Endoscopic Adenoidectomy Research Articles

A Comparative Study on Surgical Outcome of Conventional Adenoidectomy and Endoscopic Adenoidectomy in Children with Adenoid Hypertrophy

A Comparative Study on Surgical Outcome of Conventional Adenoidectomy and Endoscopic Adenoidectomy in Children with Adenoid Hypertrophy

Comparison of Perioperative Collateral Injury, Presence of Residual Adenoid Tissue and Recovery Time in Conventional Versus Microdebrider Assisted Endoscopic Adenoidectomy in Children Less than or Equal to 12 Years.

Comparison of Perioperative Collateral Injury, Presence of Residual Adenoid Tissue and Recovery Time in Conventional Versus Microdebrider Assisted Endoscopic Adenoidectomy in Children Less than or Equal to 12 Years.

Application of transoral endoscopic adenoidectomy by Coblator with shovel cutting method

Application of transoral endoscopic adenoidectomy by Coblator with shovel cutting method

Dexamethasone Reduces the Incidence of Postoperative Nausea and Vomiting in Children Undergoing Endoscopic Adenoidectomy under General Anesthesia Without Increasing the Risk of Postoperative Hemorrhage.

BackgroundPostoperative nausea and vomiting (PONV) is a common complication of pediatric anesthesia, but the overall incidence of PONV in patients undergoing adenoidectomy is unknown. The aim of this controlled study was to compare the effect of dexamethasone administration with placebo to reduce PONV in children undergoing endoscopic adenoidectomy under general anesthesia.Material/MethodsA randomized placebo-controlled study included 118 pediatric patients who underwent elective endoscopic adenoidectomy under general anesthesia. A dexamethasone-treated (0.15 mg/kg) group (Group D) (n=56) and a placebo group (Group C) (n=62) were randomly assigned. The incidence of nausea and vomiting was recorded on the day of surgery. Postoperative nausea was assessed according to illustrated Baxter Animated Retching Faces (BARF) scale. The Face, Legs, Activity, Cry, and Consolability (FLACC) scale (scores between 0–10) was used to assess pain. Follow-up was performed on the 14th postoperative day by a telephone call.ResultsOverall prevalence of postoperative nausea was 25% (30/118) and postoperative vomiting was 14% (17/118). In the first 24 hours following surgery, in Group D, the incidence of nausea and vomiting was 13% and 7%, respectively; in Group C, without pharmacological prophylaxis, the incidence of postoperative nausea and vomiting was 37%, and 21%, respectively.ConclusionsA prospective controlled study in children undergoing endoscopic adenoidectomy under general anesthesia showed that dexamethasone (0.15 mg/kg) significantly reduced the incidence of PONV without increasing the risk of postoperative hemorrhage. Dexamethasone is a safe method for the prevention of PONV that may be recommended in pediatric anesthesiology.

A comparative study of endoscopic assisted curettage adenoidectomy with conventional adenoidectomy

<p class="abstract"><strong>Background:</strong> In ENT adenoidectomy is a commonly performed surgery. It is conventionally done using the curettage method. This present study aims to evaluate endoscopic assisted curettage<strong> </strong>adenoidectomy as an alternative.</p><p class="abstract"><strong>Methods:</strong> The present study consisted of forty cases requiring adenoidectomy were divided into two groups of twenty each. In Group A adenoidectomy was done by conventional curettage method and in Group B by endoscopic assisted micro-debrider adenoidectomy. The parameters studied between two groups were intra-operative time, intra-operative bleeding and completeness of resection .The study period was from June 2015 to December 2016. </p><p class="abstract"><strong>Results:</strong> The average time taken in Group A (conventional surgery) was 5.30 minutes and in Group B (powered endoscopic surgery) was 12.30 minute. The average blood loss in Group A was 35 ml (range 10–50) as compared to 30 ml in Group B. Nearly 25 % of the patients who underwent endoscopic assisted adenoidectomy had grade II adenoids. About 30% of the patients who underwent conventional adenoidectomy had Grade III adenoids. A total of 10% of the patients developed primary haemorrhage which was more in conventional adenoidectomy (15%) as compared to endoscopic adenoidectomy (5%).</p><strong>Conclusions:</strong>Endoscopic assisted microdebrider adenoidectomy was found to be a safe and effective tool for adenoidectomy. Endoscopic adenoidectomy better for completeness of resection, accurate resection under vision. On the other hand, in conventional adenoidectomy operative time and intra-operative bleeding was less.<p> </p>

