From the Guidelines
Eustachian tube (ET) dysfunction can persist after adenoidectomy, and a stepwise approach to management is recommended, prioritizing medical management over surgical interventions to minimize morbidity and mortality. For persistent ET dysfunction post-adenoidectomy, I recommend starting with a trial of intranasal steroids such as fluticasone propionate (1-2 sprays per nostril daily) or mometasone furoate (1-2 sprays per nostril daily) for 4-6 weeks, as supported by recent clinical practice guidelines 1. This approach can help reduce inflammation and improve ET function.
- Combine intranasal steroids with oral antihistamines like cetirizine 10mg daily or loratadine 10mg daily if allergic components are suspected, to address potential allergic contributions to ET dysfunction.
- Nasal saline irrigation twice daily can help clear secretions that may block the ET, promoting better drainage and reducing the risk of complications.
- For patients with persistent middle ear effusion, a short course of oral steroids such as prednisone (1mg/kg/day for 5-7 days, maximum 60mg) may be beneficial, as it can help reduce inflammation and promote resolution of the effusion.
- Autoinflation techniques using Valsalva maneuvers or commercial devices like Otovent can help equalize middle ear pressure, reducing the risk of further complications. If medical management fails after 3 months, consider referral for tympanometry to assess middle ear function and possible tympanostomy tube placement, as recommended by recent guidelines 1. ET dysfunction may persist after adenoidectomy because while removing adenoid tissue reduces mechanical obstruction near the ET opening, it doesn't address other causes like mucosal inflammation, anatomical variations of the ET itself, or underlying conditions like allergic rhinitis that contribute to dysfunction. The risks associated with adenoidectomy, such as velopharyngeal insufficiency, refractory bleeding, and Grisel’s syndrome, should be carefully considered and discussed with patients and their families 1.
From the Research
ET Dysfunction after Adenoidectomy
- ET dysfunction is a common issue in children with adenoid hypertrophy, and adenoidectomy is often performed to alleviate symptoms 2, 3.
- Studies have shown that adenoidectomy can improve Eustachian tube function and middle ear ventilation in children with adenoid hypertrophy and ET dysfunction 2.
- However, one study found that immediate ET dysfunction is a relatively common complication in children after adenotonsillectomy, with 76% of cases being abnormal or unresolved on postoperative day 2 4.
- The use of intranasal steroids, such as Azelastine-Fluticasone, has also been shown to be effective in reducing adenoid tissue hypertrophy and improving Eustachian tube function in children with adenoid hypertrophy and ET dysfunction 5.
- It is essential to properly plan postoperative care and management in the setting of immediate ET dysfunction after adenoidectomy 4.
Risk Factors and Complications
- Adenoid hypertrophy is a significant risk factor for ET dysfunction, and the size of the adenoids can impact the frequency of ET dysfunction 2.
- Other complications of adenoidectomy include bleeding, emotional distress, and recurrence of adenoids 6, 3.
- Histologic evaluation is indicated for clinical evidence of mucopolysaccharidoses, and preoperative bleeding questionnaire is obligatory before every pediatric surgery 6.
Treatment and Management
- Adenoidectomy is usually performed on an outpatient basis, and conventional curettage remains the established standard treatment in some countries 6.
- Non-surgical treatments, such as intranasal steroids, are also used in the treatment of adenoid hypertrophy 5, 3.
- The Eustachian Tube Score 7 (ETS-7) and tubomanometry are valid tools for assessing ET dysfunction both preoperatively and postoperatively 2.