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Table of Contents
ORIGINAL ARTICLE
Year : 2021  |  Volume : 23  |  Issue : 2  |  Page : 71-74

A comparative study of conventional curettage adenoidectomy versus endoscopic microdebrider-assisted adenoidectomy in children


1 Department of ENT, GSVM Medical College, Kanpur, Uttar Pradesh, India
2 Department of Paediatrics, GSVM Medical College, Kanpur, Uttar Pradesh, India
3 Department of Central Research Station(CRS), GSVM Medical College, Kanpur, Uttar Pradesh, India

Date of Submission12-Mar-2021
Date of Decision21-Apr-2021
Date of Acceptance07-May-2021
Date of Web Publication30-Jun-2021

Correspondence Address:
Dr. Harendra Kumar Gautam
L-17, Medical College Campus, Swaroop Nagar, Kanpur - 208 002, Uttar Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/sjoh.sjoh_15_21

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  Abstract 


Introduction: Adenoid hypertrophy or chronic adenoiditis may cause significant problems requiring adenoidectomy. Patients with chronic adenoid hypertrophy causing craniofacial morphology problems, excessive snoring, or possibly quality of life issues are candidates for adenoidectomy. The aim of this study is to compare the advantages of endoscopic-assisted microdebrider adenoidectomy in comparison with conventional curettage adenoidectomy. Materials and Methods:A prospective study of patients undergoing adenoidectomy was performed in the Department of ENT, Head and Neck Surgery at Tertiary center from January 2018 to October 2019. Results: Fifty patients of adenoid hypertrophy underwent adenoidectomy (25 patients in Group I and 25 patients in Group II). The groups were almost similar in age and sex. The mean operative time was 15 min 60 s in Group I and 12 min 56 s in Group II. The average blood loss was 31 ml in Group I and 28.60 ml in Group II. The residual adenoid tissue and complications were present in eight and three patients in Group I, respectively. Conclusion: The endoscopic-assisted adenoidectomy is minimally invasive. Intraoperative bleeding, duration of surgery, and complication were less in endoscopic-assisted adenoidectomy as comparison to conventional curettage method.

Keywords: Adenoid, adenoidectomy, curettage, endoscopic, hypertrophy


How to cite this article:
Sharma SK, Gautam HK, Kanaujia SK, Srivastava A, Saxena NS, Gautam SK, Singh S. A comparative study of conventional curettage adenoidectomy versus endoscopic microdebrider-assisted adenoidectomy in children. Saudi J Otorhinolaryngol Head Neck Surg 2021;23:71-4

How to cite this URL:
Sharma SK, Gautam HK, Kanaujia SK, Srivastava A, Saxena NS, Gautam SK, Singh S. A comparative study of conventional curettage adenoidectomy versus endoscopic microdebrider-assisted adenoidectomy in children. Saudi J Otorhinolaryngol Head Neck Surg [serial online] 2021 [cited 2021 Jul 23];23:71-4. Available from: https://www.sjohns.org/text.asp?2021/23/2/71/320326




  Introduction Top


Adenoid hypertrophy or chronic adenoiditis may cause significant problems, thus requiring adenoidectomy. Patients with chronic adenoid hypertrophy, which causes craniofacial morphology problems, excessive snoring, or possibly quality of life issues are candidates for adenoidectomy. The first adenoidectomy was performed by Wilhelm Meyer of Denmark in 1876. He constructed a ring knife and passed it through the nose to remove adenoids in a patient complaining of decreased hearing and nasal obstruction.[1] In a study, it was observed that the adenoid tissue removed during endoscopic-guided adenoidectomy was more substantial and seems to be greater in total mass compared with the classic (conventional) adenoidectomy. Therefore, the use of endoscopic-guided adenoidectomy allows a more complete removal of the adenoid and in a more precise manner compared with conventional methods.[2]

The aim of study

The aim of the study is to compare the advantages of endoscopic-assisted curettage adenoidectomy with conventional curettage adenoidectomy, to compare the blood loss and duration of surgery in each surgical procedure, and to compare the postoperative residual adenoid tissue and complications in each surgical procedure.


  Materials and Methods Top


This single center, prospective, and comparative study was conducted in Department of ENT, Head and Neck Surgery at tertiary center from January 2018 to October 2019. In this study, Fifty cases were taken, who were in the age group of 5–13 years with adenoid enlargement causing nasal obstruction, snoring, recurrent episodes of upper respiratory tract infection, obstructive sleep apnea, and otitis media with effusion. Before surgery, patients were assigned either to the conventional curettage adenoidectomy group (Group 1) or endoscopic microdebrider-assisted adenoidectomy group (Group 2), and outcome measures were intraoperative blood loss, duration of surgery, postoperative residual adenoid tissue, and complications in each surgical procedure.