Cor pulmonale in an unusual case of obstructive adenoid enlargement

Enlargement and infection of the adenoids and tonsils are associated with problems of otitis media, sinusitis, obstructive sleep disordered breathing, and alterations of facial growth. In addition, they may also lead to cardiopulmonary disorders in children. This report aims to highlight the cardiopulmonary sequelae in a child with obstructive adenoid enlargement and temporomandibular joint ankylosis in our practice. The child presented at 6 years of age with complaints of noisy breathing, blocked nose, mouth breathing, and loud snoring. Her condition deteriorated with frequent apneic attacks, easy fatigability, and swelling of the legs. The blood pressure was 100/60 mmHg, the jugular venous pressure was elevated, with displaced apex beat at the sixth left intercostal space, anterior axillary line, with parasternal heave. There were first and second heart sounds with a loud P2. The findings on electrocardiogram and echocardiogram confirmed a diagnosis of cor pulmonale secondary to severe obstructive adenotonsillar disease. A flexible nasopharyngoscopy revealed a bilateral grade IV adenoidal obstruction of the choanae. She was managed for heart failure and had emergency tracheostomy. Subsequently, she had endoscopic transnasal microdebrider-assisted adenoidectomy. She has improved remarkably and on follow-ups at the ENT, pediatric, and MFU clinics. In conclusion, pulmonary hypertension and cor pulmonale, even though rare, are possible complications of untreated adenotonsillar hypertrophy in children.

Aspiration of Nasopore nasal packing

We present a case of postoperative Nasopore aspiration in an otherwise fit and well 11-year-old. An endoscopic adenoidectomy had been performed without incident and Nasopore packing placed into each nasal...

Comparison of effects of nasal endoscopic adenoid body excision and conventional adenoid body shaving in the treatment of adenoid hypertrophy

Objective To compare the effect of adenoidectomy with adenoidectomy under nasal endoscope in the treatment of adenoid hypertrophy. Methods 120 cases with adenoid hypertrophy were selected as the research subjects.The patients were randomly divided into two groups by random number table, and the control group(n=60) was treated with routine adenoidectomy.The surgical treatment of the observation group(n=60) was performed under nasal endoscope.Surgical treatment, surgery related indicators(operative time, the average amount of bleeding, hospitalization time and the incidence of postoperative complications) were compared between the two groups.Before and after operation, acoustic rhinometry examination of nasopharynx was used to detect the smallest cross-sectional area and compared. Results In the observation group, the operation time, the average amount of bleeding, hospitalization time and incidence rate of postoperative complication were (5.32±2.05)min, (51.05±8.26)mL, (8.50±2.50)d, 15.00%, respectively, which in the control group were (8.56±2.68)min, (78.45±10.15)mL, (12.00±3.50)d, 36.67%, respectively, there were significant differences between the two groups(t=7.44, 15.98, 6.30, χ2=7.35, all P<0.05).12 months after surgery, the nasal minimal cross-sectional area of nasal pharynx in the observation group was (1.99±0.51)cm2, which of the control group was (1.81±0.48)cm2, there was significant difference between the two groups(t=3.99, P<0.05). Conclusion Compared with conventional adenoidectomy, endoscopic adenoidectomy in the treatment of adenoid hypertrophy has good clinical curative effect, less bleeding, shorter operative time and less postoperative complications and other advantages, it is worthy of promotion. Key words: Adenoidal hypertrophy; Adenoidectomy; Endoscopy; Child

Effect of transoral endoscopic adenoidectomy on peripheral blood T-lymphocyte subsets in children with obstructive sleep apnea-hypopnea syndrome and its treatment strategy.

