Conventional Curettage Adenoidectomy Research Articles

Endoscopic Evaluation after Conventional Adenoid Curettage

Abstract Introduction Adenoidectomy is one of the most common procedures performed by otolaryngologists. Traditional adenoid curettage is performed blindly, which can result in inadequate removal of the adenoid and injury to the surrounding structures. Objective To perform transnasal endoscopic examinations to assess the nasopharynx after conventional curettage adenoidectomy. Methods The present prospective study included 100 children with a mean age of 4.2 ± 3.07 years. It is composed of two steps: conventional curettage adenoidectomy by a resident trainee; and endoscopic evaluation of the nasopharynx through a 0° telescope to assess adenoidal remnants, injury to the surgical field or adjacent structures, and bleeding points. Results Adenoid remnants were observed in 42% of the cases after conventional adenoid curettage in multiple locations, such as the roof of the nasopharynx over the choana (24%), the tubal tonsil (12%), the posterior pharyngeal wall (4%), and the posterior end of the nasal septum (2%). Injury to the surgical field and adjacent structures was observed in 46% of the cases (posterior pharyngeal wall: 23%; lateral pharyngeal wall: 11%; Passavant ridge: 10%; and the Eustachian tube orifice: 2%). Endoscopic bleeding was observed in 29% of the cases; 13% of the cases were from adenoid remnants, 10%, from the mucosa, and 6%, from the pharyngeal muscles. Bleeding was mild in 19% of the cases, moderate in 9%, and severe in 1%. Conclusion Endoscopic evaluation of the nasopharynx following conventional adenoid curettage provides important data regarding adenoid remnants, injury to the surgical field or nearby structures, and bleeding points, which aids in the provision of optimal care and in the achievement of a better outcome.

Assessment of middle ear function after conventional or endoscopic microdebrider assisted adenoidectomy.

To compare pre- and post-operative pure tone audiometric and impedance audiometric analysis following conventional and endoscopic microdebrider assisted adenoidectomy and compare the outcomes. Patients diagnosed with chronic adenoiditis were divided in groups of 25 each. Patients in the first group underwent conventional curettage adenoidectomy, while those in second group underwent endoscopic microdebrider assisted adenoidectomy. Pre- and post-operative pure tone and impedance audiometry were performed for all patients and outcomes were compared. The endoscopic microdebrider assisted method resulted in significantly better outcomes compared to conventional curettage. Criteria such as hearing threshold (p value 0.004 at second follow-up), peak pressure (p value 0.045 at first follow-up) and tympanogram (p value 0.016) showed that the endoscopic method was better, while peak compliance (p value 0.340 at first follow-up) did not show any significant difference between groups. The endoscopic microdebrider assisted method for adenoidectomy has a definite advantage of better visualisation resulting in better clearance of tissue, leading to enhanced middle ear function compared to conventional curettage.

Endoscopic coblation adenoidectomy and conventional adenoidectomy: a comparative study

Background: Adenoidectomy is most common paediatric surgical procedures. Commonly used methods for adenoidectomy are conventional curettage adenoidectomy and endoscopic coblator assisted adenoidectomy. The technique of coblation adenoidectomy has considerable influence on the duration of surgery, the blood lost intra operatively, pain on the first postoperative period. Methods: Sample selected for study were children of age group 3 to 11 years attending ENT OPD with clinical signs of adenoid hypertrophy, who underwent adenoidectomy during the time period from October 2019 to June 2021. We compared the efficacy of ECA with CCA based on the intra-operative (operative time and bleeding) and post-operative parameters (pain on the first post operative day). Results: Our study revealed that intra operative bleeding was more in CCA compared to ECA (p<0.001). ECA took more operative time than CCA group (p<0.001). Pain on the first post-operative day was more in CCA than ECA. Conclusions: Primary objective was comparison of intra operative bleeding among both groups and the outcome was blood loss in ECA was less than CCA. Secondary objective was comparison of operative duration and pain on the first post-operative day and the outcome was, operative duration was less in CCA and pain in the first post-operative day was more in CCA. Our conclusion is that ECA was efficient on the basis of intra operative blood loss and post- operative pain in the first day. CCA was effective in operative duration.

