Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials

Effects of visual guidance and instrument choice on symptom recurrence following adenoidectomy: a systematic review of randomized controlled trials

Objectives

To assess the impact of visual guidance and instrument choice on obstructive sleep apnea (OSA) and otitis media with effusion (OME) symptom recurrence and reoperation rates following adenoidectomy in pediatric patients.

Design

Systematic review of randomized controlled trials (RCTs).

Setting

A comprehensive literature search was conducted in Embase, PubMed/Medline, the Cochrane Library, and Scopus, with the final search on September 23, 2024. Reference lists were also screened.

Participants

Eligible studies included RCTs published from 2000 onwards, with ≥25 pediatric patients undergoing adenoidectomy for OSA or OME. Comparisons included visually guided versus blinded and cold versus hot adenoidectomy techniques. Studies involving concurrent procedures, craniofacial abnormalities, or non-primary adenoidectomy cases were excluded.

Main outcome measures

The primary outcomes were OSA and OME symptom recurrence and reoperation rates following adenoidectomy. Risk of bias was assessed using Cochrane Risk of Bias tool, and evidence quality was evaluated using Grading of Recommendations Assessment, Development and Evaluation.

Results

Of 2302 screened articles, 35 underwent full-text review, and 4r studies (373 participants) met inclusion criteria. All studies compared hot and cold techniques, with hot techniques being visually guided. Only one study directly compared both hot and cold techniques under visual guidance, reporting lower OSA recurrence rates with the hot technique, though with a high risk of bias. Other studies found no significant differences, and none reported reoperation rates. Study heterogeneity prevented meta-analysis. Overall risk of bias and evidence quality were moderate.

Conclusions

There is insufficient evidence to determine whether visual guidance reduces symptom recurrence following adenoidectomy. Further high-quality RCTs are needed to provide more sound conclusions.

PROSPERO registration number

CRD42024513408.

Comparison of classical, coblation, and combined adenoidectomy techniques in paediatric patients: a single-blind, prospective study

BACKGROUND AND OBJECTIVES

Adenoidectomy is one of the most commonly performed surgeries in pediatric otolaryngological practice. This prospective study compared three different adenoidectomy techniques' intra-operative and postoperative outcomes in pediatric patients. The techniques evaluated were classical (blind curettage), coblation, and a combined approach.

MATERIALS AND METHODS

Ninety pediatric patients undergoing adenoidectomy were enrolled in the study. The patients were divided into three groups based on the technique used: Group A, classical adenoidectomy (blind curettage); Group B, coblation adenoidectomy and Group C, combined (blind curettage + coblation) adenoidectomy. The intra-operative time, degree of bleeding, and complications during and after the operations were recorded.

RESULTS

Group A had a significantly shorter operative time than the other groups. However, there was no significant difference in the mean operative time between Groups B and C. The mean amount of intra-operative bleeding differed significantly among the groups. Group B had significantly less bleeding than Group A or Group C. The amount of bleeding also differed significantly between Groups A and C. The postoperative pain scores did not differ significantly among the groups. While complications were infrequent in all groups, Group C did not exhibit a higher complication rate than Groups A and B. The absence of residual or recurrent adenoid tissue in any of the groups during long-term follow-up examinations highlights the effectiveness of all three adenoidectomy techniques in preventing adenoid regrowth.

CONCLUSIONS

The combined approach, which was one of the techniques studied, demonstrated an intermediate profile in terms of operative time and intra-operative bleeding compared to the classical and coblation techniques. These findings suggest that this combined approach may be a feasible option for adenoidectomy in pediatric patients, considering its similar low incidence of postoperative complications.

Adenoidectomy: Anatomical Versus Clinical Success

Endoscopic adenoidectomy with powered instruments,a challenge in resource-constraint developing countries, has been on the rise. To evaluate conventional curettage as compared to endoscopic assisted adenoidectomy in the successful management of adenoid enlargement. A randomized controlled double-blinded study among children undergoing adenoidectomywas done. Primary outcomes were assessed by pre- and postoperative evaluation with a symptoms questionnaire and fiberoptic nasal endoscopy. There were 71 children aged 3-15 years, majority having grade III adenoids. Conventional adenoidectomy was done by the surgeon who was blinded to preoperative adenoid status. Patients were randomized to two groups, 35in conventional curettage where no further on-table intervention was done. Check endoscopyof the remaining 36 patients, formingthe second group, revealed residual grade III adenoidsin 5.6%. They underwentcompletion adenoidectomyendoscopically. By the 12th postoperative week, nasal endoscopy noted that 39.3% had grade I/II and 8.8% had grade I in the conventional and endoscopic groups respectively. Thoughstatistically significant, all pre-op symptoms settled except sleep-related ones which persisted in both groups (25% versus 14.7) with no complications in either group. Relief of all symptoms other than sleep-related ones, was achieved despite residual adenoids being up to grade II in both conventional and endoscopic group. This suggests non-obstructive causes in a subset of these patients. Conventional adenoid curettage is comparable to endoscopic adenoidectomy by cold method among children aged three and above. Complete adenoidclearance for achieving 'anatomical success' appears not to be necessary for 'clinical success'.