The objective of the present study was to investigate the effect of transoral endoscopic adenoidectomy on peripheral blood T lymphocyte subsets in pediatric patients with obstructive sleep apnea-hypopnea syndrome (OSAHS) and its treatment strategy. Ninety-eight pediatric patients with adenoidal hypertrophy associated with OSAHS admitted to the Department of Otolaryngology, Xuzhou Children's Hospital were selected. After admission, patients received perfected 24 h polysomnogram monitoring, routine blood examination, fasting blood biochemistry examination, T-lymphocyte subset count, 24 h ambulatory blood pressure monitoring, and nasopharyngeal computed tomography. After patients were diagnosed with adenoidal hypertrophy associated with OSAHS, they underwent transoral endoscopic adenoidectomy with a power microdebrider. Patients were evaluated at 3-, 6- and 12-week follow-up visits. The CD3+, CD4+, and CD8+ T-cell counts, CD4+/CD8+ T lymphocyte ratio, and changes of 24 h ambulatory blood pressure before and after surgery were recorded. After the 6-week follow-up visit, the mean CD4+ T lymphocyte count in patients was increased significantly compared with that before surgery, the CD4+/CD8+ T lymphocyte ratio increased gradually, and the differences were statistically significant (P<0.05). The frequency of nocturnal awakening of patients was decreased significantly after surgery and the duration of nocturnal sleep was extended significantly (P<0.05). Through analysis of the preoperative and postoperative clinical data of pediatric patients, the CD4+/CD8+ T lymphocyte ratio was negatively correlated with mean arterial pressure (MAP) (r=−1.06, P=0.003). In conclusion, adenoidectomy can significantly decrease the MAP in pediatric patients with OSAHS and increase the duration of nocturnal sleep. The peripheral blood CD4+/CD8+ T lymphocyte ratio in pediatric patients was significantly negatively correlated with MAP.

Impact of partial and total tonsillectomy on adenoid regrowth

To compare the rates of adenoid regrowth in children who underwent total tonsillectomy and adenoidectomy (TA) versus partial intracapsular tonsillectomy and adenoidectomy (ITA). Retrospective cohort study. A medical database was used to retrieve the records of 5,120 children younger than 12 years of age who had an adenoidectomy in combination with a tonsil surgery between April 2008 and September 2014. Children who had symptomatic obstructive sleep apnea without a history of recurrent tonsillitis, and underwent an endoscopic adenoidectomy with a microdebrider, in addition to a traditional tonsillectomy or partial tonsillectomy with coblation, were included in the study. Adenoid regrowth was evaluated in the children who completed at least a 1-year follow-up. The sizes of adenoids were subjectively graded and reported based upon a numerical scale. In total, 1,504 and 1,340 children met the inclusion, and were comprised of ITA and TA groups, respectively. Adenoid regrowth was seen in 98 (7.3%) children in the TA group after 1-year follow-up. Symptomatic adenoid regrowth was seen in 19 (1.4%) children in the TA group. In the ITA group, although 71 (4.7%) children had adenoid regrowth, only one (0.06%) reached grade 3 hypertrophy that could be attributed to nasal obstruction at 1-year follow-up. Comparison of the regrowth rates of both groups at the end of the 1-year follow-up period showed a statistically significant difference (P < .001). ITA seems to be a safe procedure with a low incidence of regrowth of adenoid tissue in children with adenotonsillar hypertrophy when compared to TA. 4. Laryngoscope, 127:753-756, 2017.

Defining the Surgical Limits of Adenoidectomy so as to Prevent Recurrence of Adenoids.

