Evaluation of middle ear pressure in the early period after adenoidectomy in children with adenoid hypertrophy without otitis media with effusion

Tympanoplasty can be Concurrent with Adenoidectomy. Tube Factor Assessment

To assess changes in middle ear pressures following adenotonsillectomies in children, and to evaluate the possibility of performing tympanoplasty at the same surgical time. Prospective study in which tube function was assessed using tympanometry on the first postoperative day and on the seventh postoperative day after adenotonsillectomies. A total of 39 children aged 6.8 ± 2.6 years were evaluated. On the first postoperative day, 79.5% presented with changes in middle ear pressure. On the seventh postoperative day, only 12.8% maintained this change. Tube dysfunction following adenotonsillectomy is transient and would not preclude an associated tympanoplasty from being performed, thereby reducing costs and risks related to the surgical procedure.

Different techniques of adenoidectomy and its impact on middle ear pressure: a randomized controlled study

OBJECTIVES

The aim of this work is to compare between different techniques of adenoidectomy: endoscopic microdebrider-assisted, coblation and conventional adenoidectomy and its effect on middle ear pressure.

BACKGROUND

Adenoidectomy, either alone or with tonsillectomy, is considered among the most performed procedures in pediatric otorhinolaryngology. This procedure usually related to the Eustachian tube function and middle ear status. Eustachian tube dysfunction is mainly caused by mechanical obstruction of the tubal orifice, insufficient swallowing and inflammation in the nasopharyngeal mucosa.

METHODS

This prospective randomized study was conducted on 90 patients with symptomatic adenoid hypertrophy confirmed by nasopharyngeal X-ray and endoscopic grading preoperatively. Patients were admitted at Otorhinolaryngology department of our institute during the period from January 2022 to January 2023. They were divided into three groups that were operated either by conventional (Group I), endoscopic microdebrider (Group II), or coblation technique (Group III). Each group was assessed through the audiometric parameters plus postoperative bleeding, and VAS results for pain score and postoperative endoscopic grading for adenoid recurrence.

RESULTS

Mean age in group A was 9.03 years and in group B was 8.99 years and was 8.99 years in group C with insignificant differences between three groups. There is significant improvement of tympanographic results comparing all groups of the patients at 6 months postoperatively. There is significant relation between the mean VAS comparing preoperative and postoperative results.

CONCLUSION

There are better results in tympanographic data at conventional adenoidectomy versus other techniques. However, there are also better postoperative results after either coblation or endoscopic microdebrider adenoidectomy over the conventional technique.

Comparison of middle ear function and hearing thresholds in children with adenoid hypertrophy after microdebrider and conventional adenoidectomy: a randomised controlled trial

BACKGROUND

Microdebrider has superior efficacy in clearing the adenoids, compared to curettage. We compared the improvement in middle ear function and hearing thresholds after adenoidectomy, by both methods.

MATERIALS AND METHODS

126 patients (median age-9 years) were randomized into groups A and B, where adenoidectomy was done by microdebrider and curettage, respectively. Middle ear function parameters and hearing thresholds were measured serially.

RESULTS

The mean improvement in middle ear pressure, compliance and hearing thresholds were 92.5 ± 67.6 and 84.2 ± 71.4 daPa; (p = 0.40), 0.19 ± 0.34 and 0.27 ± 0.27 mL; (p = 0.07) and 3.20 ± 4.95 and 2.54 ± 3.98 dB; (p = 0.27), in groups A and B, respectively. Reversal of type B tympanograms was noted in both groups.

CONCLUSIONS

Middle ear function and hearing thresholds improved in both groups after adenoidectomy. More improvement was noted in the microdebrider group, which, however, was not significant.

Comparison of Endoscope-Assisted Coblation Adenoidectomy to Conventional Curettage Adenoidectomy in Terms of Postoperative Eustachian Tube Function

INTRODUCTION

Adenoidectomy is one of the most common surgical procedures performed in children in otorhinolaryngology practice. This study aims to compare the conventional curettage adenoidectomy (CCA) and the endoscope-assisted coblation adenoidectomy (EACA) in terms of the postoperative Eustachian tube function and the surgical outcomes.