Outcomes of endoscopic guided adenoidectomy versus conventional adenoidectomy

: Adenoidectomy is one of the most common surgical procedures performed on children. Conventional curettage adenoidectomy is a low-cost procedure that is still widely practised, particularly in developing nations. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider. Consecutive cases for Conventional Adenoidectomy (Group I) and Endoscopic Assisted Adenoidectomy (Group II) were taken from cases undergoing adenoidectomy, with each group consisting of 20 patients. The operating time and postoperative pain score were measured and compared between the two groups. Patients were evaluated at the first and sixth weeks to measure subjective improvement of symptoms , DNE was performed to evaluate remaining adenoid tissue and scarring of adjacent structures. The total operating time in groups I and II was 13 minutes (range: 10-15 minutes) and 21 minutes (range: 15-25 minutes), respectively. In 12 cases, remnent adenoid tissue ranged from 25 to 50%. Ten of them received conventional adenoidectomy. Group I experienced significantly higher postoperative pain than group II. Endoscopic adenoidectomy is a safe and effective alternative to conventional curettage. It favours consistent restoration of nasopharyngeal patency, improved haemostasis, and reduced postoperative pain.

A comparative study of two adenoidectomy technics for efficacy and safety: Conventional curettage adenoidectomy versus endoscopic microdebrider adenoidectomy

PurposeConventional cold curettage adenoidectomy (CCA) is the most used method for Adenoidectomy. With the advances in surgical instruments, endoscopy assisted less invasive techniques are coming into use. Herein we compared CCA with endoscopic microdebrider adenoidectomy (EMA) in terms of safety and recurrence. MethodsPatients who underwent adenoidectomy in our clinic between 2016 and 2021 years were included into the study. Study performed retrospectively. Patients operated with CCA accepted as GroupA and EMA as GroupB. Two groups compared for the recurrence rate and post-operative complications. ResultsWe studied 833 children aged between 3 and 12 years (mean 4,2 years old), had adenoidectomy, including 482 male(57.86 %) and 351 female (42.14 %). There were 473 patients in GroupA, and 360 patients in GroupB. Seventeen patients (%3.59) in GroupA had reoperation for the recurrence of adenoid tissue. There was no recurrence in GroupB. Residual tissue, recurrent hypertrophy, and postoperative otitis media rates were higher in GroupA, and this was statistically significant (p < 0.05). Whereas ventilation tube insertion rates didn't differ significantly (p > 0.05). Although hypernasality rate at second week was slightly higher in GroupB, this was not statistically significant (p > 0.05), and in further period it resolved in all patients. No major complications were reported. ConclusionOur study indicates that EMA is a safer technique than CCA, and prominent postoperative complications like residual adenoid tissue, recurrent adenoid hypertrophy, and postoperative otitis media with effusion rates are lower.

Coblation Assisted Adenoidectomy vs. Conventional Curettage Adenoidectomy: A Comparative Study