This study aims to define the surgical boundaries of adenoidectomy by demonstrating that recurrence of adenoids and its symptoms can be avoided if a complete adenoidectomy is performed, by following these surgical limits. A prospective descriptive study was carried out at Speciality ENT Hospital, Mumbai, India. Endoscopic adenoidectomy was performed in 83 patients using coblation technology. In all patients, adenoids were removed superiorly till the periosteum over the body of sphenoid; posteriorly till the pharyngobasilar fascia; laterally till fossa of Rosenmuller in the posterior part and till the torus tubarius in the anterior part; and inferiorly till the Passavant's ridge. The patients were followed up postoperatively and a nasal endoscopy was done at the end of 1year to look for any recurrence or regrowth of adenoids, so as to determine the efficacy of the procedure. A total of 83 patients underwent adenoidectomy with a mean age of 12.80years. 12 patients were lost to follow up. Of the remaining 71 patients, no patient showed any evidence of recurrence of adenoid on follow-up nasal endoscopy done at the end of 1year. Recurrence of adenoid post adenoidectomy is not seen if there is complete removal of adenoids. So it is essential that all adenoid tissue be removed during adenoidectomy. The complete removal of adenoids can be ensured by following the surgical limits of adenoidectomy.

Endoscopic Adenoidectomy in Children With Otitis Media With Effusion and Mild Hearing Loss.

ObjectivesSurgical management of children with chronic otitis media with effusion (OME) includes tympanostomy tube insertion or adenoidectomy, alone or with myringotomy and tube insertion. The aim of this study was to compare the effectiveness of transoral microdebrider endoscopic-assisted adenoidectomy (TOMEA) and traditional adenoidectomy in the management of children with mild hearing loss due to OME and chronic adenoiditis.MethodsThis prospective, double-blind and controlled study involved 120 consecutive patients aged 4–12 years, who were randomised 1:1 to undergo TOMEA or traditional adenoidectomy under general anesthesia. All the patients underwent a complete otolaryngological examination, including nasopharyngeal fibre endoscopy (NFE), pneumatic otoscopy, otomicroscopy, tympanometry and supraliminar tonal audiometry, upon enrolment, and three and nine months postoperatively.ResultsThere were no statistically significant differences in age or gender distribution between the TOMEA group (mean age, 4.9±1.1 years; 53.3% males) and the traditional adenoidectomy group (mean age, 5.3±0.9 years; 56.7% males). Both procedures led to a significant improvement in choanal patency (P<0.01) and all of the otological and audiological parameters (P<0.01) 3 and 9 months postoperatively, although postoperative NFE showed that the mean percentage of residual choanal obstruction was significantly less in the TOMEA group (P=0.02). There was no significant between-group difference in the percentage of children with tympanic membrane changes, but the postoperative prevalence of children with a type B tympanogram was significantly lower in the TOMEA group after 3 (15.0% vs. 31.7%, P=0.05) and 9 months (18.3% vs. 38.3%, P=0.02), as was the percentage of children with mild conductive hearing loss (3.3% vs. 23.3%, P<0.01; and 8.3% vs. 28.3%, P<0.01).ConclusionAlthough both TOMEA and traditional adenoidectomy are effective in treating children with mild hearing loss due to adenoidal hypertrophy and OME, the former achieves the greater reduction in residual adenoidal hypertrophy and better audiological outcomes.

ACE grading—A proposed endoscopic grading system for adenoids and its clinical correlation

ObjectivesTo propose a novel endoscopic adenoid grading system using a rigid nasal endoscope and to study its correlation with the clinical diagnosis. MethodologyPrerecorded video clips of rigid nasal endoscopy taken during endoscopic adenoidectomy were retrieved. Otolaryngology consultants blinded to the clinical diagnosis of the child were presented these videos and asked to grade the adenoid hypertrophy as per the proposed endoscopic ACE (Airway/Choana/Eustachian tube) grading system. The clinical diagnosis was correlated with the different aspects of the descriptive endoscopic grading system. Results152 video clips were presented to the otolaryngology consultants for grading. The average age was 8.6 years (SD—3.48), while the male female ratio was 3:2. The A subcomponent of the ACE grading showed significant correlation with the diagnosis of sleep disordered breathing and chronic adenotonsillitis, C subcomponent with sleep disordered breathing and the E subcomponent with the diagnosis of otitis media. ConclusionThe proposed endoscopic grading is easily applicable and at the same time clearly describes the relation of the adenoids to the nasopharynx, choana and Eustachian tube. Different aspects of the grading system correlated differently with the clinical diagnosis emphasizing that a descriptive scoring rather than a comprehensive scoring is a more relevant clinical tool.