METHODS

A prospective, randomized, controlled study was carried out at a tertiary referral center and private hospital. Seventy-two adenoid hypertrophy patients without middle ear disease were randomly assigned to 2 groups to be operated via CCA and EACA techniques prior to surgery. Parameters including middle ear pressure values (MEPV), operative time, intraoperative hemorrhage, postoperative residual adenoid tissue, and postoperative pain were compared between groups.

RESULTS

In the CCA group for both ears, there was a statistically significant difference between preoperative mean MEPV and mean MEPV of postoperative day 1, while MEPV returned to normal ranges at the postoperative day 7. No statistically significant differences were observed in mean MEPV on preoperatively and 1st and 7th postoperative days in the EACA group for both right and left ears. Mean operative time was significantly higher in the EACA group compared to the CCA group (P < 0.001). Eight (22.2%) out of 36 patients who underwent CCA had a residual adenoid tissue postoperatively, while there was no residual adenoid tissue in any patients who operated via the EACA technique. Mean pain score on postoperative day 1 and 2 and blood loss were significantly less in the EACA group than the CCA group.

CONCLUSION

Endoscope-assisted coblation adenoidectomy may serve a reasonable alternative to conventional curettage adenoidectomy because it provides Eustachian tube functions preserved, decreased intraoperative hemorrhage, complete resection of the adenoid tissue, and lower pain score.

Curettage adenoidectomy versus endoscopic microdebrider adenoidectomy in children: A randomized controlled trial

INTRODUCTION

Adenoidectomy is one of the most frequently performed surgical procedures with different techniques and technologies. Although curettage adenoidectomy (CA) has been practiced conventionally for many years, endoscopic microdebrider adenoidectomy (EMA) has emerged as an innovative surgical method. Comparing physiological effects, efficacy and safety of the endoscopic microdebrider adenoidectomy (EMA) and curettage adenoidectomy (CA) in pediatric population is aimed with this prospective, single-blind, randomized, controlled trial.

METHODS

Sixty pediatric patients with type-A tympanogram according to Jerger classification in both ears before surgery were randomly assigned to receive the CA (n = 30) and the EMA (n = 30). Tympanometry evaluation for each ear was performed the day before surgery firstly and was repeated on days 1, 7 and 14 after surgery. Intraoperative time, complications during and after the operation were recorded. Postoperative pain was also evaluated for 10 days postoperatively.

RESULTS

Tympanometric evaluation revealed significantly reduced middle ear peak pressure levels with the EMA than with the CA for each ear on day 1 after surgery and for only left ear on day 7 after surgery (P < 0.05). In addition, statistically significant reduced pain scores in postoperative first 3 days were related to the EMA (P < 0.05). There was no significant difference between the methods in terms of duration of surgery and complications.

CONCLUSION

According to findings from this study, the EMA procedure may be as safe and rapid as the CA. Furthermore, the EMA may be more controlled and less invasive to the surrounding tissues. Further studies are advised to support these data.

Comparison between curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy in terms of Eustachian tube dysfunction

Introduction

Adenoidectomy can be performed with many ways, including curettage and microdebrider endoscopic-assisted adenoidectomy. Those two techniques have advantages and disadvantages.

Objective

The objective of this study is to research the effects of curettage adenoidectomy and endoscopic-assisted microdebrider adenoidectomy on the tympanum pressures in pediatric patients with adenoid hypertrophy without otitis media with effusion.

Methods

This prospective descriptive study was performed with 65 patients who had a normal tympanic membrane and normal tympanogram and then underwent adenoidectomy or adenotonsillectomy for adenoid and tonsil hypertrophy. The subjects were randomly divided into two groups: curettage adenoidectomy group and endoscopic microdebrider-assisted adenoidectomy group. They underwent tympanometry, and the preoperative as well as 1st and 7th day postoperative values of the tympanum pressures were compared within and among the groups.

Results

There were 32 patients in the curettage adenoidectomy group and 33 patients in the microdebrider adenoidectomy group. Statistically significant differences were observed in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears with curettage adenoidectomy (p < 0.001, p < 0.001). This difference occurred on the 1st postoperative day, and the value returned to normal on the 7th day. There was no significant difference in the median tympanum pressure on the preoperative and 1st and 7th postoperative days for both the left and right ears in the microdebrider adenoidectomy group (p = 0.376, p = 0.128).

Conclusion

Postoperative Eustachian tube dysfunction is seen less often with the endoscopic-assisted microdebrider adenoidectomy technique than with the conventional adenoidectomy technique.