Suction diathermy adenoidectomy

Use and Abuse of Electrocautery in Adenoidectomy Hemostasis

Background and objectives: Bipolar electrocautery is commonly used to control bleeding after cold-instrument pediatric adenoidectomy, but the surgeon should be aware of the possible side effects. OBJECTIVE: The aim of our study is to investigate the effects of bipolar electrocautery when used for bleeding control at the end of an adenoidectomy procedure. Materials and Methods: We evaluated the effect of electrocautery on postoperative pain, velopharyngeal insufficiency symptoms, postoperative nasal obstruction, and rhinorrhea in a group of 90 children undergoing adenoidectomy in our ENT department over a period of 3 months. Results: After statistically analyzing the data, we found that the duration of postoperative pain, the duration of rhinorrhea and nasal obstruction, and the duration of painkiller administration, as well as the velopharyngeal insufficiency symptoms, were significantly longer in patients in whom electrocautery was used for hemostasis. A significantly higher incidence of posterior neck pain and halitosis (oral malodor) was noted in the patients in whom electrocautery was used for adenoidectomy hemostasis. Conclusions: Bipolar electrocautery use should be limited during pediatric adenoidectomy hemostasis because of the possible side effects: longer postoperative pain, prolonged nasal obstruction, rhinorrhea and velopharyngeal insufficiency, and halitosis. We noted some side effects that were specific to electrocautery use during adenoidectomy: posterior neck pain and oral malodor. Acknowledging the risk for these symptoms can help to alleviate the anxiety of both the parents and the patients regarding the expected postoperative outcomes.

Effect of hot saline pack versus topical tranexamic acid in post adenoidectomy bleeding

Background

Adenoidectomy is a popular surgical technique in the field of otolaryngology that is successful, safe, and effective. Diffuse microvascular post-adenoidectomy bleeding, on the other hand, is still a common concern.

Aim

The objective of this study is to do a comparison between the efficacy of a hot saline pack versus topical tranexamic acid when administered topically in children who have had only adenoidectomy in terms of intra-operative blood loss and post-operative bleeding.

Methods

This prospective case-control study contained a total of 180 patients, divided into three classes. Class A: This included 60 patients with application of a hot saline pack in control of intra-operative adenoidectomy bleeding. Class B: This included 60 patients with application of a topical tranexamic acid pack in control of intra-operative adenoidectomy bleeding. Class C: This included 60 patients with the use of a pack to hold intra-operative adenoidectomy bleeding

Results

The mean intraoperative blood loss in class B was lower than classes A and C, the mean pre- and post-operative HB level was lower in class C than in classes A and B, the difference was statistically considerable between the three classes, comparison between classes showed statistically considerable differences between classes A and C and also between classes B and C, while there was a statistically non-considerable difference between classes A and B.

Conclusion

The current study found that a topical tranexamic acid pack was more effective for post-adenoidectomy haemostasis than a hot saline pack, with a shorter time to haemostasis and fewer recurettage and electrocauterization procedures.

Trial registration

Name of registration trial: Research ethics committee faculty of medicine Benha university. Registration number: Ms1-1-2020. Date of registration: 22-1-2021.

Hot nasal packing with hot saline irrigation for hemostasis after adenoidectomy: A prospective randomized controlled study

OBJECTIVE

This study aimed to investigate the efficacy of hot posterior nasal packing and hot saline irrigation in bleeding control after adenoidectomy.

METHODS

A total of 130 patients scheduled for adenoidectomy were included in the study, and randomized into two groups at the beginning of the surgical operation. After adenoidectomy, saline impregnated tampon, and saline irrigation at room temperature (22 °C) was applied to the patients in one group while 50 °C saline impregnated tampon and saline irrigation at the same temperature were applied to the patients in the other group. We recorded hemostasis for up to 3 min after tamponade for bleeding control, and the amount of bleeding into the nasopharynx.

