Adenoid Curette Research Articles

Comparison between Endoscopic Microdebrider Adenoidectomy and Conventional Curettage Method

Background: Adenoidectomy is a surgical removal of hypertrophic nasopharyngeal lymphoid tissue forming a part of the Waldeyer's ring. Adenoid hypertrophy causes nasal obstruction and airway problems such as snoring, obstructive sleep apnea, recurrent sinusitis, and/or Eustachian tube dysfunction. These complications frequently lead to a need for adenoidectomy. Objective: To compare between cold curettage and endoscopic assisted powered technique as regard operative time, blood loss, postoperative complications. Patients and Methods: This prospective study included 18 patients, both genders, all suffering from hypertrophied adenoid tissue, presented clinically with mouth breathing, snoring, bilateral nasal obstruction and/or discharge and evidenced radiologically with plain X-ray film lateral view to the nasopharynx. All cases presented to ENT Department Zagazag University, during the period from July 2019 to July 2021, seeking for management of their problem. Patients were divided into two groups (9 patients each); Group I: In which patients were undergone conventional adenoidectomy with adenoid curette. Group II: Patients were undergone endoscopic assisted powered adenoidectomy. Results: Conventional curettage method of adenoidectomy group was associated with more operative bleeding than endoscopic assisted powered adenoidectomy group, but there was no significant difference. Nasal packing of conventional curettage method of adenoidectomy group was distributed as following; one patient (11.1%) required mild packing, 3 patients (33.3%) required moderate packing. While in endoscopic assisted powered adenoidectomy group, one (11.1%) required moderate packing. Conclusions: Endoscope assisted powered adenoidectomy needs to be acknowledged as a safe alternative to conventional adenoidectomy.

A Comparative Study between Coblation Adenoidectomy and Conventional Adenoidectomy

Back ground: the classic surgical technique performed with an adenoid curette or an adenotome has recently developed by the introduction of the endoscopic sinus surgery Aim: to compare the safety and efficacy of coblation adenoidectomy versus conventional curettage adenoidectomy. Patients and methods: This study was conducted on 50 patients who came to outpatient clinics in the Otolaryngology department, of age group between 4-14 years with adenoids hypertrophy from February 2019 to February 2020. Results: results revealed that the mean time of operation, it was11.1 ± 1.5 min in group A, but was 14.2 ± 1.8 min in group B, with statistical significance relationship P=000. Regarding the mean of Intra operative blood loss, it was32.4±3.2 ml in group A, but was 2.5±1.2 ml in group B, with statistical significance relationship P=000. Conclusion: The advent of endoscopes made a significant impact in adenoidectomy. Endoscopic assisted adenoidectomy is a natural progression of this technology to allow a more complete adenoidectomy. From this we concluded that the overall advantages of coblation adenoidectomy, compared with cold curettage, are the decrease in intra and post-operative bleeding, better safety, precision of adenoid removal and less injury to adjacent tissues.

Suction diathermy adenoidectomy: audit of current practice in a tertiary care hospital

<p class="abstract"><strong>Background:</strong> Adenoidectomy is conventionally performed using adenoid curette as a blind procedure. Suction diathermy adenoidectomy is a technique of ablating the adenoid tissue using thermal energy and removing it by suction. This audit aims to study the efficacy and complications of this technique in a tertiary care center.</p><p class="abstract"><strong>Methods:</strong> Retrospective analysis of hospital database was conducted. Twenty-seven patients who underwent suction diathermy adenoidectomy were identified and hospital records studied. Parents were contacted and enquired regarding improvement in child's symptoms.</p><p class="abstract"><strong>Results:</strong> No instances of postoperative complications identified. All except 2 parents were completely satisfied with the improvement in their child's symptoms. Two children had occasional mouth breathing.</p><p class="Standard"><strong>Conclusions:</strong> Suction diathermy adenoidectomy is a feasible alternative to conventional adenoidectomy with few complications and minimal rate of recurrence.</p>

Comparison of blood loss in endoscopic powered adenoidectomy and conventional curettage

