From the Guidelines
Adenoid regrowth after adenoidectomy is a relatively uncommon occurrence, happening in about 10-20% of cases, and its management should prioritize watchful waiting and symptom management over revision surgery, unless significant regrowth causes persistent symptoms 1.
Adenoid Regrowth Overview
Adenoid regrowth can occur after adenoidectomy, and its incidence is more common in younger children under 5 years due to the natural growth pattern of adenoid tissue until ages 5-7, after which it gradually shrinks. The immune function of adenoids is largely compensated by other lymphatic tissues, so removal or regrowth typically does not compromise overall immunity.
Diagnosis and Treatment
Diagnosis of adenoid regrowth requires evaluation by an otolaryngologist (ENT) who will perform a nasal endoscopy or nasopharyngoscopy to visualize any regrown tissue. Treatment depends on symptom severity and may include:
- Watchful waiting with nasal saline irrigation for mild cases.
- Intranasal steroids like fluticasone (1-2 sprays per nostril daily) for mild to moderate cases.
- Revision adenoidectomy may be necessary for significant regrowth causing persistent symptoms.
Considerations
The decision to perform adenoidectomy, especially in the context of otitis media with effusion (OME), should be based on the presence of distinct indications such as nasal obstruction, chronic adenoiditis, or recurrent ear infections, as the benefits of adenoidectomy in reducing the need for future operations and improving hearing outcomes are well-documented, particularly in children aged 4 years or older 1. However, the risks associated with adenoidectomy, including velopharyngeal insufficiency, refractory bleeding, and Grisel’s syndrome, must be carefully weighed against its potential benefits.
Management Approach
Given the potential risks and benefits, the management of adenoid regrowth should prioritize a conservative approach, focusing on symptom management and watchful waiting, reserving revision adenoidectomy for cases with significant regrowth and persistent symptoms 1. Regular follow-up with an ENT specialist is crucial to monitor for regrowth and manage symptoms appropriately, ensuring the best possible outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Adenoid Regrowth
- Adenoid regrowth is a possible outcome after adenoidectomy, although clinically significant regrowth is infrequent 2
- A study found that 74%-87% of parents reported improvement in symptoms such as nasal obstruction, snoring, and obstructive sleep disorder 3-5 years after adenoidectomy, while some patients experienced adenoid regrowth 2
- The use of intranasal corticosteroids has been shown to reduce adenoid size and improve symptoms in patients with adenoidal hypertrophy, which may help prevent regrowth 3, 4, 5
- However, the effectiveness of intranasal corticosteroids may vary depending on the presence of allergic rhinitis, with one study finding that treatment was more successful in reducing adenoid size in patients without allergic rhinitis 5
Factors Influencing Adenoid Regrowth
- Anatomic nasal abnormalities and significant adenoid enlargement were found to be associated with persistent symptoms and adenoid regrowth after adenoidectomy 2
- The presence of allergic rhinitis may also impact the effectiveness of treatment and the likelihood of adenoid regrowth 5
Treatment Options
- Adenoidectomy is a common treatment for adenoidal hypertrophy, but it may not always be necessary, and non-surgical interventions such as intranasal corticosteroids may be effective in reducing symptoms and preventing regrowth 6, 3, 4
- Intranasal corticosteroids have been shown to reduce adenoid size and improve symptoms in patients with adenoidal hypertrophy, and may be a useful treatment option for preventing regrowth 3, 4, 5