From the Guidelines
Adenoids should not be removed twice as a standard practice, but in rare cases, a second removal may be necessary if significant symptoms persist due to adenoid regrowth. The decision to remove adenoids twice should be made on a case-by-case basis, considering the individual patient's symptoms and medical history. According to the most recent study 1, adenoidectomy is not recommended for initial otitis media with effusion (OME) surgery unless a distinct indication exists, such as adenoiditis, postnasal obstruction, or chronic sinusitis.
When considering a second adenoidectomy, it is essential to weigh the benefits against the surgical risks, including velopharyngeal insufficiency, refractory bleeding, and Grisel’s syndrome, as noted in the study 1. The study also highlights that adjuvant adenoidectomy may be offered to patients older than 4 years if the indication is for otitis media or for children of any age when there are symptoms directly related to the adenoids.
In terms of morbidity, mortality, and quality of life, the study 1 suggests that adenoidectomy can reduce the prevalence of middle ear effusion and achieve hearing outcomes comparable to tube insertion alone, but it also notes that the benefit of adenoidectomy on otitis media is unrelated to adenoid size. The study 1 also supports the idea that adenoidectomy should not be performed unless a distinct indication exists, and that tympanostomy tube insertion is the preferred initial procedure for OME.
Key points to consider when deciding on a second adenoidectomy include:
- The patient's age and medical history
- The presence of significant symptoms, such as chronic nasal obstruction, recurrent ear infections, or sleep apnea
- The results of a nasal endoscopy to confirm adenoid regrowth and rule out other causes of symptoms
- The potential risks and benefits of the procedure, as noted in the studies 1.
Ultimately, the decision to remove adenoids twice should be made in consultation with a healthcare professional, taking into account the individual patient's needs and circumstances. The primary goal should be to improve the patient's quality of life while minimizing the risks of morbidity and mortality.
From the Research
Adenoid Removal
- The decision to remove adenoids is typically made based on the presence of certain symptoms or conditions, such as recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome 2.
- Adenoidectomy is a common pediatric surgical procedure, but it is not without risks and may cause emotional distress for the patient and their family 2.
- Non-surgical treatments, such as intranasal steroids, are also available for the treatment of adenoid hypertrophy and may be effective in reducing symptoms and adenoid size 3, 4.
Recurrence of Adenoids
- Some studies suggest that adenoid regrowth is not rare, but clinically significant adenoid regrowth is infrequent 5.
- Persistent or recurrent symptoms after adenoidectomy are often attributable to other nasal pathologies rather than adenoid regrowth 5.
- There is no clear evidence to suggest that adenoids should be removed twice, and the decision to perform a second adenoidectomy should be made on a case-by-case basis.
Treatment Options
- Topical nasal steroids have been shown to be effective in reducing adenoid hypertrophy and eliminating obstructive symptoms, and may be a useful alternative to surgery in some cases 4.
- Adenoidectomy may be necessary in cases where symptoms are severe or persistent, and other treatment options have been unsuccessful 2, 3.
- The choice of treatment should be based on the individual patient's needs and circumstances, and should take into account the potential risks and benefits of each option 2, 3, 4.