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 comparison of parecoxib sodium and flurbiprofen axetil in children undergoing endoscopic adenoidectomy and tonsillectomy

Objective To investigate the postoperative analgesia effect of parecoxib sodium and flurbiprofen axetil in children undergoing endoscopic adenoidectomy and tonsillectomy.Methods Sixty children,aged 5 y-8 y,scheduled for endoscopic adenoidectomy and tonsillectomy under general anesthesia were randomly divided into group A(parecoxib sodium),group B(flurbiprofen axetil),group C (normal saline)(n=20).Parecoxib sodium 1 mg/kg and flurbiprofen axetil 1 mg/kg were administered intravenously 15 min before the start of operation,meanwhile children in group C received normal saline.The extubation time,agitation occurrences,recovery period pain scores,remifentanil dose and side effects were observed and compared.Results There was no difference between the three groups in operation time,extubation time and remifentanil dose (P＞0.05).The emergence of postoperative agitation was 5％ in group A and group B,55％ in group C,which was significantly lower in group A and group B than that in group C(P＜0.01).The pain scores of group C were significantly higher than those in group A and group B(P＜0.01).The emergence of nausea and vomiting was 5％ in group C.Conclusions Applying of parecoxib sodium and flurbiprofen axetil in children undergoing endoscopic adenoidectomy and tonsillectomy can provide a good analgesia effect,reduce postoperative agitation,and do not postpone the extubation time. Key words: Parecoxib sodium; Flurbiprofen axetil ; Analgesia; Children; Tonsillectomy; Adenoidectomy

Efficacy of adenoidectomy combined myringotomy in treatment of children with secretory otitis media

Objective To evaluate the efficacy of combination of myringotomy adenoidectomy in treatment of children with secretory otitis media.Methods 36 children patients with secretory otitis media from March 2010 to February 2013 in our hospital were randomly divided into two groups,a control group of 18 patients taking endoscopic tympanostomy tube treatment; 18 cases in observation group took endoscopic tympanostomy tube joint adenoidectomy treatment,the incidence of the two groups were observed as well as the efficacy and complications.Results The total effective rate in observation group was 94.4％,while 83.2％ in the control group,showing statistical significant difference (P ＜ 0.05).Complications occurred in the observation group was 16.7％; while it was 36.1％ in the control group,showing statistical significant difference (P ＜ 0.05).Conclusion The combination of myringotomy and adenoidectomy has good clinical efficacy in the treatment of secretory otitis media,which is good for children,with high safety factor,deserved to be promoted in clinical practice. Key words: Adenoidectomy; Myringotomy; Secretory otitis media; Efficacy

Topographic Distribution of Biofilm-Producing Bacteria in Adenoid Subsites of Children with Chronic or Recurrent Middle Ear Infections