The data were collected from these two groups and statistically analyzed using the Fisher Z-Test and Chi-square.


  Results Top


In our study, 50 cases were operated by either conventional method or endoscopic-assisted technique (25 cases each). The cases were grouped into Group I for conventional curettage methods and Group II for endoscopic microdebrider-assisted adenoidectomy. The mean age in Group I was 9.96 years and Group II was 9 years [Table 1]. In Group I, 44% were males and 56% were females and in Group II, 56% were males and 44% were females [Table 2]. Nasal obstruction was the single most common complaint in the patients of both groups affecting all 50 patients. It was followed by mouth breather in 48 patients and snoring in 44 patients. Twenty-eight patients had nasal discharge, 11 patients had associated throat pain, six patients had associated ear discharge but only two patients had decreased hearing between the two groups [Table 3]. Grade 3 (44%) adenoid hypertrophy was the most common followed by Grade 4 (28%) and Grade 2 (24%) in between the two groups [Table 4]. The mean operative time was 15 min 60 s in Group I and 12 min 56 s in Group II [Table 5]. The average blood loss was 31 ml in Group I and 28.60 ml in Group II [Table 6]. Complete airway patency and no remnant of adenoids were seen in all patients assessed by endoscopic evaluation in Group II while 17 in Group I. Eight patients had residual adenoid tissue in Group I in diagnostic nasal endoscopic finding [Table 7]. Endoscopic examination showed no  Eustachian tube More Details stenosis or nasopharyngeal stenosis in any of the 17 patients in Group I and 20 in Group II while three patients had Eustachian tube stenosis in Group I. Ten patients between the two groups were lost to follow-up [Table 8].
Table 1: The age distribution of the patients in both the groups

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Table 2: The sex distribution of the patients in both the groups

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Table 3: The signs and symptoms of the patients in both groups

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Table 4: The grade of adenoid hypertrophy between two groups

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Table 5: Correlation between mean duration (minute) of surgery between two groups during surgery

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Table 6: Comparison of the mean blood loss (ml) between two groups during surgery

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Table 7: The residual tissue between two groups in diagnostic nasal endoscopic

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Table 8: The diagnostic nasal endoscopic finding after 6-month follow-up

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  Discussion Top


Adenoidectomy is one of the most common procedures performed by otolaryngologists. It has been performed for more than 100 years.[1] For many years, it was performed by strictly a transoral approach with curettes, an adenoid punch, and an adenotome. One advantage in performing a more complete adenoidectomy involves decreasing the bacterial reservoir, which affects children with otitis media, nasopharyngitis, and possibly sinusitis as well. It would also be beneficial in preventing recurrent airway obstructive symptoms.[3]

In our study, 50 cases were operated by either conventional method or endoscopic-assisted technique. The cases were grouped into Group I for conventional curettage methods and Group II for endoscopic microdebrider-assisted adenoidectomy.

The patient's age ranged from 5 to 13 years with a mean age of 9.0 years for Group I and 9.96 years for Group II. In our study, 25 patients were males accounting for 50% of the total and rest 25 patients were females, accounting for the rest 50%. In Group I, 56% patients were males and 44% were females and in Group II, 44% patients were males and 56% were females.Which was the similar to the study of Jain et al. shows that the maximum number of patients were from 7 to 9 years (50%) followed by 9 to 12 years (30%) and 5 to 7 years (20%). Out of 40 patients, 60% were male and 40% were female. Males were more common in both serous otitis media (60%) and adenoid hypertrophy (57%).[4]

In our study, the most common symptoms were nasal obstruction (50), mouth breathing (48), snoring (44) followed by nasal discharge (28). In the study by Georgalas et al., the patients had mouth breathing, snoring, rhinorrhea, and cough.[5] In the study by Huang et al., patient's most common complaints were nasal obstruction, mouth breathing, and snoring during sleep.[6] Presenting symptoms of our study correlate with the previous studies as it shows similar findings.

In our study, Grade 3 adenoid hypertrophy was the most common (44%) followed by Grade 4 (28%) and Grade 2 (24%), least common grade of adenoid size was Grade 1 (4%) in Group I, while Grade 3 adenoid hypertrophy was the most common (40%) followed by Grade 2 (36%) and Grade 1 (20%), least common grade of adenoid size was Grade 4 (4%) in Group II.