Background: Adenoid is a patch of tissue that is situated high up in the throat and just behind the nose in the nasopharynx. Adenoid along with the tonsils, is a part of the lymphatic system that clears away infection and keeps body fluids in balance.Whenever, adenoid become enlarged, seriously infected or causes certain complications, adenoidectomy becomes essential. It can be performed with many ways includingcoblation assisted adenoidectomy and conventional curettage adenoidectomy.&#x0D; Aim of the study: The aim ofthis study was to assessthe advantages of coblation assisted adenoidectomy over conventional curettage adenoidectomy.&#x0D; Methods: This comparative observational study was conducted in the Department of ENT, Bangladesh Medical College Hospital and Popular Medical College Hospital, Bangladesh during the period from July 2019 to June 2022. A total of 100 admitted patients for adenoidectomy were included as the study. All the participants were divided in two groups. In Conventional group, there were 50 participants selected for conventional curettage adenoidectomy.On the other hand, in coblation group, other 50 participants selected for coblation assisted adenoidectomy. For comparison of both the method all necessary data along with demographic and clinical status were collected in a predesigned questioner. All data were processed and analyzed and disseminated by using MS Office and SPSS version 23 programs as per need.&#x0D; Results: In this study, as the superiority of coblation assisted adenoidectomy over conventional curettage adenoidectomy we found significantly lower ‘intra operative blood loss in ml (7.58±3.28 ml)’, ‘post-operative bleeding (0%)’, presence of residual lymphoid tissue (8%)’, ‘days with analgesics (10.42±3.60 days), ‘post operative adenoid grading (0.0±0.0)’, ‘rate of recurrence (20%)’ and ‘needed days for recovery (4.68±2.17 days)’ among coblation group patients than that among conventional group patients.&#x0D; Conclusion: Coblation assisted adenoidectomy ensures more easier and specific treatment for the patient. As per the findings of this study we can conclude that, considering the attractive features like lower intra operative and post-operative blood loss, presence of residual lymphoid tissue, days with analgesics, post operative adenoid grading, rate of recurrence and needed days for recovery coblation assisted adenoidectomy may be considered as the method of choice for such treatment.&#x0D; Bangladesh J Otorhinolaryngol 2022; 28(2): 128-134

Comparison of the efficacy and safety of conventional curettage adenoidectomy with those of other adenoidectomy surgical techniques: a systematic review and network meta-analysis

ObjectivesThere is a lack of robust evidence in regards to whether the intra and post-operative safety and efficacy of conventional curettage adenoidectomy is better than those of other available surgical techniques. Therefore, this study was conducted as a systematic review and network meta-analysis of published randomized controlled trials (RCTs) with the aim of comparing the safety and efficacy of conventional curettage adenoidectomy with all other available adenoidectomy techniques.Materials and methodsA systematic search of published articles was performed in 2021 using databases such as PubMed/Medline, EMBASE, EBSCO, and the Cochrane Library. All RCTs that compared conventional curettage adenoidectomy with other surgical techniques and were published in English between 1965 and 2021 were included. The quality of the included RCTs have been assessed using Cochrane Collaboration Risk of Bias Tool.ResultsAfter screening 1494 articles, 17 were identified for comparing several adenoidectomy techniques and were eligible for quantitative analysis. Of those, 9 RCTs were analyzed for intraoperative blood loss, and 6 articles were included for post-operative bleeding. Furthermore; 14, 10, and 7 studies were included for surgical time, residual adenoid tissue, and postoperative complications respectively. Endoscopic-assisted microdebrider adenoidectomy yielded a statistically significantly greater estimate of intraoperative blood loss compared with conventional curettage adenoidectomy (mean difference [MD], 92.7; 95% confidence interval [CI] 28.3–157.1), suction diathermy (MD, 117.1; 95% CI 37.2–197.1). Suction diathermy had the highest cumulative probability of being the preferred technique because it was estimated to result in the least intraoperative blood loss. Electronic molecular resonance adenoidectomy was estimated to be more likely to result in the shortest surgical time (mean rank, 2.2). Participants in the intervention group were 97% less likely to have residual adenoid tissue than children in the conventional curettage group (odds ratio 0.03; 95% CI 0.01–0.15); therefore, conventional curettage was not considered an appropriate technique for complete removal of adenoid tissue.ConclusionThere is no single technique that can be considered best for all possible outcomes. Therefore, otolaryngologists should make an appropriate choice after critically reviewing the clinical characteristics of children requiring adenoidectomy. Findings of this systematic review and meta-analysis may guide otolaryngologists when making evidence-based decisions regarding the treatment of enlarged and symptomatic adenoids in children.