<p class="abstract"><strong>Background:</strong> Adenoidectomy is one of the most common surgeries done in children. Over the years many techniques have evolved like powered adenoidectomy, radiofrequency ablation, electro cautery etc. Use of endoscopes has enabled surgeons to perform adenoidectomy under direct vision. The objectives of the study were to compare blood loss of conventional and endoscopic assisted powered adenoidectomy.</p><p class="abstract"><strong>Methods:</strong> In this a prospective observational study of 30 children attending ENT department in MES Medical College was done. In the conventional technique, adenoidectomy was done using St Claire Thomson adenoid curette. In powered adenoidectomy technique, micro debrider was used under guidance of 0<sup>0</sup> nasal endoscope (2.7 mm). Intra operatively blood loss during surgery were looked for and noted in both groups. </p><p class="abstract"><strong>Results:</strong> In the study of 30 children divided in to 2 groups who are comparable statistically. Average blood loss in patients who underwent CA was 38.53 ml and in patients who underwent EAA was 28.27 ml, with standard deviation of 4.704 and 3.863 respectively. The difference in mean blood loss was 10.26 ml.</p><p class="abstract"><strong>Conclusions:</strong> Endoscopic assisted powered adenoidectomy has lower blood loss as compared to conventional adenoidectomy.</p>

Comparison of microdebrider assisted adenoidectomy and adenoid curette adenoidectomy

<p class="abstract"><strong>Background:</strong> Adenoidectomy is the surgical procedure to remove the adenoids. It is conventionally performed using the curettage method. The aim is to compare between adenoid curette adenoidectomy and microdebrider assisted adenoidectomy.</p><p class="abstract"><strong>Methods:</strong> From April 2016 to March 2017, 50 patients (34 males and 16 females), requiring adenoidectomy were randomized into two groups each of twenty five. Group A underwent microdebrider assisted adenoidectomy. Group B underwent conventional adenoidectomy using the curettage method. The parameters studied were intra-operative time, blood loss, residual tissue, associated trauma, and post-operative symptomatic relief and complications. </p><p class="abstract"><strong>Results:</strong> Microdebrider assisted adenoidectomy was significantly better in terms of residual tissue left behind as compared to adenoid curette adenoidectomy (p<0.001), similar operative blood loss and operative time with no difference in complications.</p><p class="abstract"><strong>Conclusions:</strong> Microdebrider-assisted adenoidectomy is a safe and effective alternative to curettage method as it allows complete removal of adenoid tissue under direct vision.</p>

Trans-oral endoscopic partial adenoidectomy does not worsen the speech after cleft palate repair

IntroductionAdenoid hypertrophy may play a role in velopharyngeal closure especially in patients with palatal abnormality; adenoidectomy may lead to velopharyngeal insufficiency and hyper nasal speech. Patients with cleft palate even after repair should not undergo adenoidectomy unless absolutely needed, and in such situations, conservative or partial adenoidectomy is performed to avoid the occurrence of velopharyngeal insufficiency. Trans-oral endoscopic adenoidectomy enables the surgeon to inspect the velopharyngeal valve during the procedure. ObjectiveThe aim of this study was to assess the effect of transoral endoscopic partial adenoidectomy on the speech of children with repaired cleft palate. MethodsTwenty children with repaired cleft palate underwent transoral endoscopic partial adenoidectomy to relieve their airway obstruction. The procedure was completely visualized with the use of a 70° 4mm nasal endoscope; the upper part of the adenoid was removed using adenoid curette and St. Claire Thompson forceps, while the lower part was retained to maintain the velopharyngeal competence. Preoperative and postoperative evaluation of speech was performed, subjectively by auditory perceptual assessment, and objectively by nasometric assessment. ResultsSpeech was not adversely affected after surgery. The difference between preoperative and postoperative auditory perceptual assessment and nasalance scores for nasal and oral sentences was insignificant (p=0.231, 0.442, 0.118 respectively). ConclusionsTransoral endoscopic partial adenoidectomy is a safe method; it does not worsen the speech of repaired cleft palate patients. It enables the surgeon to strictly inspect the velopharyngeal valve during the procedure with better determination of the adenoidal part that may contribute in velopharyngeal closure.

A Review and Outcome of Adenoidectomy Performed in Resource Limited Settings.

