criteria. All studies compared hot and cold techniques, with hot techniques being visually guided. Only one study directly compared both hot and cold techniques under visual guidance, reporting lower OSA recurrence rates with the hot technique, though with a high risk of bias. Other studies found no significant differences, and none reported reoperation rates. Study heterogeneity prevented meta-analysis. Overall risk of bias and evidence quality were moderate.
Conclusions:
There is insufficient evidence to determine whether visual guidance reduces symptom recurrence following adenoidectomy. Further high-quality RCTs are needed to provide more sound conclusions.
Prospero Registration Number:
CRD42024513408.
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