Yaseen et al. (2012) 67 study revealed that according to plain X-ray of the nasopharynx, large size adenoid was seen in 74 patients (49.3%), moderate size in 51 patients (34%), and small size seen in 25 patients (16.7%). According to endoscopic assessment, the most common grade of adenoid size was Grade 3 seen in 50 patients (33.3%) and the least common grade of adenoid size was Grade 1 seen in 20 patients (13.3%).[7]

In our study, the mean operative time was 15 min 60 s in Group I (conventional curettage adenoidectomy) and 12 min 56 s in Group II (endoscopic microdebrider-assisted adenoidectomy). Average blood loss was 31 ml in Group I and 28.60 ml in Group II. Shin and Hartnick studied 3 cases in which operative time for the adenoidectomy portion of the procedure, including endoscopic equipment set up and photograph documentation, was 10–15 min.[8]

One retrospective review of complete adenoidectomy using microdebrider versus curettes showed that power-assisted adenoidectomy was 58% faster (11 min vs. 19 min) but the blood loss (22 ml vs. 32 ml), recovery time, and complications were not significantly different.[9]

A subsequent prospective randomized study showed again that operative time was much less with microdebrider (10 min 13 s vs. 12 min 14 s) and also that blood loss was less with microdebrider (17.5 ml vs. 24.0 ml, 27% less).[10]

In our study, complete airway patency and no remnant of adenoids were seen in all patients assessed by endoscopic evaluation in Group II (endoscopic microdebrider-assisted adenoidectomy) and 17 patients in Group I (conventional curettage adenoidectomy), while 8 (32%) patients had residual adenoid tissue in Group I (conventional curettage adenoidectomy). Which was similar to the study of Havas T et al. a prospective study involving endoscopic evaluation of cases operated by curette and microdebrider showing that following traditional curette adenoidectomy, 39% of patients had residual obstructive tissue which was completely cleared by powered shaver adenoidectomy later.[11] Another study by Cannon et al. found that after conventional adenoidectomy, there was always residual tissue in the posterior superior choana of the nose and nasopharynx, while endoscopic-assisted technique allows more complete removal of adenoid tissue.[12]

In our study, two patients had nasal obstruction and one patient had nasal discharge after 6 months of conventional curettage adenoidectomy, while 10 patients between two groups were lost during the follow-up.


  Conclusion Top


From this, we conclude that endoscopic-assisted adenoidectomy is minimally invasive and is not associated with excessive bleeding. Duration of surgery is less as compared to conventional curettage method. Patients who underwent endoscopic-assisted adenoidectomy have less chance of remnants and postoperative complication.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Curtin JM. The history of tonsil and adenoid surgery. Otolaryngol Clin North Am 1987:20:415-6.  Back to cited text no. 1
    
2.
Wan YM, Wong KC, Ma KH. Endoscopic-guided adenoidectomy using a classic adenoid curette: A simple way to improve adenoidectomy. Hong Kong Med J 2005;11:42-4.  Back to cited text no. 2
    
3.
Cannon CR, Replogle WH, Schenk MP. Endoscopic – Assisted adenoidectomy. Otalaryngol Head Neck Surg 1999;121:740-4.  Back to cited text no. 3
    
4.
Jain A, Kumar H, Kaushik S. Role of adenoid and nasopharyngeal flora in the etiology of serous otitis media. J Evolu Med Dent Sci 2015;79:13824-34.  Back to cited text no. 4
    
5.
Georgalas C, Thomas K, Owens C, Abramovich S, Lack G. Medical treatment for rhinosinusitis associated with adenoidal hypertrophy in children: An evaluation of clinical response and changes on magnetic resonance imaging. Ann otol Rhinol Layrngol 2005;114:638-44.  Back to cited text no. 5
    
6.
Huang HM, Chao MC, Chen YL, Hsiao HR. A combined method of conventional and endoscopic adenoidectomy. Laryngoscope 1998;108:1104-6.  Back to cited text no. 6
    
7.
Yaseen ET, Khammas AH, Al Anbaky F. Adenoid enlargement, Assessment by plain X ray and Nasoendoscopy. Iraqi J Comm Med. 2012;25:88-91.  Back to cited text no. 7
    
8.
Shin JJ, Hartnick CJ. and pediatric endoscopic transnasal adenoid ablation. Ann otol Rhinol Laryngol 2003;112:511-4.  Back to cited text no. 8
    
9.
Koltai PJ, Kalathia AS, Stanislaw P, Heras HA. Power assisted adenoidectomy. Arch Otolaryngol Head Neck Surg 1997;123:685-8.  Back to cited text no. 9
    
10.
Stanislaw P, Koltai PJ, Feustel PJ. Comparison of powerassisted adenoidectomy vs adenoid curette adenoidectomy. Arch Otolaryngol Head Neck Surg 2000;126:845-9.  Back to cited text no. 10
    
11.
Havas T, Lowinger D, Obstructive adenoid tissue: An indication for powered-shaver adenoidectomy. Arch Otolaryngol Head Neck Surg 2002;128:789-91.  Back to cited text no. 11
    
12.
Cannon CR, Replogle WH, Schenk MP. Endoscopic-assisted adenoidectomy. Otolaryngol Head Neck Surg 1999;121:740-4.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5], [Table 6], [Table 7], [Table 8]



 

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