RESULTS

The age of the patients ranged from 1.5 to 13 years (mean ± SD: 6.07 ± 3.08 years, and 5.33 ± 2.55 years, 22 °C and 50 °C saline irrigation groups, respectively). There were 37 males and 28 females in the 22 °C saline group, while 34 males and 31 females in the 50 °C saline group. When comparing the two groups, there was no statistically significant difference in terms of duration of hemostasis (p = 0.64). However, bleeding scores at 2 nd min after the tamponade were significantly lower in the 50 °C saline group (p = 0.007). The amount of bleeding in the 50 °C saline group was also significantly lower than the 22 °C saline group (p = 0.015).

CONCLUSION

In this study, application of 50 °C saline impregnated tampon, and hot saline irrigation was found to be more effective in the control of bleeding after adenoidectomy by reducing the amount of bleeding compared to 22 °C saline impregnated tampon application and saline irrigation at 22 °C. However, hot nasal packing and hot saline irrigation did not affect duration of hemostasis and cauterization.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction

INTRODUCTION

Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages.

OBJECTIVE

The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion.

METHODS

This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups.

RESULTS

There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p<0.001, p<0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p=0.376, p=0.128).

CONCLUSION

Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.

The impact of bilateral endoscopic inferior turbinoplasty with or without adenoidectomy on the quality of life of children: a retrospective case series study

BACKGROUND

Inferior turbinoplasty (IT) and adenoidectomy (Ad) are frequently resorted to in children with chronic rhinitis (CR) refractory to medical therapy. The aim of this study is to document the long-term improvement in quality of life (QOL) in children with CR following endoscopic IT with or without Ad.

METHODS

A retrospective case series study was conducted. We searched a prospectively kept surgical database for children ≤18 years old who had CR who underwent endoscopic IT with or without Ad between 2009 and 2016 at a tertiary care children's center. Patients with sinonasal pathologies other than CR, had craniofacial syndromes or dysmorphism and had other sinonasal procedures or trauma were excluded. Collected data included demographics, secondary diagnoses, duration of follow-up, and complications of procedures. The Glasgow Children's Benefit Inventory (GCBI) was administered by phone to assess QOL improvement.

RESULTS

One hundred sixty-five eligible subjects were identified. Eighty-nine subjects met the inclusion criteria. Data was collected for the 60 subjects that were reached. Forty-two patients had IT only while 18 had IT and Ad. The mean age was 10.7 ± 2.7 years, with 31 males and 29 females. The median duration of follow-up (25th, 75th percentile) was 38.1 months (24.6, 55.8). The median GCBI score (25th, 75th percentile) was 22.9 (6.3, 39.6) revealing an overall positive benefit in all domains. There was only one complication.

CONCLUSIONS

This study validates prior findings regarding improvement of QOL and safety of IT with or without Ad for children with CR and indicates it is maintained in the long term.

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 1 year 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 12.80 years. 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 1 year. 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.

Comparative Study for Efficacy and Safety of Adenoidectomy according to the Surgical Method: A Prospective Multicenter Study

Background/Objective

There have been several operative techniques for adenoidectomy and their efficacy and morbidity are different according to the technique. This prospective multicenter study was aimed to compare the efficacy and morbidity of coblation adenoidectomy (CA) with those of power-assisted adenoidectomy.

Study Design

Prospective multi-institutional study.

Methods

Children who underwent CA, power-assisted adenoidectomy with cauterization (PAA+C) or without cauterization (PAA-C) due to adenoid hypertrophy were enrolled from 13 hospitals between July 2013 and June 2014. Mean operation time, degree of intraoperative bleeding and postoperative bleeding rate were evaluated.

