eMedicine Specialties > Otolaryngology and Facial Plastic Surgery > Pediatric Otolaryngology

Adenoidectomy: Follow-up

Author: John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
Contributor Information and Disclosures

Updated: Oct 30, 2008

Outcome and Prognosis

Chronic persistent otitis media

Gates et al have the most quoted article concerning the effectiveness of adenoidectomy for preventing the recurrence of chronic (ie, > 2 mo) serous otitis media in children aged 4-9 years.8 In a study consisting of 491 children published in the New England Journal of Medicine in 1987, Gates et al showed that not only was adenoidectomy effective independent of the size of the adenoids, they showed that a hierarchy existed in effectiveness for preventing ear fluid from returning when treated with surgery.8 In that study, Gates et al showed that adenoidectomy and tympanostomy tube placement were better than adenoidectomy and myringotomy, which was better than tympanotomy tube placement alone, which was better than myringotomy alone.8

Maw and Speller, Paradise et al, and others have confirmed the findings reported by Gates et al.4,9 The improvement appears to be a 30-50% reduction in the recurrence of fluid if the adenoids are removed in conjunction with other surgeries for persistent otitis media.

Recurrent otitis media

The evidence supporting adenoidectomy for recurrent otitis media is weaker than that for persistent otitis media. However, a modest 30% improvement in resolution of recurrent infections occurred when the adenoids were removed.

Chronic sinusitis

A study by Lee and Rosenfeld in 1997 showed that children with sinusitis improved after adenoidectomy, and improvement was independent of the weight of the adenoids.5 Other studies show that size is important to the resolution of symptoms of sinusitis.

Nasal airway obstruction

If the adenoid is enlarged and blocking the nasal cavity, the symptoms of nasal airway obstruction, snoring, and nasal congestion should resolve after an adenoidectomy.

Future and Controversies

The future controversy related to adenoidectomy appears to be the determination of the age at which adenoidectomy is safe, based on the possibility of the immunological benefit of the adenoids. Some studies indicate that markers for the production of antibodies that may help fight viruses are observed in the adenoids. No studies show that immunity is impaired in a child following adenoidectomy. However, adenoidectomy in children younger than 1 year is rare and adenoidectomy in children younger than 2 years is uncommon. The adenoid tissue itself is not usually significantly enlarged until age 18-24 months. Certain individuals who have adenoid hypertrophy and complete nasal obstruction as young as age 7-8 months have difficulty breathing and do not feed well. These children benefit from adenoid removal to improve their breathing and ability to eat.

Because a certain set of children with chronic and acute otitis media appears to have persistent problems after tube placement or has early extrusion of the tubes with recurrence of ear disease and benefits from adenoidectomy, identification of these children prior to placement of their first set of tubes may be beneficial. However, this may be difficult to determine.

Despite the numerous techniques available for removing the adenoids, the standard and generally most successful method of using the curette for removal appears to be the most widely performed procedure. Because adenoidectomy is a common procedure, new techniques will always be evaluated in attempts to improve the medical or surgical therapy for the diseases for which the adenoids are responsible.

 


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References
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References

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  2. Brodsky L, Koch RJ. Bacteriology and immunology of normal and diseased adenoids in children. Arch Otolaryngol Head Neck Surg. Aug 1993;119(8):821-9. [Medline].

  3. Maw AR, Speller DC. Are the tonsils and adenoids a reservoir of infection in otitis media with effusion (glue ear)?. Clin Otolaryngol Allied Sci. Oct 1985;10(5):265-9. [Medline].

  4. Lee D, Rosenfeld RM. Adenoid bacteriology and sinonasal symptoms in children. Otolaryngol Head Neck Surg. Mar 1997;116(3):301-7. [Medline].

  5. Brodsky L, Moore L, Stanievich JF. A comparison of tonsillar size and oropharyngeal dimensions in children with obstructive adenotonsillar hypertrophy. Int J Pediatr Otorhinolaryngol. Aug 1987;13(2):149-56. [Medline].