Bacterial biofilms have been found in the adenoids of children with recurrent acute otitis media (AOM) and persistent otitis media with effusion (OME). However, the possible difference in biofilm-producing bacteria (BPBs) between the adenoid surface at the nasopharyngeal dome (ND) and near the ostium of the eustachian tube (ET) has not been investigated. This study aimed to assess the difference in BPBs between adenoid biopsy specimens of the ND and those taken near the pharyngeal ostium of the ET in children with chronic adenoiditis with recurrent AOM and/or persistent OME. We collected adenoid biopsy specimens from the ND and ET during transoral endoscopic adenoidectomy to assess BPB by means of spectrophotometric analysis. We collected 135 adenoid biopsy specimens from 45 children. BPBs were detected significantly (p = 0.04) more frequently in the ET samples than in the ND samples, mainly Staphylococcus aureus. Although the prevalence of S aureus was slightly greater in the ND samples, and that of Streptococcus pneumoniae and Moraxella catarrhalis was slightly greater in the ET samples, these differences were not statistically significant. The fact that BPBs were significantly more frequently located near the ostium of the ET suggests that the adenoids are a reservoir for bacteria and indicates that hypertrophic adenoids (particularly hypertrophy near the ostium of the ET) play a role in recurrent AOM and/or OME.

Comparison of Transoral Power-Assisted Endoscopic Adenoidectomy to Curettage Adenoidectomy

The aim of this prospective and randomized study was to compare patients who underwent curettage adenoidectomy (CA) or transoral power-assisted endoscopic adenoidectomy (PAEA) performed as isolated procedures by a single surgeon over a period of 7 years. The success of an adenoidectomy has been evaluated by assessing the amount of reduction in the adenoid size and the symptomatic improvement at the sixth postoperative month. Patients' nasal airway obstruction was graded by the parents of the patient on a visual analog scale (VAS), with a range from 0 to 10, with grade 10 representing total obstruction. The ratio of the choanal opening obstructed by an adenoid mass was measured and expressed in percentages as representative of the adenoid size. Preoperative and 6-month postoperative adenoid sizes were compared. Fifty-three patients (CA group 27 patients/PAEA group 26 patients) completed the study. In the CA group, VAS score improved from the preoperative score of 8.63 ± 0.88 to the 6-month score of 2.22 ± 1.01 (P < 0.0001); and in the PAEA group, the preoperative VAS score of 8.69 ± 0.84 improved to 2.08 ± 1.05 in the same period (P < 0.0001). No statistical significance was found when VAS score improvements were compared (P = 0.4569). The average ratio of choanal opening obstructed by an adenoid mass improved from the preoperative ratio of 89.41% ± 6.48% to the 6-month ratio of 7.85% ± 2.28% in the CA group; and the preoperative ratio of 90.19% ± 6.95% in the PAEA group improved to 3.65% ± 1.38% after 6 months. The reduction of adenoid size was significantly superior in PAEA than CA (P < 0.0001). The operative time in PAEA was significantly shorter than that in CA (P < 0.0001). Although symptomatic improvement at the 6-month follow-up is statistically indifferent, PAEA has been shown to be superior to CA with its superior performance in providing a near-total elimination of the adenoid mass in a shorter operating time.

Endoscopic Adenoidectomy with Microdebrider

To describe endoscopic power assisted adenoidectomy and review the experience with the procedure demonstrating its safety and efficacy. Prospective study of 44 patients aged between 7 to 15years undergoing power assisted adenoidectomy between Jan 2004 and July 2006. Tertiary care private teaching hospital. Forty four consecutive children with adenoid hypertrophy undergoing power assisted adenoidectomy. Therapeutic endoscopic adenoidectomy using microdebrider. Operative time, blood loss, complications, completeness and depth of removal, surgeon's satisfaction and recovery period. The average operative time was 12min (range: 8-16min) and average blood loss was 30ml (range: 24-42ml). Complete resection was possible under vision with few complications. The surgeon satisfaction was high and post-operative recovery good. Power assisted adenoidectomy is quick, precise and safe. There is good visualization during resection thus improving precision and ensuring complete removal of adenoid tissue.

Endoscopic Adenoidectomy Secondary to Druginduced Trismus

We present the case of a 4 year old girl whose adenoidectomy had to be performed via an endoscopictrans oral approach due to the unexpected inability to fully open the mouth during the procedure. The patient had previously been taking Risperidone for behavioral symptoms associated with her autism. The jaw tone returned to normal following the procedure and there were no complications. An interaction between the Risperidone and the anesthetics were the likely cause of the trismus.