Failures of Adenoidectomy for Chronic Rhinosinusitis in Children: For Whom and When Do They Fail?

Abstract

Ramadan HH, Tiu J. Laryngoscope. 2007;117(6):1080–1083 PURPOSE OF THE STUDY. To determine which children who undergo adenoidectomy for chronic rhinosinusitis will subsequently undergo endoscopic sinus surgery. STUDY POPULATION. Children who had adenoidectomy for treatment of refractory chronic rhinosinusitis over a 10-year period at a tertiary pediatric facility were included in the study. Excluded children were those with immunodeficiency, cystic fibrosis, or previous sinus surgery. All patients had an extensive preoperative workup to rule out allergy, immunodeficiency, and cystic fibrosis. METHODS. Charts were reviewed, and data were collected retrospectively. All patients underwent adenoidectomy via the suction electrocautery technique. Children were followed monthly for 3 months after adenoidectomy and then every 3 months. Data collected included age, presence of allergy or asthma, severity of sinusitis as indicated on computed tomography (CT) scans, and dates of adenoidectomy and subsequent sinus surgery. Endoscopic sinus surgery was performed for persistent symptoms despite adenoidectomy and medical management with radiographic evidence of sinusitis on CT scans. RESULTS. A total of 143 children had adenoidectomy for sinusitis, and follow-up data were available for 121 children. Adenoidectomy failed for 61 (50%) children, with data available from 55 who had subsequent endoscopic sinus surgery. The mean time between adenoidectomy and endoscopic sinus surgery was 24 months (range: 4.4–77.4 months). Children with asthma had a mean of 19 months between surgeries, whereas those without asthma had an interval of 28 months (P = .04). Children younger than 7 years of age had sinus surgery a mean of 15 months after adenoidectomy, compared with an interval of 27.5 months between surgeries for children ≥7 years (P = .01). The presence of allergy, severity of sinusitis as indicated by CT scans, and gender did not seem to affect the time of failure of adenoidectomy. CONCLUSIONS. At least 50% of children with rhinosinusitis will benefit from an adenoidectomy without the need for subsequent sinus surgery. Children who have persistent sinusitis that requires endoscopic sinus surgery after adenoidectomy tend to be younger children and/or children with asthma, with a mean of 24 months between surgeries. REVIEWER COMMENTS. Adenoidectomy is a simple procedure that is effective for treating children with rhinosinusitis whose conditions fail medical therapy, but a number of children do go on to have more extensive surgical procedures. The retrospective nature of this study and limited information on how sinusitis symptoms were stratified, as well as how treatment failure was defined, affect our ability to generalize the conclusions of this study. The shorter interval between adenoidectomy and endoscopic sinus surgery in children with asthma may reflect a more aggressive approach to surgical management of sinusitis in the presence of pulmonary disease rather than an actual difference in the natural history of sinusitis in these children. The shorter interval between adenoidectomy and endoscopic sinus surgery in the younger children suggests more severe sinus symptoms in this group, although it may just reflect the natural history of sinusitis and upper respiratory infections in children, with eventual resolution expected for many older children regardless of treatment.