Comparison Between Different Approaches Applied in Pediatric Adenoidectomy: A Network Meta-Analysis

OBJECTIVE

Adenoidectomy is a surgical procedure most frequently performed by otolaryngologists. However, there are no universally accepted guidelines for the choice of the surgical approach in specific circumstances. Therefore, a network meta-analysis (NMA) is needed to summarize existing studies and provide more evidence-based medical guidelines.

METHODS

A systematic search of the literature was conducted in the Cochrane Central Register of Controlled Trials, PubMed, and EMBASE databases from inception to 31 July 2021. A network meta-analysis of operating time, intraoperative blood loss, postoperative pain score, and incidence of postoperative residual tissue was performed.

RESULTS

A total of 20 studies with 2329 patients were included. Four common surgical approaches, including powered vacuum shaver adenoidectomy (PVSA), plasma field ablation adenoidectomy (PFAA), curettage adenoidectomy (CUA), and suction diathermy adenoidectomy (SDA), were compared for operative time, intraoperative blood loss, postoperative pain score, and incidence of postoperative residual tissue. There were no significant differences between the surgical techniques for the 3 endpoints, operative time, intraoperative blood loss, and incidence of postoperative residual tissue. The data showed lower postoperative pain scores for PFAA than for CUA (MD = -3.45, 95% CI [-6.01, -0.95]). There were no significant differences in other surgical approaches for postoperative pain scores.

CONCLUSION

There were no significant differences between PVSA, PFAA, CUA, and SDA for operative time, intraoperative blood loss, and incidence of postoperative residual tissue. PFAA had advantages over CUA for postoperative pain scores.

Endoscopic Adenoidectomy Replacing the Outdated Curette Adenoidectomy: Comparison of the Two Methods at a Tertiary Care Centre

To compare intraoperative and postoperative parameters of the two techniques of adenoidectomy, endoscope and microdebrider powered adenoidectomy and conventional adenoidectomy. Study Design Prospective study. Setting: Academic tertiary referral centre. In our study, cases of adenoid hypertrophy were randomly selected from the outpatient department of department of ORL & HNS. Out of these patients, 30 underwent Endoscopic adenoidectomy (EA) (Group A) and 30 underwent Conventional adenoidectomy (CA) (Group B). All of the patients were assessed pre-operatively, intra-operatively and post-operatively to compare the various parameters. The most common complaint in both the groups was mouth breathing with snoring. Intra-operative bleeding was 29.15 ml in group EA and 15.2 ml in group CA. Operative time for CA was shorter at 21.8 min as compared to 32.1 min for group EA. Residual adenoids and injury to adjacent structures were more common in group CA. Hospital stay was 3.2 days for EA patients and 3.43 days for CA patients. Resolution of symptoms was near comparable in both groups. Operative time and intra-operative bleeding are both significantly reduced with the CA as opposed to EA. However, injury to adjacent structures and residual adenoids occur significantly less in group EA. After weighing the risks and benefits, we can conclude that EA is comparatively better than CA.

Modern Approaches to the Management of Children with Mucopolysaccharidosis Type I

This article presents modern data on epidemiology, etiology, and clinical manifestations of mucopolysaccharidosis (MPS) type I in children. MPS develops due to deficiency of particular lysosomal enzyme which determines the disease type. The article considers in details disease's pathogenesis and classification. Evidence-based approaches to diagnosis (differential diagnosis included) are covered, moreover, special attention is paid to pathogenetic, symptomatic, and surgical treatment of MPS.