Results

A total of 388 children (mean age ± standard deviation = 6.6 ± 2.5 years; 245 males and 143 females) were included. According to the adenoidectomy technique, the children were classified into 3 groups: (1) CA (n = 116); (2) PAA+C (n = 153); and (3) PAA-C (n = 119). Significant differences were not found in age and sex among three groups. In the CA group, mean operation time was significantly shorter (P < 0.001) and degree of intraoperative bleeding was significantly less (P < 0.001) compared to PAA+C or PAA-C group. Delayed postoperative bleeding rate of PAA-C group was significantly higher than that of CA or PAA+C group (P = 0.016).

Conclusions

This prospective multicenter study showed that CA was superior to PAA in terms of mean operation time and degree of intraoperative bleeding.

Evaluation of middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion

OBJECTIVE

Our aim was to analyze the changes in middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion.

METHODS

This prospective, descriptive study was performed on 64 patients (with normal tympanic membranes and tympanograms) undergoing adenoidectomy or adenotonsillectomy. All patients were operated by single experienced team using curettage technique. First tympanometry was done on the day before surgery. Tympanometry was repeated on the first-, third-, and seventh-day after the operation. Patients are separated into two groups according to age as patients younger than 6 years (Group A) and patients older than 6 years (Group B). All data were separately evaluated for each ear using Jerger Classification.

RESULTS

Of the 64 patients included in the study, 35 were male and 29 were female, and the average age was 91.01 ± 37.4 (35-178) months. Pathological decreases in the middle ear pressures of at least one ear were determined in 48 (75%) patients on the first postoperative day and in 10 (15.6%) patients on the third postoperative day. Middle ear pressures returned to preoperative values by the seventh postoperative day except in two patients. There were statistically significant differences (p<0.0001) among preoperative and first, third, and seventh postoperative day mean middle ear pressure. There were no statistically significant differences between Groups A and B in terms of tympanometry values of both ears obtained preoperatively and on the first, third, and seventh postoperative day.

CONCLUSION

In our study, temporary eustachian dysfunction and aural fullness occur in the early period after adenoidectomy and/or adenotonsillectomy. This situation may be due to post-surgery clots and edema in nasopharynx. We consider that tubal orifice can be exposed to surgical trauma as adenoidectomy surgeries are done by curettage technique. There is a need for comparative studies using microdebrider or laser adenoidectomy accompanied by an endoscope.

Suction cautery adenoidectomy (SCA): is the additional cost justified?

OBJECTIVES

Adenoidectomy is one of the oldest and most frequent ENT procedures. This study aimed to compare adenoidectomy using suction-cautery adenoidectomy (SCA) to curettage with respect to operative time, postoperative complications, and cost-effectiveness.

METHODS

The data for this retrospective case control study were retrieved from the Medical Records Department at one of the few medical centers that perform this technique in the Kingdom of Saudi Arabia. The data for each case included the following: patient demographic features, type of procedure, time of operation, occurrence of any postoperative complications, length of hospital stay and cost of the procedure. To minimize the sources of variance in our data, all adenoidectomies were performed by the same consultant otolaryngologist, using either SCA or curettage.

RESULT

Of the 86 patients who underwent adenoidectomy in this study, SCA was performed in half of them (43) and curettage in the other half. The two groups were well matched with no significant group differences in either age or gender (p=0.2 and p=0.19, respectively). There was a significant reduction in operative time (p<0.001) in the SCA group. There were no cases of postoperative hemorrhage after SCA, but there was one case of hemorrhage in the curette group that required a 2nd surgery to control the bleeding. Regarding cost, there were additional profits of more than 700,000 SR (US$180,000) each month with SCA as compared to curettage.

CONCLUSIONS

The suction cautery technique was superior at reducing operative time, increasing cost-effectiveness and decreasing the risk of postoperative complications. Therefore, we suggest suction cautery as the most appropriate method for adenoidectomy.

Hot saline irrigation for control of intraoperative bleeding in adenoidectomy: a randomized controlled trial

OBJECTIVE

To investigate the efficiency of hot (50 degrees C) saline irrigation for hemostasis after adenoidectomy.