Adenoidectomy remains invaluable in alleviating the obstructive symptoms of adenoid enlargement in children. The aim of this study is to review the conventional method of adenoidectomy with a view to establish its role and success in resource limited setting. A 5-year retrospective review of pediatric patients that had adenoidectomy operations done at two tertiary healthcare facilities was conducted. The clinic, ward, theatre registers and the patients' case files were the sources of information. Patients that had adenoidectomy with other otolaryngological procedures were excluded from the study. Data generated were descriptively analyzed using SPSS version 14.0. A total of 71 patients had adenoidectomy done. Of this, 65 cases were reviewed. There were a total of 45 males and 20 females with age range 11months-10years. The main indication for surgery was obstructive nasal symptoms. Conventional adenoidectomy was performed with standard adenoid curette. Intra-operative blood loss was less than 60ml and none of the patients had blood transfusion. The average duration of admission post-operatively was 1.1day. Fifty-eight (89%) of the patients were relieved of their obstructive symptoms postoperatively. Conventional curettage adenoidectomy still have a role to play especially in resource limited setting where newer techniques may be nothing but a luxury. Adequate preoperative work-up, good anesthetic and surgical techniques are sine-qua-none to successful surgical outcome. There is also a need for early referral to otolaryngologists as this will not only ensure optimal intervention but also minimal postoperative complications.

Removal of adenoid remnants after curettage adenoidectomy: Do we need powered instruments?

Abstract To compare powered to cold instruments for removing adenoid remnants after conventional curettage adenoidectomy. 110 patients (4 to 12 years old) scheduled for adenoidectomy with or without other surgeries (tonsillectomy, myringotomy and ventilation tube insertion) were enrolled in this prospective controlled study. We included patients with endoscopically detected adenoid remnants after curettage adenoidectomy including revision cases. Adenoidectomy was done using the adenoid curette, adenoid remnants detected endoscopically were removed by blakesley forceps (Group A) or by the microdebrider (Group B). Both groups were compared in terms of operative time, operative bleeding, post operative complications and adenoid recurrence. 20 patients were excluded due to absence of adenoid remnants after curettage and 10 more were lost for follow up, so we were left with 80 patients (42 in group A and 38 in group B). The mean age was 4.5 years for group A and 5 years for group B. The mean operative time was 10 minutes in group A and 9.5 minutes in group B, the difference was not statistically significant (p>0.05). Excessive intra operative bleeding was encountered in 1 patient of group B, which was controlled with suction cauetry. We didn’t encounter any postoperative bleeding in either group. Also, there were no other post operative complications like nasopharyngeal stenosis and velopharyngeal insufficiency, no adenoid recurrence was detected in both groups. Both the powered instruments (microdebrider) and the traditional instruments (blakesley forceps) under endoscopic control were characterized by a high level of precision, complete resection of residual adenoid with a very low incidence of post-operative bleeding and no recurrence, but we feel that powered instruments didn’t add any advantage over the traditional ones especially if the cost of the disposable blades is taken in consideration

Microdebrider tonsillectomy associated with more intraoperative blood loss than electrocautery

ObjectiveTo describe and compare the intraoperative blood loss in children who underwent tonsillectomy and/or adenoidectomy during a transition from using electrocautery to a microdebrider. MethodsRetrospective case series of a single pediatric otolaryngologist at an urban general hospital. Patients aged 2–20 years who had tonsillectomy, adenoidectomy, or adenotonsillectomy over a 12 month period were included. Tonsillectomy was performed by microdebrider or electrocautery and adenoidectomy was performed by microdebrider, curette, or suction electrocautery. Total intraoperative blood loss was measured and compared between surgical techniques. ResultsOf the 148 patients, 109 had tonsillectomy with or without adenoidectomy and 39 had adenoidectomy alone. The mean blood loss was 47ml or 1.8±1.6ml/kg and the maximum blood loss was 11ml/kg. Adenoid curette and adenoid microdebrider yielded similar blood loss but were associated with more bleeding than suction electrocautery (P<0.05). Microdebrider tonsillectomy yielded more blood loss than electrocautery tonsillectomy (mean of 2.6±2.2ml/kg versus 1.2±1.2ml/kg, P=0.0002). Eighteen percent of adenotonsillectomy patients lost greater than 5% of calculated circulating blood volume (95% CI, 9.8–26). Linear regression models did not show an association between the amount of blood loss and patient age, clinical indication, or the surgeon's experience with the microdebrider (P>0.05). ConclusionsMicrodebrider tonsillectomy is associated with more intraoperative bleeding than electrocautery tonsillectomy. Approximately twice as much blood was lost with the microdebrider, but the absolute increase was insignificant from a hemodynamic perspective.

