A Case-Control Study of Repeated Adenoidectomy in Children

Duval, Mélanie; Chung, Justin; Vaccani, Jean‐Philippe

doi:10.1001/jamaoto.2013.1060

Cited by 31 publications

(28 citation statements)

References 14 publications

(26 reference statements)

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“…36 Repeat adenoidectomy is sometimes required for persistent or recurrent symptoms, with the likelihood of repeat adenoidectomy being 2.5 times higher in children under 5 years of age at the time of the first surgery and also higher in those whose first surgery was adenoidectomy alone. 37 Adenoidectomy was the treatment option for 17% (4/23; 3 with PS and 1 MS OSA) of the children who were treated in our study; however, SDB remained unresolved in only one of those children (one with PS). As many children in our cohort had PS or Mild OSA, we chose to include nasal steroids in the treatment group as this is a recognized treatment for mild OSA, 38 rather than omitting these children.…”

Section: Discussionmentioning

confidence: 66%

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Walter

Biggs

Nisbet

et al. 2015

Journal of Clinical Sleep Medicine

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Study Objectives: Sleep disordered breathing (SDB) in preschool-aged children is common, but long-term outcomes have not been investigated. We aimed to compare sleep and respiratory parameters in preschool children to examine the effects of treatment or non-treatment after 3 years. Methods: Children (3-5 years) diagnosed with SDB (n = 45) and non-snoring controls (n = 30) returned for repeat overnight polysomnography (39% of original cohort), 3 years following baseline polysomnography. Children with SDB were grouped according to whether they had received treatment or not. SDB resolution was defi ned as an obstructive apnea hypopnea index (OAHI) ≤ 1 event/h, no snoring detected on polysomnography and habitual snoring not indicated by parents on questionnaire. Results: Fifty-one percent (n = 23) of the children with SDB were treated. Overall, SDB resolved in 49% (n = 22), either spontaneously (n = 8) or with treatment (n = 14). SDB remained unresolved in 39% (n = 9) of those treated and 64% (n = 14) of the children who were untreated. Two of the non-snoring controls developed SDB at follow-up. The treated group had signifi cantly lower OAHI (p < 0.01), respiratory disturbance index (p < 0.001), total arousal and respiratory arousal indices (p < 0.01 for both) at follow-up compared with baseline. There were no differences between studies for the untreated group. Conclusion: Although treatment resulted in an improvement in indices related to SDB severity, 39% had SDB 3 years following diagnosis. These fi ndings highlight that parents should be made aware of the possibility that SDB may persist or recur several years after treatment. This is relevant regardless of the severity of SDB at baseline and the treatment given.

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Section: Discussionmentioning

confidence: 66%

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Walter

Biggs

Nisbet

et al. 2015

Journal of Clinical Sleep Medicine

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“…One of the main purposes of this study was to clarify the revision rate of pediatric adenoidectomy, and our results re-total, 44 potentially pertinent studies were identified. Finally, 16 studies were included in the quantitative analyses ( Table 2) (29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44) . Table 2 shows the basic characteristics of the included studies.…”

Section: Discussionmentioning

confidence: 99%

Revision adenoidectomy in children: a meta-analysis

Lee¹,

Hsu

et al. 2019

Rhin

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Background:To estimate the rate of revision surgery after previous adenoidectomy in children and to compare the rate of revision adenoidectomy in children with different conditions and by using different surgical techniques. Methodology:The study protocol was registered on PROSPERO (CRD42018107877). Two authors independently searched databases, specifically PubMed, MEDLINE, EMBASE, and the Cochrane Review database. The keywords used were "adenoids, " "adenoidectomy, " "reoperation, " "revision, " and "regrowth. " The revision rate was pooled using a random-effect model. Subgroup analyses were conducted for children based on different settings, countries, risks of bias, and surgical techniques. Results:A total 16 studies with 95 727 children were analyzed (mean age: 4.69 (1.62) years; 60% boys; sample size: 5983 patients).Five studies had a low risk of bias, 10 studies had a moderate risk of bias, and one study had a high risk of bias. The rate of revision adenoidectomy was 1.9%. Ages at initial surgery and follow-up were not significantly associated with revision surgeries. The revision rate was not significantly different in children receiving surgeries in different settings (single center vs multicenter vs population-based, country (non-United States vs United States, and risk of bias. Moreover, surgical techniques, such as curettage, suction cautery, microdebridement, and coblation did not significantly affect revision rates in children who received adenoidectomy. Conclusions:Revision surgery was undertaken with a frequency of 1.9% in children who underwent adenoidectomy. A lack of strong evidence exists to correlate surgical techniques with revision rate in pediatric adenoidectomy.

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“…Regrowth of adenoid tissue is also a potential concern following adenoidectomy. In a large study of over 10,000 adenoidectomies, it was found that the rate of revision adenoidectomy was 1.5%, and children under 5 years of age were 2.5 times more likely to have a second adenoidectomy [41]. Another study reported a revision adenoidectomy rate of 9%, with a median re-operation time of 16 months following initial procedure [5].…”

Section: Adenoid Regrowth and Revision Adenoidectomymentioning

confidence: 99%

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

Schüpper

Nation

Pransky

2018

Curr Otorhinolaryngol Rep

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Purpose of Review Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions. Recent Findings Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscopeassisted removal of the adenoids has proven to be a safe technique, with good short-and long-term outcomes. Novel nonsurgical therapies including immunotherapy have been evaluated. Summary Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.

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A Case-Control Study of Repeated Adenoidectomy in Children

Cited by 31 publications

References 14 publications

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Long-Term Improvements in Sleep and Respiratory Parameters in Preschool Children Following Treatment of Sleep Disordered Breathing

Revision adenoidectomy in children: a meta-analysis

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

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