STUDY DESIGN

A prospective, controlled, randomized study to investigate hot saline solution in hemostasis of adenoidectomy.

SETTING

A tertiary care pediatric hospital.

SUBJECTS AND METHODS

A group of 120 children, undergoing adenoidectomy alone, were randomized into two groups, either the room-temperature (25 degrees C) or 50 degrees C saline group, at the start of the operation.

RESULTS

One hundred and twenty consecutive patients were enrolled in the study. Age ranged from 1.5 to nine years (mean +/- SD: 4.5 +/- 1.9 years vs 4.9 +/- 1.8 years, 25 degrees C vs 50 degrees C saline groups). There were 36 males and 24 females in the control group (25 degrees C saline group), and 30 males and 30 females in the 50 degrees C saline group. Compared to patients in the control group, 50 degrees C saline reduced the operative time by 3.1 minutes (95% confidence interval [CI] 1.79-4.41, P = 0.001) and reduced the time for hemostasis by 1.77 minutes (95% CI 0.83-2.70, P = 0.008).

CONCLUSION

The present study demonstrated that the 50 degrees C saline irrigation was more effectual for postadenoidectomy hemostasis in comparison to room-temperature (25 degrees C) saline irrigation by providing a lesser hemostasis time and requiring lesser need of recurettage and electrocauterization.

Adenoidectomy techniques: UK survey

Objectives:

To determine (1) the preferred adenoidectomy technique among UK ENT consultants, and (2) the need for revision adenoidectomy following the standard technique of blind curettage with digital palpation.

Method:

Postal questionnaire.

Participants:

We included 539 consultant members of the ENT–UK.

Main outcome measures:

Commonly used adenoidectomy techniques, and whether revision adenoidectomy was considered a problem.

Results:

The response rate was 66.6 per cent (359 respondents). Twenty-seven respondents did not perform adenoidectomy, while 332 did. A total of 312/332 respondents (94 per cent) believed that adenoidectomy had a role in the treatment of chronic serous otitis media. The majority of respondents (232/332; 69.9 per cent) reported examining the postnasal space digitally at adenoidectomy. The preferred routine adenoidectomy technique was blind curettage for 263 respondents (79.2 per cent), suction diathermy ablation for 27 (8.1 per cent) and curettage under direct vision (using a mirror) for 13 (3.9 per cent). In response to the question ‘Do you recognise the need for revision adenoidectomy as a problem?’, 205 (61.7 per cent) respondents replied ‘never’, 39 (11.7 per cent) ‘rarely’, 54 (16.3 per cent) ‘< 2 per cent’ and 36 (10.8 per cent) ‘>2 per cent’.

Conclusions:

The most commonly used adenoidectomy technique in the UK is digital palpation followed by blind curettage, according to this postal questionnaire survey. Few respondents reported performing adenoidectomy under direct vision: only 10 per cent used a mirror during the procedure and only 8 per cent used an endoscope.

Electrocautery adenoidectomy outcomes: A meta-analysis

Objective: Review the published literature regarding clinical outcomes of suction electrocautery adenoidectomy (ECA) in pediatric patients.

Data Source: The MEDLINE database was systematically reviewed for articles reporting on the use of ECA.

Review Methods: Each study was independently reviewed by each investigator. Inclusion criteria included English language, sample size greater than five, and presentation of extractable data regarding outcomes with ECA. Random-effects modeling was used to estimate summary outcomes.

Results: Nine studies met the inclusion criteria. The mean sample size was 276 patients with a grand mean age of 6.0 years. Random-effects modeling of intraoperative hemorrhage (4.1 cc vs 24.0 cc, 95 percent CI of difference = 16.5–23.1, P < 0.001) and operative time (10.0 minutes vs 18.4 minutes, 95 percent CI of difference = 0.82–2.90, P < 0.001) favored ECA vs curette adenoidectomy. Subjective success was reported in 95.0 percent (95% CI = 92.7%-97.3%, P < 0.001) of ECA patients with a grand mean of 5.8 months of follow-up. Adenoid regrowth was evaluated objectively (endoscopy or x ray) in only 116 of 2132 patients (5.4%), with an observed regrowth rate of 2.8 percent that (95% CI = 0%-5.5%, P = 0.052).

