Adenoidectomy is Not Indicated for Mouth Breathing Alone
Adenoidectomy should not be performed for mouth breathing alone without additional symptoms or conditions. 1, 2
Appropriate Indications for Adenoidectomy
Adenoidectomy is indicated for specific conditions where there is clear evidence of benefit:
- Obstructive Sleep Apnea (OSA): Adenoidectomy is recommended for children with OSA who have adenotonsillar hypertrophy and no contraindications to surgery 1
- Recurrent Otitis Media: Adenoidectomy is recommended as an adjunct to tympanostomy tube insertion in children with recurrent acute otitis media who have middle ear effusion 2
- Repeat Surgical Management: When a child needs repeat surgery for otitis media with effusion, adenoidectomy is recommended as it reduces the need for future operations by 50% 2
- Chronic Sinusitis: Adenoidectomy is effective for medically refractory pediatric chronic rhinosinusitis, with approximately 69.3% of patients showing significant improvement 3
Age Considerations
- The benefit of adenoidectomy is greatest for children aged 3 years or older and is independent of adenoid size 2
- For children under 4 years old, adenoidectomy is not recommended for a primary indication of otitis media unless a distinct indication exists such as nasal obstruction or chronic adenoiditis 4
Contraindications and Cautions
- Adenoidectomy should not be performed in children with overt or submucous cleft palate due to risk of velopharyngeal insufficiency 2
- Potential complications include hemorrhage, transient velopharyngeal insufficiency, and in rare cases, more serious complications 2, 5
Relationship Between Adenoid Hypertrophy and Symptoms
- Laterally hypertrophic adenoid tissue encroaching upon the Eustachian tube orifice has been strongly correlated with otitis media with effusion requiring pressure equalization tubes 6
- While adenoid hypertrophy can cause nasal obstruction leading to mouth breathing, mouth breathing alone is not considered a sufficient indication for surgical intervention 1
- Recent clinical studies recommend a trial of intranasal corticosteroids for adenoidal hypertrophy before surgical intervention 1
Alternative Management for Mouth Breathing
For children with mouth breathing due to adenoid hypertrophy without other symptoms:
- Medical Management: Trial of intranasal corticosteroids is recommended before considering surgical intervention 1
- Address Contributing Factors: Manage factors that cause edema of the nasopharyngeal mucosa, including prevention of viral infections, allergen avoidance for allergic children, and elimination of indoor air pollution such as passive smoke 7
- Monitoring: Regular follow-up to assess for development of more significant symptoms that might warrant intervention 4
When to Consider Surgery for Nasal Obstruction
Surgery should be considered for nasal obstruction only when:
- It is associated with sleep-disordered breathing or obstructive sleep apnea 1, 8
- It occurs with chronic adenoiditis or recurrent infections 1, 4
- It is accompanied by chronic sinusitis 1, 3
- Medical management has failed and the obstruction significantly impacts quality of life 8
Mouth breathing as an isolated symptom without these associated conditions is not a sufficient indication for adenoidectomy.