Comparative Study Between Conventional Curettage Adenoidectomy Versus Endoscopic Microdebrider Assisted Adenoidectomy: Our Experience

Adenoidectomy is one of the commonest surgical procedures performed by otolaryngologists however; its recurrence rates are very high. Our objective in this study was to compare safety and efficacy between conventional curettage and endoscopic assisted microdebrider adenoidectomy. This was a prospective comparative parallel randomized control trial conducted at a tertiary care hospital from April 2017 to December 2018. We divided patients (N = 42) into two groups i.e. conventional adenoidectomy (group A) (n1 = 21) and endoscopic microdebrider assisted adenoidectomy (group B) (n1 = 21) groups using the lottery method of randomization. Among 42 patients, 33 (79%) were male and 9 (21%) were female. The average operative time in group A was 16.15 min and in group B was 22.9 min with p value < 0.05. Average blood loss in group A was 35.57 ml and in group B was 37.14 ml. In group A, 1 (4.76%) of 21 patients developed temporary velopharyngeal insufficiency which was relieved after 4 weeks of surgery whereas in group B, 5 (23.8%) patients developed nasal bleed and 2 (9.52%) patients presented with nasal synechiae on follow-up. Eight (38%) patients in group A showed grade I adenoids after 3 weeks of surgery while group B showed complete clearance in all patients (p < 0.05). Conventional adenoidectomy has less intra-operative blood loss and shorter surgical time duration as compared to endoscopic assisted microdebrider adenoidectomy but with higher chances of residual adenoid tissue.

Pediatric Adenoidectomy: A Comparative Study Between Cold Curettage and Coblation Technique

The objective of the study was to assess endoscopic coblation adenoidectomy and conventional cold curettage adenoidectomy in terms of safety and efficacy in pediatric patients. Study included 40 pediatric patients, aged between 4-17 years. 20 patients underwent cold curettage adenoidectomy and 20 underwent Coblation adenoidectomy. The 2 procedures were compared on various parameters like duration of surgery, intra-operative blood loss, and post -operative pain. To further the comparison, follow -up Nasal Endoscopy was done after 1 week and after 1 month to assess for injury to peripheral tissues and completeness of removal of adenoids. There was statistically significant difference, favouring Coblation adenoidectomy in terms of lesser intra-operative blood loss (mean blood loss of 19 mL Vs 28.5 mL) and lesser post -operative pain measured on Visual Analogue Scale (median VAS score of 2 Vs 2.67). Shorter duration of surgery (mean operative time of 10.3 min Vs 15.5 min) was the only parameter in favour of conventional cold curettage method. Injury to peripheral tissue and residual adenoid were seen in patients who underwent curettage adenoidectomy. The overall advantages of Coblation adenoidectomy when compared with cold curettage adenoidectomy are less intra-operative bleeding, less post -operative pain, completeness and preciseness of adenoid removal with minimal injury to adjacent tissues. For these reasons, Coblation adenoidectomy should be the standard technique adopted for adenoidectomy.

ANATOMICAL RATIONALE FOR CHOOSING A BLADE FOR POWER-ASSISTED ADENOIDECTOMY IN CHILDREN DEPENDING ON DENTITION

OBJECTIVE

The aim: To study the anatomic features of the facial skull structures in children of various ages depending on dentition.

PATIENTS AND METHODS

Materials and methods: One hundred and forty-four children aged 2-12 years were divided into 4 groups depending on dentition. They underwent anthropometric measure¬ments during adenoidectomy. Based on the cosine theorem, the calculated values were obtained.

RESULTS

Results: The distance from choana to the free edge of the retracted soft palate gradually increases from 2.01±0.61 cm in children with stable primary dentition up to 3.09±1.02 cm with mixed dentition. Palato-nasopharyngeal angle in children with stable primary dentition is 126.25±8.76°, in children with aging primary dentition - 132.81±12.21°, and in children with mixed dentition - 120.54±13.72°.

CONCLUSION

Conclusions: The optimal configuration of the blade for power-assisted adenoidectomy in children with stable primary dentition has an angle of 53.53±8.76°, and the length of the working part of 2.01±0.61 cm, in children with aging primary dentition - 47.18±12.21° and 2.10±0.71 cm, with mixed dentition - 59.45±13.72° and 3.09±1.02 cm, respectively.

Evaluation of endoscopic assisted suction coagulation adenoidectomy versus traditional curettage technique

Background

Adenoidal hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. The curettage adenoidectomy has some disadvantages, especially the intranasal extension of the adenoid tissue that makes this technique inadequate. This study is conducted to evaluate and compare between assisted suction coagulation adenoidectomy and traditional curettage techniques.

Results

One hundred twenty-two patients with symptomatic adenoid hypertrophy such as nasal obstruction, snoring, and mouth breathing were included in our study. Patients underwent adenoidectomy either traditional curettage adenoidectomy (60 patients as group A) or endoscopic assisted suction coagulation adenoidectomy (62 patients as group B). Patients were scheduled for follow-up visits with respect to operative time, operative and postoperative complications. The mean age of groups A and B were 6.57+2.8 and 7+2.8 ranging from 3 to12 years. There was a statistically significant difference between groups as regard intraoperative blood loss, trauma, postoperative complications as neck stiffness and bad odor plus postoperative endoscopic and radiological grading after the operation.