Conclusions: The preponderance of available evidence favors ECA vs curette adenoidectomy in terms of decreased intraoperative hemorrhage and operative time. Long-term outcome data for ECA are scarce but suggest a low regrowth and complication rate.

Prospective, randomized, single-blind, controlled study to compare two methods of performing adenoidectomy

OBJECTIVE

To compare adenoidectomy using suction-diathermy ablation to curettage adenoidectomy with respect to operative time and adenoid regrowth at 6 months after surgery.

STUDY DESIGN

A prospective, randomized, single-blind, study to compare two methods of performing adenoidectomy. A group of 100 children, undergoing adenoidectomy alone or in combination with tonsillectomy, were randomized into two groups and underwent either suction diathermy or curettage adenoidectomy by a single surgeon.

SETTING

A tertiary care Paediatric Hospital.

METHOD

Indication for surgery, adenoidal size, duration of surgery and complications were recorded and compared. Six-month follow-up was conducted and adenoidal size and symptom status were recorded and compared. Statistical analysis was performed using Microsoft Excel.

RESULTS

One hundred patients participated in this study and underwent adenoidectomy alone or adenotonsillectomy. Ninety-two patients returned for follow-up and 91 patients completed the study. The two treatment groups were well matched for age and gender. The main indications for both groups were snoring, nasal obstruction and obstructive sleep apnoea. For adenoidectomy alone there was no significant difference in duration of surgery between the curette and suction diathermy groups. When performing tonsillectomy and adenoidectomy together suction diathermy took significantly longer to complete than curettage (P<0.001). Overall 96% of patients' symptoms had either improved or resolved. The post-operative comparison at 6 months showed a significant difference in the residual adenoidal size between the two groups, the suction diathermy group being generally smaller than the curettage group.

CONCLUSIONS

Suction diathermy was better at reducing the adenoidal size 6 months after surgery. Although the difference in size was statistically significant it did not seem to be of clinical significance.

Suction diathermy for adenoidectomy: complications and risk of recurrence

OBJECTIVES

When introduced, suction coagulation was initially utilised for haemorrhage control following curettage of the adenoid pad. More recently the whole procedure has been performed using the technique. This study aims to report post-operative haemorrhage rates and risk of recurrence in adenoidectomy performed solely by suction diathermy in children.

METHODS

A retrospective study of 1411 consecutive paediatric patients. Surgery was performed using suction diathermy. No patients were excluded. All patients were followed up.

RESULTS

There were no cases of post-operative haemorrhage. 1.7% of patients remained symptomatic and underwent revision adenoidectomy. None required a third procedure.

CONCLUSIONS

Re-growth of adenoid tissue may occur despite visualisation of the nasopharynx at the time of surgery. The incidence of re-growth is similar to that reported in patients undergoing conventional adenoidectomy by curettage. Post-operative haemorrhage was not encountered in children having adenoidectomy by suction diathermy. The authors suggest suction diathermy as the most appropriate method for adenoidectomy in children.

Day-case adenoidectomy: outcomes are improved using suction coagulation and prophylactic anti-emetic treatment