„Die Österreichische Tonsillenstudie 2010“ – Teil 1: Statistischer Überblick

Tonsillectomy (TE), tonsillotomy (TO) and adenoidectomy (AE) are surgeries performed routinely by otorhinolaryngologists. There were 5 cases of fatal postoperative bleeding in Austria during the years 2006 and 2007, all in children under 6 years of age. The intensive discussion following these sad events resulted in a Consensus Paper of the Austrian Society of ORL, H&NS with the Austrian Society of Pediatrics with modified recommendations towards indications and surgical techniques in different age groups; in addition, the prospective study presented here was initiated. In Austria for the first time a full census could be performed assessing all TE, TO and AE with standardized definitions. Within the study period of 9 months' from October 1, 2009, to June 30, 2010, data on patients' characteristics, indication for surgery, surgical technique and postoperative haemorrhage were prospectively collected. Postoperative haemorrhage was defined as any bleeding after extubation regardless of whether or not a surgical intervention was required. Postoperative bleeding events were categorised into 7 grades depending on severity. More than one million data of 9,405 patients from 32 ENT-departments in Austria were collected and analysed. One third were children younger than 6 years (n=3,474; 37%) and one third were adults (n=3,507, 37%). A TE ±AE was performed in 48.8% (n=4,594), an AE in 37.1% (n=3,492) and a TO in 14.0% (n=1, 319). For the indication "recurrent tonsillitis and tonsilar hypertrophy" 70% of children had a TO but 95% of adults had a TE (p<0.001). Adults with OSAS had a TE whereas in children aged younger than 6 with the same indication a TO was preferably performed in 90% (p<0.001). For TO the Colorado-needle and the Coblation technique were most commonly used. The Adenotome by La Force and the Adenoid curette by Beckmann, with or without endoscopic control, were most frequently used for AE. For the first time a prospective full survey could be performed in one country assessing all tonsil and adenoid surgeries along standardized criteria. The study gives an overview about the types of surgery, the indications, the operation techniques and the frequency of postoperative haemorrhage. The latter, because of its clinical importance, is dealt with and described in detail in the second part of this publication.

Técnicas actuales de cirugía adenoamigdalar en los trastornos respiratorios del sueño de los niños

In recent years, consolidation of tonsillar hypertrophy as the principal surgical procedure has led to the emergence of new techniques. Most aim to reduce volume (tonsillectomy or tonsil reduction). These techniques have considerably decreased intra- and postoperative hemorrhages and pain intensity. The present article describes the mechanisms and the advantages and disadvantages of the various techniques, including electro-dissection using electrical scalpels, reduction using a microdebrider, ultrasonic scalpel, radiofrequency (with its different variations) and CO 2 laser. When techniques that reduce tonsil volume are used, the possibility of recurrence of the tonsillar hypertrophy is high if less than 85% of the tonsil is removed. There is also a considerable possibility of infection of the remaining tonsils, whichever technique is used, and therefore these techniques are not valid in the case of repetitive tonsillitis. Recently, alternatives to classical adenoidectomy using adenoid curette have also appeared. Bleeding can be minimized by using a microdebrider, radiofrequency or a blood coagulator. We also discuss the concept of partial adenoidectomy, which is preferred in patients at risk of velopharyngeal insufficiency.

Comparison of adenoidectomy methods: Examining with digital palpation vs. visualizing the placement of the curette

Objective To evaluate the effectiveness of adenoidectomy by defining the remnant volume and localization in nasopharynx, following being satisfied with completeness of removal of the adenoid tissue with digital palpation. Methods A prospective study conducted on 99 patients undergoing adenoidectomy ± tonsillectomy. The main mass of the patient's adenoid tissue was removed with a sharp adenoid curette without visualization and the surgeon was allowed to palpate the adenoid bed and repeat the curettage until satisfied with completeness of removal. Then nasopharynx was visualized with a laryngeal mirror for defining the anatomical localization of the residual adenoid tissue and curettage completed under indirect mirror visualization. The volumes of the adenoid tissue excised at both stages were measured. Results By blunt curettage and digital palpation, only 20.2% of the patients (20) had no residual adenoid tissue. In patients who had residual adenoid tissue, the proportion of the median percentage of residual adenoid tissue to total adenoid tissue was 19.98% (range 3.22–50%). The anatomical localization of the residual adenoid tissue were, along the torus tubarius on either side of the nasopharynx in 9 (11.4%), on the pharyngeal roof near choanal openings in 64 (81%), along the torus tubarius on either side of the nasopharynx + on the pharyngeal roof near choanal openings in 5 (6.3%), and on the pharyngeal roof near choanal openings + on the posterior wall of nasopharynx in 1 (1.3%) patients. There was no difference found among surgeons in the percentage and the location of the residue left ( p > 0.05). Conclusion Digital palpation is not a dependable technique and visualization of the nasopharynx is crucial for a complete adenoidectomy.

