Adenoidectomy

Adenoidectomy

Download https://bltlly.com/2sZ8zo

After an adenoidectomy, a child almost always has a full recovery. Children go on to live healthier lives with far fewer breathing and ear problems. Children without adenoids have immune systems that are just as strong as children with adenoids.

The indications for adenoidectomy are still controversial.[2][3][4] Widest agreement surrounds the removal of the adenoid for obstructive sleep apnea, usually combined with tonsillectomy.[5] Even then, it has been observed that a significant percentage of the study population (18%) did not respond.There is also support for adenoidectomy in recurrent otitis media in children previously treated with tympanostomy tubes.[6]Finally, the effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections, common cold, otitis media and moderate nasal obstruction has been questioned with the outcome,[1] in some studies, being no better than watchful waiting.[7][8]

By 1996, roughly a half million children underwent some surgery on their adenoid and/or tonsils in both outpatient and inpatient settings. This included approximately 60,000 tonsillectomies, 250,000 combined tonsillectomies and adenoidectomies, and 125,000 adenoidectomies. By 2006, the total number had risen to over 700,000 but when adjusted for population changes, the tonsillectomy "rate" had dropped from 0.62 per thousand children to 0.53 per thousand. A larger decline for combined tonsillectomy and adenoidectomy was noted - from 2.20 per thousand to 1.46. There was no significant change in adenoidectomy rates for chronic infectious reasons (0.25 versus 0.21 per 1000).[10]

The relationship between enuresis and obstructive apnea, and the benefit of adenoidectomy by implication, is complex and controversial. On one hand, the frequency of enuresis declines as children grow older. On the other, the size of the adenoid, and again by implication, any obstruction that they might be causing, also declines with increasing age. These two factors make it difficult to distinguish the benefits of adenoidectomy from age-related spontaneous improvement. Further, most of the studies in the medical literature which appear to show benefit from adenoidectomy have been case reports or case series. Such studies are prone to unintentional bias. Finally, a recent study of six thousand children has not shown an association between enuresis and obstructive sleep in general but an increase with advancing severity of obstructive sleep apnea, observed only in girls.[13]

A decline in the frequency of the procedure started in the 1930s as its use became controversial. Tonsillitis and adenoiditis requiring surgery became less frequent with the development of antimicrobial agents and a decline in upper respiratory infections among older school-aged children. Also, several studies had shown that adenoidectomy and tonsillectomy were ineffective for many of the indications used at that time as well as the suggestion of an increased risk of developing poliomyelitis after the procedure, later disproved.[14] Prospective clinical trials, performed over the last 2 decades, have redefined the appropriate indications for tonsillectomy and adenoidectomy (T&A), tonsillectomy alone, and adenoidectomy alone.[9]

Purpose of review: Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions.

Recent findings: Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscope-assisted removal of the adenoids has proven to be a safe technique, with good short- and long-term outcomes. Novel non-surgical therapies including immunotherapy have been evaluated.

Tonsils and adenoids are often removed when they become large and inflamed and begin to cause frequent infections. The procedure to remove tonsils is known as a tonsillectomy, and removal of the adenoids is called an adenoidectomy. Because they are often removed at the same time, the procedure is referred to as a tonsillectomy and adenoidectomy, or T&A. The surgery is most commonly performed in children.

Some children may be referred to an ear, nose, and throat surgeon to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy (T&A). Often, the tonsils and adenoids are removed at the same time, but, sometimes, only one is removed. Your child's physician will discuss this with you.

Tonsillectomy and adenoidectomy (T&A) surgery is a common major surgery performed on children in the United States. About 400,000 surgeries are performed each year. The need for a T&A will be determined by your child's ear, nose, and throat surgeon and discussed with you. Most T&A surgeries are done on an outpatient basis. This means that your child will have surgery and then go home the same day.

This document addresses the use of adenoidectomy, a surgical procedure to remove the adenoids, which are also known as pharyngeal tonsils or nasopharyngeal tonsils. Adenoidectomy is a common surgical procedure used to treat an array of conditions.

