From the Guidelines
Adenoidectomy in children is primarily indicated for persistent nasal obstruction, recurrent or chronic sinusitis, and recurrent otitis media with effusion that has not responded to medical management, as well as sleep-disordered breathing, including obstructive sleep apnea 1. The procedure is typically considered when a child has experienced at least 3-4 episodes of otitis media within 6 months, or chronic otitis media with effusion lasting more than 3 months with associated hearing loss. Key indications for adenoidectomy include:
- Persistent nasal obstruction
- Recurrent or chronic sinusitis
- Recurrent otitis media with effusion
- Sleep-disordered breathing, including obstructive sleep apnea
- Chronic rhinorrhea, persistent halitosis, or as part of management for recurrent streptococcal pharyngitis The timing of surgery generally depends on symptom severity rather than age alone, though most procedures are performed between ages 3-7 years, as supported by the most recent study 1. The rationale behind adenoidectomy is that enlarged adenoid tissue can obstruct the nasopharynx and eustachian tube openings, contributing to recurrent infections and breathing difficulties, as noted in the clinical practice guideline 1. Preoperative evaluation should include a thorough history, physical examination, and sometimes nasal endoscopy or lateral neck radiographs to assess adenoid size. Postoperatively, children typically experience mild throat pain for 7-10 days, and should avoid strenuous activity for about 2 weeks to prevent bleeding complications. It is essential to consider the potential benefits and risks of adenoidectomy, including the reduction in the need for future operations, as highlighted in the study 1. In summary, adenoidectomy is a recommended procedure for children with specific indications, and its benefits outweigh the risks, particularly when considering the reduction in morbidity, mortality, and improvement in quality of life 1.
From the Research
Indications for Pediatric Adenoidectomy
The indications for pediatric adenoidectomy include:
- Sleep-disordered breathing 2
- Nasal airway obstruction 2, 3
- Recurrent acute otitis media 2, 3
- Chronic rhinosinusitis 2, 3
- Obstructive sleep apnea (OSA) 2, 4, 5
Specific Considerations
- Adenoidectomy is not recommended as a primary indication for otitis media in children under 4 years old, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis 2
- Adenoidectomy alone may be a reasonable option for non-obese children with moderate OSA and small tonsils 4, 5
- The procedure can be performed with or without tonsillectomy, and the choice of procedure depends on the individual child's condition and needs 6
Benefits and Outcomes
- Adenoidectomy can lead to excellent outcomes and improve the quality of life of children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis 2
- The procedure is safe and has a low risk of adverse events and hospitalization 2
- Adenoidectomy can provide significant improvement in quality of life for children with obstructive sleep apnea 4