Head and Neck Surgery: Meeting the Needs of the 21st Century

Laryngoscope Highlights

Which Children Will Require Endoscopic Surgery Following Adenoidectomy?

Indications for surgery for chronic rhinosinusitis (CRS) in children lack consensus, and no scientific guidelines are available. Most experts agree that adenoidectomy should be considered for children with CRS who do not respond to medical management, as adenoidectomy improves major symptoms in about three-quarters of all patients. Jeremy Tiu, MD, and Hassan H. Ramadan, MD, MSc, performed a study to determine which children who are treated with adenoidectomy for CRS will ultimately require endoscopic sinus surgery (ESS) and to estimate the length of time between adenoidectomy and ESS.

The researchers employed a retrospective chart review of prospectively collected data in a tertiary pediatric otolaryngology service, looking at children who underwent adenoidectomy for CRS over a 10-year period after failing medical management.

Half the children failed the procedure and required ESS, according to this review. The mean time from adenoidectomy to ESS was 23.7 months; children with asthma had a mean failure time of 19 months, compared with a mean failure time of 28 months for children without asthma. Furthermore, children who failed within 24 months had a mean age of 6 years, compared with a mean age of 8 years for children who failed after 24 months.

The authors point out that the relationship between adenoid hypertrophy and sinusitis is unclear; however, if the adenoids were large and there was stasis of secretions, symptoms of sinusitis could be mimicked. These secretions could also cause inflammation of the sinuses with blockage of the ostia, causing sinusitis. The consensus is that an adenoidectomy should be the first surgical procedure performed on children with CRS, and that this will be effective in about half of all patients. A significant number of the remaining 50% of children will require ESS. Results of this study indicate that this will occur at an average of 24 months after adenoidectomy with children who have asthma and are less than 7 years of age; children who are older than 7 years or who do not have asthma will have a longer period before requiring ESS.

(Laryngoscope 2007;117:1080-3)

©2007 The Triological Society