The effect of adenoidectomy on right ventricular performance in children

Objective Several studies have shown a reduction in pulmonary artery pressure (PAP) after adenoidectomy in children suffering form upper airway obstruction caused by adenoid hypertrophy (AH). However, it is not clear whether this would be significantly reflected on right ventricle output (RVO). Methods Our aim was to determine if there were any detectable changes in RV performance parameters after adenoidectomy in children with AH. Thirty children with AH (female/male: 11/19) aged between 2.5 and 12 years (median: five years) were included in this study. Adenoidectomy was performed under sinuscopic guide using adenoid curette and microdebrider. All children were examined by echocardiography one day before and one month after adenoidectomy. Velocity time integral of tricuspid valve flow (VTItv) and pulmonary valve flow (VTIpa); E/ A ratio of tricuspid valve flow; RV end-diastolic diameter (RVEDd) and left ventricle fraction shortening (FS) were measured. Heart rate (HR) was also recorded. Results Preoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 18.6 ± 3.0 cm, 20.8 ± 3.1 cm, 1.21 ± 0.31, 11.5 ± 2.1 mm, 35.1 ± 4.3%, and 112 ± 19, respectively. Postoperatively VTItv, VTIpa, E/ A ratio, RVEDd, FS, and HR were 21.5 ± 2.5 cm, 24.4 ± 4.3 cm, 1.44 ± 0.32, 9.3 ± 2.6 mm, 33.9 ± 3.5%, and 104 ± 28, respectively. There were significant differences between preoperative and postoperative VTItv ( p = 0.03), VTIpa ( p = 0.01), E/ A ratios ( p = 0.04), and RVEDd ( p = 0.01). FS and HR were not significantly different. Conclusions This study illustrated that in children suffering from AH, relieving upper airway obstruction by adenoidectomy may result in improvement of RV filling and RVO, associated with the reduction in PAP.

Transoral Endoscopic Adenoidectomy

Objective. Adenoid curette guided by an indirect transoral mirror and a headlight is a simple and quick procedure that has already been in use for a long time, but this method carries a high risk of recurrence unless done by a well-experienced surgeon. The purpose of this paper was to evaluate the efficacy of transoral endoscopic adenoidectomy in relieving the obstructive nasal symptoms. Methods. 300 children underwent transoral endoscopic adenoidectomy using the classic adenoid curette and St Claire Thomson forceps with a 70∘ Hopkins 4-mm nasal endoscope introduced through the mouth and the view was projected on a monitor. Telephone questionnaire was used to follow-up the children for one year. Flexible nasopharyngoscopy was carried out for children with recurrent obstructive nasal symptoms to detect adenoid rehypertrophy. Results. No cases presented with postoperative complications. Only one case developed recurrent obstructive nasal symptoms due to adenoid regrowth and investigations showed that he had nasal allergy which may be the cause of recurrence. Conclusion. Transoral endoscopic adenoidectomy is the recent advancement of classic curettage adenoidectomy with direct vision of the nasopharynx that enables the surgeon to avoid injury of important structures as Eustachian tube orifices, and also it gives him the chance to completely remove the adenoidal tissues.

Is the Traditional Treatment Approach Adequate in Children with Adenoid Hypertrophy?

Aim: We aimed to show the necessity of 1) endoscopic assessment after adenoidectomy performed blindly by adenoid curette, adenotome or adenoid punch forceps after checking adenoid size with finger palpation, which is commonly used in routine practice and 2) extraction of residual adenoids with additional methods. Materials and Methods: Prospective intraoperative flexible endoscopic evaluation of the nasopharynx in a case series of 51 patients was performed. The degree of residual postnasal obstruction due to adenoid tissue was assessed endoscopically with 2.7-mm 0° telescope (small, moderate, large) after routine transoral adenoidectomy. The telescope was then introduced transnasally, and residual adenoid tissue was both assessed and removed with powered-shaver adenoidectomy. Results: In the first assessment (E1) of 51 patients, 15 (29.4%) cases with moderate- and 36 (70.6%) with large-size adenoids were found, while in the second assessment (E2) after traditional blind curettage adenoidectomy, 26 of the patients had moderate and 25 had small residual adenoid tissue. Adenoid size was reduced 1 level in 41 patients (80.4%) and 2 levels in 10 patients (19.6%). Residual adenoid tissue rate was higher in large adenoids when the adenoid sizes determined in the first assessment were compared (P = 0.024). Conclusions: Residual tissue rate is fairly high after blind curettage adenoidectomy, particularly in large adenoids. Therefore, residual tissues should be cleaned with additional methods.