Endoscopic Adenoidectomy with Microdebrider Versus Conventional Adenoidectomy

Background: Adenoidectomy is one of the most common surgical procedures performed in children in Bangladesh. Though conventional curettage is highly popular as it has the advantage of being cost effective and continues to be a commonly used method especially in developing countries but Microdebrider has opened the new horizon in this arena. To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider.&#x0D; Materials and methods: This is randomized single blinded comparative study, which was performed in the Medical Center Hospital, Chattogram from August 2019 to July 2020. A total of 60 patients were randomly divided into two groups. Group I underwent conventional curettage adenoidectomy while Group II underwent endoscopic- assisted powered adenoidectomy. Duration of surgery, amount of intra-operative bleeding, adequateness of removal and damage to the adjacent structures were assessed and compared between two groups. All patients were followed for 12 months. Statistical analysis was done using statistical software package SPSS v 22.0. Data were represented as mean ± SD. Continuous variables were compared using the were using the t test while nonparametric data were compared using Mann-Whitney U test. The c2 test was used to compare the nominal data. A p value &lt;0.05 was considered statistically significant. Ethical directives from the Managing Body of Medical Centre Hospital, Chattogram for this study was obtained.&#x0D; Results: in our study, we observed approximately almost three times more mean blood loss and total operating time in the endoscopic-assisted powered procedure compared to the conventional technique (149 and 56 ml, respectively, 63 and 27 min, respectively). Nine (30%) cases in group I had more than 50% residual adenoid tissue while 20 – 50% of residual adenoid tissue was documented among 7 patients (23%). Postoperative pain was found to be significantly higher in group I compared to group II. In both groups, recovery time ranged from 24-48 hour with a mean of 33.6 hour in group I and 36 hour for group II. 23 patients (77%) in group I presented with residual disease in the 3 months follow up period, where number of patients with the exact instance in group II was 0.&#x0D; Conclusion: Endoscopic assisted adenoidectomy may appear more handy over conventional curettage. But precise peri-operative care and awareness are required to attain the successful outcomes.&#x0D; JCMCTA 2022 ; 33 (1) : 88-92

English

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

A comparative study of conventional curettage adenoidectomy versus endoscopic microdebrider-assisted adenoidectomy in children

Introduction: Adenoid hypertrophy or chronic adenoiditis may cause significant problems requiring adenoidectomy. Patients with chronic adenoid hypertrophy causing craniofacial morphology problems, excessive snoring, or possibly quality of life issues are candidates for adenoidectomy. The aim of this study is to compare the advantages of endoscopic-assisted microdebrider adenoidectomy in comparison with conventional curettage adenoidectomy. Materials and Methods:A prospective study of patients undergoing adenoidectomy was performed in the Department of ENT, Head and Neck Surgery at Tertiary center from January 2018 to October 2019. Results: Fifty patients of adenoid hypertrophy underwent adenoidectomy (25 patients in Group I and 25 patients in Group II). The groups were almost similar in age and sex. The mean operative time was 15 min 60 s in Group I and 12 min 56 s in Group II. The average blood loss was 31 ml in Group I and 28.60 ml in Group II. The residual adenoid tissue and complications were present in eight and three patients in Group I, respectively. Conclusion: The endoscopic-assisted adenoidectomy is minimally invasive. Intraoperative bleeding, duration of surgery, and complication were less in endoscopic-assisted adenoidectomy as comparison to conventional curettage method.

