THE PART PLAYED BY ADENOIDECTOMY IN THE COMBINED OPERATION OF TONSILLECTOMY WITH ADENOIDECTOMY. SECOND PART OF A CONTROLLED STUDY IN CHILDREN.

Abstract

Most of the literature on tonsillectomy concerns the combined operation, tonsillectomy with adenoid ectomy, and one is left in doubt whether the benefits can be attributed to the tonsillectomy, to the adenoidectomy, or to both parts of the operation. It was noted by Fry (1957) that otitis media featured in more than half of the children referred for tonsillectomy from his practice. In a survey of physicians in the United States, Wolman (1956) found that tonsillectomy was recommended by 77 per cent, for the relief of otitis media. However, Brown (1954) found that adenoidectomy was not likely to benefit recurring otitis media. He con cluded from his review that the main indication for adenoidectomy was occlusion of the nasopharynx which was an uncommon condition. Sataloff and Menduke (1958) considered that middle ear disease causing deafness was an indication for adenoid ectomy in children, but that the adenoids might also be suspect where there were other symptoms, such as nasal obstruction, running nose, and recurrent upper respiratory infections. Recent lists of indica tions for tonsillectomy do not include frequent colds or coughs. Most writers agree that adenoid ectomy should be performed at any age when the indications for it are seen. An earlier paper by McKee (1963) described the effects of tonsillectomy and adenoidectomy in child ren referred to a surgeon. A 2-year morbidity survey demonstrated that the incidence of throat disease was reduced in the children who had immediate operation, but remained high in those for whom the operation was deferred. Other changes after opera tion were a reduction in the occurrence of otitis media and chronic catarrhal illness. One of the aims