Transoral “Adenoidectomy” Excision of Juvenile Nasopharyngeal Angiofibromas

We describe a minimally invasive technique for excision of selected juvenile nasopharyngeal angiofibromas (JNAs) using indirect visualization of the nasopharynx. An observational case series with follow-up of 9 months to 3 years was performed. The subjects included 4 teenage boys with early-stage nasopharyngeal angiofibromas. The intervention included computed tomography, magnetic resonance imaging, angiography and embolization, tumor excision, pathologic examination, and follow-up. The outcome measures included blood loss, perioperative morbidity, and surgical cure. Four teenage boys underwent excision of early stage JNAs--3 with preoperative embolization. The JNAs were excised under indirect mirror guidance with an adenoid curette and the nasopharynx packed. Residual tumor was removed endoscopically. The operative time was less than 1 hour in each case, and blood loss was less than 100 mL. All 4 boys are free of disease. With the advent of refined imaging techniques and relatively safe preoperative embolization, minimally invasive approaches to JNA excision have been advocated. Endoscopic transnasal piecemeal excision is feasible but time-consuming. Transoral avulsion of the tumor mass by adenoidectomy techniques combined with endoscopic removal of tumor remnants from the pterygopalatine fossa allows complete, controlled surgical excision with minimal blood loss.

Electrocautery versus cold knife technique adenotonsillectomy: A cost analysis

Much has been written about the merits of various techniques of adenotonsillectomy. Proponents of each technique tout many virtues over one another. However, cost remains one variable that has not been thoroughly addressed. In this study, we compared the surgery time, anesthesia time, bleeding, and cost between 2 well-established techniques. Electrocautery tonsillectomy/adenoid ablation was compared against traditional cold knife dissection with adenoid curette. A retrospective chart review of 275 patients in a large tertiary teaching hospital. The electrocautery group had overall savings of 8, 8, and 9 minutes in surgery, anesthesia, and operating room times, respectively. In terms of cost, the variable cost of the electrocautery group was 19% less than the cold knife dissection group. This study demonstrated that cautery ablation of adenoids, when employed as part of adenotonsillectomy, enables the surgical team to save significant amount of time, and substantial cost for patients. B-3.

Prospective, randomized, controlled clinical trial of a novel matrix hemostatic sealant in children undergoing adenoidectomy