Comparison between endoscope assisted powered and conventional adenoidectomy

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adenoidectomy is one of the commonest operations done on children. It is conventionally performed using the curettage method. This present study was done to compare the results of endoscopic powered adenoidectomy and conventional adenoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The present prospective randomized study was conducted among 50 patients between 4-16 years of age requiring adenoidectomy with or without tonsillectomy in department of ENT in Government Medical College and Rajindra Hospital, Patiala. All the 50 patients were divided into two groups (group A and group B) by systematic random sampling. Group A consisted of 25 patients who underwent conventional curettage adenoidectomy and group B consisted of 25 patients who underwent Microdebrider-Assisted Adenoidectomy. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In group A and B, mean±SD intraoperative blood loss (in ml) was 20.60±7.96 and 30.60±7.96 respectively. Mean±SD operative time (in minutes) was 28.60±4.71 in group A, while in group B it was 39.60±4.71 with statistically significant difference. Complete adenoid removal was found in 52% of the subjects in group A while it was found in 96% of the subjects in group B with statistically significant difference. In group A, mean±SD recovery time (in hrs) observed was 33.52±10.58 while in group B, recovery time (in hours) observed was 36.22±11.31.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Based on the results of this study, it can be concluded that the new method of microdebrider assisted powered adenoidectomy was found to be safer and more useful tool for adenoidectomy than conventional method.&lt;/p&gt;

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.

Comparison of transnasal and transoral routes of microdebrider combined curettage adenoidectomy and assessment of endoscopy for residue: a randomized prospective study.

The aim of this study is to investigate the frequency and locations of residual adenoid tissue in conventional curettage adenoidectomy (CA) via transnasal endoscopic examination at the end of the operation and to determine the most appropriate technique for residual adenoid tissue removal by transoral or transnasal microdebrider usage. Sixty-three patients aged 4-12years who were scheduled for CA were included in this randomized prospective study in a tertiary reference center. Patients who underwent CA had the endoscopic residual tissue exploration at the end of surgery. The amount and locations of residual tissue were recorded. Patients with > 20% residual tissue were divided into two groups according to randomization list for removing the residual tissue, depending on the use of transoral microdebrider (TOMD) and transnasal microdebrider (TNMD). Two procedures were compared in terms of duration, bleeding, pain, post-anesthesia care unit (PACU) transfer time, and complications. Residual tissue was detected in 38 patients (60.2%). The most common location of residual tissue was peritubal area (41.3%). The TOMD group had lower surgical duration, blood loss, pain scores and shorter PACU transfer time (p = 0.001, p = 0.002, p˂0.001, and p = 0.006, respectively). Endoscopic exploration at the end of CA should be considered to avoid residual tissue retention. Furthermore, if residual tissue is present, the use of TOMD is easier, faster, and associated with lower morbidity than the use of TNMD.

Comparison of Conventional Curettage Adenoidectomy Versus Endoscopic Powered Adenoidectomy: A Randomised Single-Blind Study.

Globally adenoidectomy is increasingly being performed in isolation for children who have middle ear effusion or chronic otitis media, chronic rhinosinusitis and nasopharyngeal obstruction causing sleep apnoea and mouth breathing. Several techniques have been described lately including endoscopic powered adenoidectomy with debrider. The present study was undertaken to compare the effectiveness of endoscopic powered adenoidectomy (EA) with respect to conventional adenoidectomy (CA). It is a prospective study of 60 patients requiring adenoidectomy consisting of 33 males and 27 females randomized into group A with 30 patients undergoing conventional adenoidectomy with curette and 30 patients undergoing endoscopic powered adenoidectomy with micro-debrider. The demographic data (age, sex, adenoid hypertrophy grade assessed by Clemens and Mcmurray scale) in both groups were not statistically significant (p > 0.05). However, significant differences were observed in mean operative time of both groups (CA-29.12 ± 6.70, EA-37.80 ± 6.90min, p < 0.05). The intra-operative blood volume loss was 21.30 ± 5.80ml, 28.24 ± 6.93ml in CA and EA respectively. No significant difference was seen in post-operative pain assessed by Visual Analogue Scale (VAS) (p-0.39). Complete removal of adenoids was seen in 83.3% cases with EA versus 53.3% with CA (p < 0.05). The residual adenoids noted after the CA and EA in Grade I was 23.3% and 13.3% respectively while in CA, grade II with 16.7% and grade III with 6.7% cases had residual adenoids. Injury to surrounding structure was seen in 16.7% and 10% of CA and EA respectively. However, no difference in complication rate was observed between the study groups (p > 0.05). We conclude that endoscopic powered adenoidectomy is more complete, accurate, with less post-operative pain and lower incidence of recurrence in comparison with conventional adenoidectomy.

