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.

A Comparative Study of Endoscopic Coblation Adenoidectomy and Regular Curettage Adenoidectomy in a Tertiary Care Hospital in Kerala

BACKGROUND An ideal surgery to remove hypertrophied adenoid mass should be safe, with less bleeding and operation time along with post-operative improvement in the eustachian tubal ventilation and normal respiration. It should also have low morbidity and mortality. Among the various methods described for its removal, the two commonly used methods are conventional cold curettage method and coblation technique. The purpose of this study was to collate the safety and efficacy of endoscopic coblation adenoidectomy with the conventional curettage adenoidectomy. METHODS A prospective comparative study with fifty patients was studied who underwent adenoidectomy. Twenty five patients underwent endoscopy assisted coblation adenoidectomy and twenty five patients underwent regular adenoidectomy by curettage. RESULTS Patients who underwent coblation adenoidectomy showed better results during follow up in terms of completeness of removal. 80 % of children undergoing regular adenoidectomy by curettage method showed remnant adenoid tissue in the nasopharynx at the end of the procedure. But it was 6 % among the children undergoing endoscopic assisted coblation adenoidectomy. The mean duration of operation was higher for endoscopic assisted coblation adenoidectomy which was significant statistically. The mean blood loss was 30.36 ml in regular curettage adenoidectomy; 10.6 ml with endoscopic coblation adenoidectomy. The grading of pain was significantly lower in endoscopic assisted coblation adenoidectomy. There was no significant difference between two groups in terms of eustachian tube function after surgery. CONCLUSIONS Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of completeness of removal, reduced blood loss, and lower post-operative pain grade. KEYWORDS Coblation, Adenoidectomy, Curettage, Haemorrhage and Complications

Adenoid Hypertrophy with Deviated Nasal Septum in Young Adults

Adenoid hypertrophy is a common cause of nasal obstruction in children but relatively uncommon in adults, however adenoid hypertrophy in young adults is thought to be a persistence of untreated adenoid hypertrophy of childhood. This case series also notes that adenoid hypertrophy can be associated with deviated nasal septum. Coblation assisted endoscopic adenoidectomy usually has good result in adenoid clearance. Hence, routine endoscopic examination of nasopharynx helps in early diagnosis of adenoid hypertrophy and subsequent better management in young adults with complaints of nasal blockage. Nasopharyngeal vegetations were earlier described by Wilhelm Meyer in 1870 as forming part of Waldeyer’s ring of lymphoid tissue and he coined the term ‘adenoid’ to describe the same. In younger children, it has been thought that the adenoids may have an important role in development of an immunological memory. Physiologically it has been considered that hypertrophy of adenoid tissue occurs during 6 - 10 years and tend to regress and atrophy at 16 years. Grading of adenoid hypertrophy as described by Clemens et al. is as follows.1  Grade I: adenoid tissue filling 1/3rd. of the vertical height of choana.  Grade II: adenoid tissue filling up to 2/3rd of the vertical height of choana.  Grade III: from 2/3rd to nearly all but not completely filling the choana.  Grade IV: complete choanal obstruction We present three cases of adenoid hypertrophy with deviated nasal septums in adults who visited ENT outpatient department (OPD) at National Institute of Medical Sciences, Jaipur during COVID era of January 2021 to April 2021.

Novel Classification System Of Adenoids Based On Appearance And Its Relationship With Drug Therapy

Objective: To investigate the appropriate drug therapy based on a novel classification system for adenoids based on their appearance. Methods: We used fiberoptic nasal endoscopy to determine the degree and appearance of adenoid hypertrophy (AH). The adenoids were divided into three types: edematous type, common type, and fibrous type. In adenoid tissues, the eosinophils were counted. Immunohistochemistry and western blot were done to determine the expression of CysLTR1, CysLTR2, CGR-α, and CGR-β in different types of adenoids. Results: 70.67% (106/150) AH patients with AR, and of them 68% (72/106) of adenoids were the edematous type. The expression of CGR-α and CGR-β and eosinophil count were higher in the edematous type but not in common and fibrous types. The expression of the leukotriene receptor was stable in all types. There was a positive correlation between eosinophil count in the blood and in the adenoid tissue. Conclusion: AR was the risk factor for the development of AH. Leukotriene receptor antagonist was an important drug for the treatment of AH. The glucocorticoid was only useful in the edematous type. Therefore, for AH patients with AR, patients with edematous type adenoids and/or patients with increased eosinophils in blood routine choose nasal glucocorticoid combined with leukotriene receptor antagonist is appropriate. On the contrary, leukotriene receptor antagonists alone can be selected to treat AH.

Comparative study between conventional adenoidectomy and adenoidectomy using micro-debrider

Background Adenoidectomy is a common ENT procedure. This article aims to evaluate micro-debrider-assisted adenoidectomy as a substitute for the conventional curettage method. Results The study aimed to compare between two study groups: micro-debrider-assisted adenoidectomy (group A) and conventional adenoidectomy (group B). The average time needed in group A was 34.1 min while it was 22.83 min in group B (p<0.001). The average amount of blood lost in group A was 29.57 ml and 16.67 ml in group B (p<0.001). The resection was nearly complete in group A, while in group B, five (16.66%) cases had more than 50% of the adenoid tissue left behind. Four cases in group B had damage to collaterals while in group A no major injuries were noted. Postoperative pain has only been studied in cases where adenoidectomy solely was done. Candidates in group A (n=8) reported a pain score of 3.5-3.09 whereas candidates in group B (n=11) reported a pain score of 2.75-2.55. The mean recovery time was 2.8 days in group A and 8.23 days in group B (p<0.001). Conclusions Endoscopic adenoidectomy using micro-debrider is both an effective and safe adenoidectomy tool. The strengths of this technique include resection completeness, precise resection under vision, minor damage to collaterals, and a more rapid recovery period. Conventional adenoidectomy, however, scored better regarding lesser operative time and bleeding intraoperatively.

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.