Floseal is a novel matrix hemostatic sealant composed of collagen-derived particles and topical bovine-derived thrombin. It is applied as a high-viscosity gel for hemostasis and has been clinically proven to control bleeding. This study is a prospective, randomized, controlled clinical trial of Floseal sealant compared to traditional suction cautery hemostasis in children undergoing adenoidectomy. Seventy patients (mean age 7.0 yrs, 45.7% male) with obstructive sleep apnea underwent traditional cold steel adenoidectomy with an adenoid curette and were then randomized to receive the hemostatic sealant (Floseal) or cautery to obtain hemostasis. Patients were crossed over to the other hemostatic technique if hemostasis was not achieved after more than 100 mL of blood loss or 15 minutes elapsed time. Objective data collected included time to hemostasis and blood loss during hemostasis. Visual analog scales (VAS) were used to record subjective data by the operating surgeon including bleeding following adenoid pack removal (0 = none, 3 = brisk) and ease of operation (1 = extremely easy, 6 = extremely difficult). Parents recorded diet on a journal and were contacted by phone at postoperative day 7 and questioned with regard to return to regular diet and use of narcotics. Compared to patients in the cautery group (n = 35), Floseal patients (n = 35) had significantly shorter times to hemostasis (0.6 +/- 1.3 minutes vs 9.5 +/- 5.4 minutes [mean +/- SD], P < 0.001), less blood loss (2.5 +/- 9.2 mL vs 29.4 +/- 27.1 mL, P < 0.001), less subjective bleeding (0.0 +/- 0.6 vs 2.0 +/- 0.7, [median 4-point VAS +/- SD], P < 0.001), and subjectively easier operations (2.6 +/- 1.0 vs 5.2 +/- 1.0 [mean 6-point VAS +/- SD], P < 0.001). Furthermore, Floseal patients returned to regular diet earlier (2.7 +/- 0.7 vs 4.1 +/- 0.5 days [mean +/- SD], P < 0.001) and had less use of narcotics at 7 days postoperatively (40% vs 69%, P < 0.05). Lastly, three patients in the cautery group were crossed over to the Floseal group, but no Floseal subjects were crossed over to the cautery group. The retail cost of Floseal is US 85 dollars. Operating room costs are estimated at US 12 dollars/minute. Reducing the operative length by 8.9 minutes on average produces a cost savings of US 106.80 dollars per operation. There were no complications in either experimental group including postoperative hemorrhage, hospitalization, blood transfusion, or aspiration. Floseal matrix hemostatic sealant is a safe, efficacious, easy, and cost-effective technique for obtaining hemostasis in children undergoing adenoidectomy. Limitations of the study include the fact that it is nonblinded, which does allow for some bias in the subjective data recorded. However, utilizing 4 different operating surgeons, 3 of whom were not affiliated with the study, minimized this. CLINICAL SIGNIFICANCE OF STUDY: This study demonstrates the safety and efficacy of a novel hemostatic sealant in children undergoing adenoidectomy. Floseal matrix hemostatic sealant can be used as a first-line hemostatic agent, and it is a good tool in the armamentarium of otolaryngologists who encounter significant bleeding following adenoidectomy.

What is the right size of the adenoid curette?

The use of an adenoid curette of appropriate size is recommended in operative textbooks for adequate adenoid removal and avoidance of potential injury to the eustachian tubes. The aim of this study is to calculate the right size of adenoid curettes to be used for children of different ages. The inter-tubal space (ITS) between the torus tubarius on both sides is the narrowest passage for adenoid curettage, and is identified in this study as the nasopharyngeal dimension to be considered in selecting the size of the adenoid curette. This prospective study is carried out on a series of 72 adenoidectomy cases aged from three to nine years at the Hearing and Speech Institute in Cairo, Egypt. The inter-tubal dimension (ITD) is measured for each child at the end of adenoidectomy and the results are recorded against the patient's age. The ITD ranged from 17-21 mm in our series with no significant difference between males and females. There is an increase in ITD with age with a sharp increase at ages five and seven years. Accordingly, the patients are divided into three age groups and recommendations for appropriate adenoid curette sizes ranging from 18 to 21 mm are given for each group.

A combined method of transoral and transnasal endoscopic adenoidectomy

Objective: Conventional adenoidectomy is usually performed with either a curette or an adenotome under blind or indirect visualization. The possibility of injury to the Eustachian tube or posterior choanae can not be excluede during surgery. We present a safe and more effective technique, which can be performed using endoscopic direct visualization during the whole procedure. Patients and Methods: Between January 1995 and December 1999, 105 children underwent this new surgical procedure under general anesthesia. All procedures were performed under endoscopic direct visualization. Using guidance via a 4.0 mm or 2.7 mm 70 endoscope, there was a clear operative field transorally. The adenoid curette was applied transorally to the nasopharynx to remove the main bulk of the adenoids and a 90 Blakesley forceps was also used to perform a peritubal adenoidectomy under intraoral visualization. To remove any residual adenoid tissue obstructing the orifice of the Eustachian tube or posterior choanae, we adopted a transnasal approach with a 45 or straight Blakesley forceps using a 4.0 mm or 2.7 mm 0 or 30 endoscope for guidance. Epinephrine-and H2O2-rinsed gauze was packed in the nasopharynx for post-operative hemostasis. Results: The method was successfully applied in all patients. None of the 105 patients had complications, such as post-operative nasopharyngeal hemorrhage or injury to the Eustachian tube or posterior choanae.Conclusions: the combined method of a transoral 70 and transnasal 0 or 30 endoscopic approach offered a clear and stable operative field. The surgical procedures were all performed under direct visualization. Damage to the Eustachian tube or posterior choanae was not a problem. This method has the potential to become the procedure of choice for adenoidectomy.