Revisiting conventional adenoidectomy using technology

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adenoidectomy is one of the most frequently applied surgical procedures in the paediatric population, either alone or in conjunction with tonsillectomy and/or insertion of ventilation tubes. The main purpose of the adenoidectomy is to eliminate the nasopharyngeal respiratory pathogens and to remove nasal airway obstruction. Aim of the study was to compare the outcomes of conventional and endoscopic assisted curettage adenoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; In this comparative study, 50 patients were divided into 2 groups. Group 1 (25 patients) underwent endoscopic curettage adenoidectomy and group 2 (25 patients) underwent conventional curettage adenoidectomy. Intraoperative time, complications and postoperative pain were recorded. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; 72% in group 1 and 64% in group 2 had grade 2 adenoid hypertrophy. 68% in group 1 and 64% in group 2 had a moderate degree of obstruction in lateral view of soft tissue X-ray nasopharynx. The mean time taken for surgery in group 1 was 13.29±3.28 minutes, and in group 2,6.28±2.31 minutes. Minimal loss of blood was recorded in group 1 with less than 20 ml, whereas in group 2, the blood loss was high; 30% of patients had blood loss more than 30 ml. In group 1, the mean VAS was 3.25 and 2.55 in group 2 2.55. In group 1, 4% of patients had primary haemorrhage and in group 2, 8% of patients had primary haemorrhage. No patient had velopharyngeal dysfunction in either group.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; More operative time but less blood loss were noted in endoscopic adenoidectomy. Intraoperative visualisation of the nasopharynx in endoscopic procedures showed no significant advantage over conventional adenoidectomy.&lt;/p&gt;

Conventional Curettage Adenoidectomy vs Curettage Adenoidectomy With Transoral Endoscopic Residue Ablation in Children

Conventional Curettage Adenoidectomy vs Curettage Adenoidectomy With Transoral Endoscopic Residue Ablation in Children

Endoscopic evaluation of completeness of conventional curettage adenoidectomy: a single-blinded observational study

BackgroundConventional curettage adenoidectomy is a blind procedure, which performed in a confined postnasal space produces surgical challenges. The aim was to examine the completeness of conventional adenoidectomy and compare it with surgeon satisfaction and to identify the need to objectively assess the residual tissue at the end of procedure.AimThe primary aim was to objectively assess the residual adenoid mass after curettage adenoidectomy and compare it with surgeon satisfaction using digital palpation.Settings and designA prospective single-blinded observational study was conducted at a tertiary care hospital between February 2015 and September 2015.Patients and methodsA total of 45 cases that underwent conventional curettage adenoidectomy were included in the study. Intraoperative images of the postnasal space were recorded and compared with surgeon satisfaction score by a single-blinded observer.Statistical analysisStatistical analysis of interobserver correlation was performed using Cohen’s κ statistics using Graphpad Prism, version-6.07 (trial).ResultsThe 45 cases had a mean±SD age of 8.45±2.47 years, and female to male ratio was 1.4 : 1. The kappa analysis of surgeon satisfaction in relation to the presence of residual adenoid tissue showed that the strength of agreement was worse than that expected by chance (κ=−0.383, SE=0.129).ConclusionThe study showed that surgeon satisfaction via digital palpation alone fails to assess residual adenoid tissue, and we recommend endoscopic visualization of the nasopharynx to assess completeness of adenoidectomy.