Conclusions

Suction coagulation diathermy adenoidectomy is alternative to cold adenoidectomy with significantly fewer intraoperative complications such as blood loss and trauma of prevertebral muscle plus post-operative complications such as primary or secondary bleeding and rhinolalia aperta.

The benefits of endoscopic look after curettage adenoidectomy

Background

Conventional curettage adenoidectomy (CCA) has a risk of incomplete removal of all adenoid tissue, and digital nasopharyngeal palpation is not enough to assess adenoid removal. The aim of this study was to evaluate the benefits of trans-oral endoscopic look of the nasopharynx (ELN) after CCA.

Results

This prospective study included 1900 children with adenoid hypertrophy. CCA was used for treatment, followed by ELN. Bleeding points and/or adenoid tissue remnants were recorded and managed. One year postoperatively, nasal endoscopy was performed to detect adenoid regrowth. ELN showed bleeding points in 17 patients (0.9%) and residual adenoid tissue remnants in 855 patients (45%). Intraoperatively, the lesions were cauterized and ablated under visualization. However, adenoid regrowths were detected in 263 (42%) out of 627 children (33%) who were subjected to endoscopic examination after 1 year of adenoid removal.

Conclusions

Trans-oral endoscopic look of the nasopharynx after CCA is a beneficial method in detection of adenoid remnants and bleeding points. Also, it could decrease symptomatic adenoid regrowth postoperatively.

Endoscopic adenoidectomy: a systematic analysis of outcomes and complications in 1006 patients

Adenoid hypertrophy (AH) is an extremely common condition in the paediatric population, relating to different pathological scenarios. Failure in responding to medical therapy often leads to adenoidectomy. While traditional adenoidectomy is indeed a relatively “blind” procedure, endoscopic procedures allow more radical resections, bleeding monitoring and complete Eustachian tube sparing, making adenoidectomy a safer, more manageable and functional procedure. Though the literature widely describes endoscopic adenoidectomy, only small case series are available and the procedure itself has never really taken hold in routine otolaryngology practice. The aim of this article is to report data on endoscopic adenoidectomy in a large single centre patient population. We retrospectively evaluated the medical records of 1006 children who underwent endoscopic adenoidectomy with or without tonsillectomy (respectively 493 and 513 patients). Data on surgical time, blood loss, hospital stay, short and long-term complications, recurrences and post-operative pain were collected. Our analysis showed that the endoscopic approach requires a longer surgical time, but it is associated with less intraoperative blood loss, a lower complication rate and less treatment failures compared to large contemporary case series of either traditional or power-assisted approaches. The overall better outcomes are more noticeable when comparing our data with classic technique case series than with power-assisted case series. Endoscopic adenoidectomy should therefore be regarded as a valid technique, which, in expert hands, lowers the rates of complications and recurrences at the expense of a slightly increased surgical time.

Partial Adenoidectomy in Patients With Palatal Abnormalities

BACKGROUND

Velopharyngeal insufficiency is a feared complication of adenoidectomies in patients with palatal abnormalities. Thus, the benefits of adenoidectomy in this population are less understood. The techniques of partial adenoidectomy aim to preserve velopharyngeal closure while sufficiently debulking the nasal airway to ameliorate obstruction and snoring.

METHODOLOGY

Systematic review of online databases using a combination of search terms including "cleft palate," "submucosal cleft palate," "short palate," "adenoidectomy," "partial adenoidectomy," "subtotal adenoidectomy," and "powered adenoidectomy." Two independent reviewers assessed the eligibility of each study based on predefined inclusion criteria.

RESULTS

From 323 studies identified, 8 were included. All were retrospective case series, except 1 prospective study. Study period ranged from 1.1 to 14 years (median 7.5 years). There were 172 patients with a cleft palate (n = 80), submucous cleft palate (n = 67) or another defined palatal abnormality [short soft palate (n = 14), bifid uvula (n = 4), questionable palatal mobility (n = 4) or incomplete CP (n = 3)] identified. Mean age was 5.5 years and just over half were male (58%). Nearly all patients showed improvement in nasal airway obstruction and snoring. The pooled risk for velopharyngeal insufficiency across all studies was 2 out of 122, which approximates to 1.6% of patients. There were very few complications.

CONCLUSION

This is the first systematic review of partial adenoidectomy in patients with palatal abnormalities. Sub-total adenoidectomy in patients with submucosal cleft palate or repaired cleft palate appears to be a safe and efficacious procedure. There is; however, a need for prospective data collection using a standardized technique in large patient series required to properly assess outcomes.

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

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.

Summary

Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.