  6. McClay JE. Resistant bacteria in the adenoids: a preliminary report. Arch Otolaryngol Head Neck Surg. May 2000;126(5):625-9. [Medline].

  7. Gates GA, Avery CA, Prihoda TJ, et al. Effectiveness of adenoidectomy and tympanostomy tubes in the treatment of chronic otitis media with effusion. N Engl J Med. Dec 3 1987;317(23):1444-51. [Medline].

  8. Paradise JL, Bluestone CD, Rogers KD, et al. Efficacy of adenoidectomy for recurrent otitis media in children previously treated with tympanostomy-tube placement. Results of parallel randomized and nonrandomized trials. JAMA. Apr 18 1990;263(15):2066-73. [Medline].

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  20. Potsic WP. Tonsillectomy and adenoidectomy. Int Anesthesiol Clin. Spring 1988;26(1):58-60. [Medline].

  21. Potsic WP, Pasquariello PS, Baranak CC, et al. Relief of upper airway obstruction by adenotonsillectomy. Otolaryngol Head Neck Surg. Apr 1986;94(4):476-80. [Medline].

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  23. Tomonaga K, Kurono Y, Chaen T, et al. Adenoids and otitis media with effusion: nasopharyngeal flora. Am J Otolaryngol. May-Jun 1989;10(3):204-7. [Medline].

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Further Reading

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Keywords

adenoidectomy, tonsillectomy adenoidectomy, adenoids, adenoid, adenoid surgery, adenoid removal, infected adenoids, pediatric adenoidectomy, pediatric adenoid removal, pediatric adenoid surgery, tonsillectomy and adenoidectomy, T&A, adenoiditis, tonsillectomy, middle ear effusion, otitis media, OM, middle ear infection, rhinosinusitis, ear infection, ear disease, chronic sinusitis, COM, AOM, acute otitis media, chronic otitis media, otitis media with effusion, OME, adenoid curette, adenoid punch

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Contributor Information and Disclosures

Author

John E McClay, MD, Associate Professor of Pediatric Otolaryngology, Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Dallas, University of Texas Southwestern Medical School
John E McClay, MD is a member of the following medical societies: American Academy of Otolaryngic Allergy, American Academy of Otolaryngology-Head and Neck Surgery, American College of Surgeons, and American Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Ari J Goldsmith, MD, Chief of Pediatric Otolaryngology, Long Island College Hospital; Associate Professor, Department of Otolaryngology, Division of Pediatric Otolaryngology, State University of New York Downstate Medical Center
Ari J Goldsmith, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Medical Association, and Medical Society of the State of New York
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: eMedicine Salary Employment

Managing Editor

Gregory C Allen, MD, Assistant Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Gregory C Allen, MD is a member of the following medical societies: American Academy of Otolaryngology-Head and Neck Surgery, American Academy of Pediatrics, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Laryngological Rhinological and Otological Society, American Medical Association, Christian Medical & Dental Society, and Colorado Medical Society
Disclosure: Nothing to disclose.

CME Editor

Christopher L Slack, MD, Otolaryngology-Facial Plastic Surgery, Private Practice, Associated Coastal ENT; Medical Director, Treasure Coast Sleep Disorders
Christopher L Slack, MD is a member of the following medical societies: Alpha Omega Alpha, American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Medical Association
Disclosure: Nothing to disclose.

Chief Editor

Arlen D Meyers, MD, MBA, Professor, Department of Otolaryngology-Head and Neck Surgery, University of Colorado School of Medicine
Arlen D Meyers, MD, MBA is a member of the following medical societies: American Academy of Facial Plastic and Reconstructive Surgery, American Academy of Otolaryngology-Head and Neck Surgery, and American Head and Neck Society
Disclosure: Covidien Corp Consulting fee Consulting; US Tobacco Corporation unstricted gift unknown; Axis Three Corporation Ownership interest Consulting; Omni Biosciences Ownership interest Consulting; Sentegra Ownership interest Board membership; Syndicom Ownership interest Consulting; Oxlo  Consulting; Medvoy Ownership interest Management position

 
 
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