Endoscopic-Assisted Powered Adenoidectomy versus Conventional Adenoidectomy: A Randomized Study

Background: Adenoidectomy is one of the most common surgical procedures performed in children. Conventional curettage adenoidectomy has the advantage of being cost-effective and continues to be a commonly used method, especially in developing countries. Objective: To compare conventional curettage adenoidectomy and endoscopic-assisted powered adenoidectomy using a microdebrider. Methods: A total of 60 patients were randomly divided into two groups. Group I underwent conventional curettage adenoidectomy while group II underwent endoscopic-assisted powered adenoidectomy. Duration of surgery, amount of intraoperative bleeding, adequateness of removal, and damage to adjacent structures were assessed and compared between the two groups. All patients were followed for 24 months. Results: In our study, we observed approximately three times more mean blood loss and total operating time in the endoscopic-assisted powered procedure compared to the conventional technique (150 and 56 mL, respectively; 63 and 27 min, respectively). Nine (30%) cases in group I had more than 50% residual adenoid tissue while 20–50% of residual adenoid tissue was documented among 7 patients (23%). Postoperative pain was found to be significantly higher in group I compared to group II. In both groups, recovery time ranged from 24 to 48 h with a mean of 33.6 h for group I and 36 h for group II; 23 patients (77%) in group II presented with residual disease in the 3-month follow-up period. Conclusion: The endoscopic-assisted powered adenoidectomy technique is very efficient in complete removal of adenoid tissue, thus preventing patients from undergoing a second surgery and its possible associated risks. The precision of the microdebrider prevents damage to adjacent vital structures. However, on the other hand, conventional adenoidectomy scored better in terms of shorter duration of surgery and less intraoperative bleeding.

Comparing endoscopic microdebrider assisted adenoidectomy with curettage procedure

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Adenoid is a mass of lymphatic tissue situated posterior to the nasal cavity, in the roof of the nasopharynx, forming a part of the Waldeyer's ring, was initially described in 1868 by Meyer. Adenoidectomy is one of the commonest operations done on children. It is done alone or along with tonsillectomy or with ventilation tube insertion for otitis media with effusion. Objective of the study was to compare the results of endoscopic microdebrider assisted adenoidectomy with that of conventional curettage adenoidectomy.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; A prospective randomized study of 60 patients with clinical features of adenoid hypertrophy. These patients were randomly divided into two groups, 30 each using the table of random numbers. Group I, underwent endoscopic microdebrider assisted adenoidectomy and group II underwent adenoidectomy by curettage. All the patients were followed up for a period of 3 months. Parameters such as operating time, blood loss, intra-operative/post-operative complications and residual adenoid tissue were assessed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; In this study mean age of patients in group I (EAA) was 9±0.50 years (range 6–15 years) and group II (CA) was 9.86 ± 2.31 years (range 6-15 years). The mean operating time was 20.79 minutes for the group I (range: 12 to 35 minutes) and 14.42 minutes for group II (range: 10 to 22 minutes, p=0.001). Blood loss was around 31.06 ml (range: 21 to 46 ml) in group I and 22.26 ml (range: 10 to 60 ml) in group II. Adenoidectomy by curette group showed more residual nasopharyngeal adenoid tissue (43.33%) than by endoscopic microdebrider assisted adenoidectomy (20%).&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Endoscopic microdebrider assisted adenoidectomy is a safe and more effective compared to curettage method, with very minimal chances of injury to the surrounding structures during the procedure.&lt;/p&gt;

The value of endoscopic examination at the end of conventional adenoidectomy

AimThe aim of this study was to evaluate the value of the use of endoscopes after a conventional curettage adenoidectomy for detecting any residual adenoid tissue and to determine whether removing any residual, if present, affects the recurrence or not.Patients and methodsFifty patients were divided randomly into two equal groups. Group A underwent a conventional curettage adenoidectomy, followed by an endoscopic examination of the nasopharynx to detect and remove any residual adenoid tissue. Group B underwent a conventional curettage adenoidectomy only. Both groups were followed up for recurrence of symptomatic adenoid at fixed follow-up intervals at 10 days, 1, 3, and 6 months postoperatively.ResultsThere was a significant difference in the rate of adenoid recurrence between both groups 6 months postoperatively. Two (8%) patients in group A and nine (36%) patients in group B developed recurrence. The P value was statistically significant at 0.04.ConclusionEndoscopic examination after a conventional adenoidectomy is a safe and essential step for complete removal of the adenoid, thus reducing the recurrence rate.