In 2004, the Department of Health published 10 High Impact Changes across the NHS. Of these, the first was treating day surgery as the norm for elective operations, releasing up to half a million in-patient beds each year. Adenoidectomy is an operation commonly performed in children for upper respiratory tract obstruction and as part of the surgical management of otitis media with effusion. Many surgeons consider the traditional curettage adenoidectomy as an unsatisfactory operation because it is performed blind, and is associated with varying reported levels of post-operative bleeding. Concern about the risk of bleeding and the frequent occurrence of post-operative nausea and vomiting have discouraged many surgeons from adopting adenoidectomy as a day-case procedure. We have audited the management and discharge of a cohort of 72 children undergoing traditional curettage adenoidectomy. Based on the results, we have completed the audit loop, by managing a second cohort of 77 children by suction coagulation adenoidectomy. An anaesthetic protocol has been designed to reduce post-operative nausea and vomiting, and facilitate same day discharge from hospital. The rate of post-operative nausea and vomiting fell from 21 to 1.3%, and the post-operative bleeding from 9.7% to nil. Discharge on the day of operation rose from 40.3 to 100%. Our audit confirms that these measures permit safe, day-case adenoidectomy.

A survey on the management of reactionary haemorrhage following adenoidectomy in the UK and our practice

We present the results of a nation-wide survey in the management of reactionary haemorrhage following adenoidectomy, in the absence of specific national guidelines for this complication in the UK. We have reported the practice of the consultant members of the BAO-HNS through a confidential postal questionnaire with regard to their preferred method of management and experience. Valid replies were received from 285 ENT surgeons, of which 87.3% (249) prefer to manage reactionary haemorrhage with post-nasal packs and 223 (78.2%) would use an overnight post-nasal pack. 7.7% (22) use other techniques, and 9.1% (26) leave post-nasal packs for as short time as possible. Our experience of using a post-nasal pack for 4 h appears equally as effective as a post-nasal pack left for 24 h and reduces the discomfort and subsequent risks related to overnight post-nasal packing.

Pediatric endoscopic transnasal adenoid ablation

We describe a technique in which suction diathermy is used for adenoid ablation through a solely endoscopic transnasal approach in the older pediatric population. This procedure has proved to be both effective and convenient during other transnasal endoscopic procedures, as it provides excellent visualization of both the superior and inferior parts of the nasopharynx and results in minimal to no bleeding in the adenoid bed. In all cases to date, there has been complete resolution of preoperative problems of infection, pain, and bleeding. All patients had good control of postoperative pain. There has been no evidence of postoperative nasopharyngeal stenosis and no velopharyngeal insufficiency. Although transnasal adenoid ablation is not appropriate for the entire pediatric population, this procedure has multiple benefits when another endoscopic sinonasal procedure is planned, when there is neck instability, or when enhanced visualization of the nasopharynx is desired.

Pediatric adenoidectomy under vision using suction-diathermy ablation

OBJECTIVES

To compare adenoidectomy using suction-diathermy ablation with adenoidectomy by way of curettage in a pediatric tertiary care setting.

STUDY DESIGN

A prospective series of 68 children undergoing adenoidectomy (without tonsillectomy) under vision using a suction-diathermy ablation technique over 2 years was compared with an historical control group of 58 children undergoing adenoidectomy (without tonsillectomy) by way of curettage over 2 years.

METHOD

Intraoperative blood loss was recorded and compared. Efficacy in improving nasal symptomatology was compared between the two groups using an ordinal "nasal symptom score" preoperatively and postoperatively. Complications were recorded and compared. Analysis was performed using two-tailed t tests.

RESULTS

The two groups were well matched for age, weight, and adenoid size (P > .4). Follow-up ranged from 4 to 48 months. Adenoidectomy using suction-diathermy resulted in significantly less blood loss (P < .001). The technique was no less efficacious in terms of reducing the nasal symptom score than conventional adenoidectomy by way of curettage (P = .07). Complication rates were no different. No recurrences were identified and no instances of nasopharyngeal stenosis were recognized.

CONCLUSIONS

Routine use of suction-diathermy ablation for adenoidectomy converts a difficult, often bloody procedure into a surgically precise operation. It is especially applicable to children. It may have additional advantages in aiding the prevention of the spread of the human form of bovine spongiform encephalopathy (variant Creutzfeldt-Jakob disease [CJD]). Compared with other recently introduced techniques for adenoidectomy, it is considerably less expensive.