The use of adenoidectomy for the treatment of otitis media (OM), either acute (AOM) or with effusion (OME), has been a focus of investigation for many years. One area of concern is the use of this procedure, with or without the use of tympanostomy tubes, in the treatment of OM in children under 4 years of age. Several large, well-designed randomized controlled trials (RCTs) have published a mix between no benefit and only small benefits reported. Of the studies reporting no benefit, the use of tympanostomy tubes was included in the study protocol (Casselbrant, 2009; Hammaren, 2005; Koivunen, 2004; Mattila, 2003). The studies that did report some benefit, tympanostomy tubes were used in two (Kujala, 2012; MRC, 2012), but not in a third (Paradise, 1999).

The AAO-HNS guideline also changed their position on the use of adenoidectomy only as a second line treatment after failure of an initial trial of tympanostomy tubes. The updated recommendation suggests that adenoidectomy should be considered a first-line therapy along with, or as an option to tympanostomy tube insertion. As with the previously mentioned change, this recommendation is based on recent systematic review data (Boonacker, 2014; Mikals, 2014; Wallace, 2014). However, the data supporting this change are weak. Most notably, the Boonacker study does not address adenoidectomy as a primary procedure. The only support for primary adenoidectomy comes from the Mikals study which states:

Thus, at this time the evidence is not supportive of the use of adenoidectomy with or without tympanostomy tubes, in children under the age of 4 years of age who have chronic OM with effusion or recurrent acute otitis media.

The use of adenoidectomy is widely accepted to be an effective treatment for suspected adenoid tumor. While there is little clinical trial evidence to support this procedure, the removal of malignant tissue is the standard of care in most head and neck cancers (NCCN, 2020).

In children less than 3 years of age, behavioral issues related to SDB may be more difficult to identify (for example, they may not yet be continent and, as such, enuresis would not necessarily be a sign of SDB). In addition, access to diagnostic polysomnography may be difficult and the results may be less reliable. Based on additional clinical input from specialists in the field, it would be appropriate to consider adenoidectomy when a parent or caregiver reports regular episodes of nocturnal choking, gasping, apnea, or breath holding which have persisted for several months in the setting of documented adenoid hypertrophy.

Obstructive sleep apnea (OSA) is a major subset of SDB. Individuals with OSA suffer from redundant soft tissue in the pharynx, including the adenoids and tonsils, which blocks the upper airway leading to periodic cessation of breathing. Individuals with OSA must change sleep position or increase their respiratory effort to overcome the blockage, disrupting sleeping patterns. Symptoms of OSA may include nocturnal gasping, cyanosis, excessive daytime sleepiness, pulmonary hypertension, and snoring, to name just a few. The diagnosis of OSA in children has not been standardized, although there is some consensus that a threshold of greater than one on the AHI is an indication of OSA (Au, 2009; Chan, 2004; Spruyt, 2012). The AAP regards adenoidectomy as a reasonable option for any child with documented OSA and adenoid hypertrophy (2012; Marcus, 2012).

The majority of authoritative recommendations and research-based literature addressing adenoidectomy are focused on pediatric populations. This is primarily due to the fact that there are unique characteristics of pediatric anatomy that may predispose to certain conditions. However, there may be some circumstances where adenoidectomy alone may be a reasonable course of treatment in older individuals, such as when hypertrophic adenoid tissue causes airway obstruction or when chronic adenoiditis is symptomatic .

General InformationYou may lack energy for several days, and may also be restless at night. This will improve over 3 to 4 days after an adenoidectomy, and 10 to 14 days after a tonsillectomy. Recovery from an adenoidectomy alone is easier than recovery from a tonsillectomy. It is quite common for you to feel progressively worse during the first 5 to 6 days after surgery. You may also become constipated during this time for three reasons: you will not be eating your regular diet, you will be taking pain medications, and you may be less active. 2b1af7f3a8