Polysomnographic outcomes of revision adenoidectomy in children with obstructive sleep apnea and recurrent/residual adenoidal hypertrophy

INTRODUCTION

Recurrent/residual adenoidal hypertrophy after adenotonsillectomy in children can result in obstructive sleep apnea (OSA). We aimed to assess the polysomnographic (PSG) outcomes of revision adenoidectomy in children with recurrent/residual adenoidal hypertrophy and OSA.

METHODS

This was a single-center retrospective study that included children with sleep studies that confirmed OSA and known history of adenotonsillectomy who were diagnosed with adenoidal hypertrophy and subsequently underwent revision adenoidectomy. Pre- and postoperative PSG variables of revision adenoidectomy were included in the analysis.

RESULTS

A total of 20 children were included in the study. The cohort included 13 males and 7 females with a mean age of 7.8 years (± 3.6 years). The mean BMI z score was 1.96 [1.31, 2.43]. The median duration from adenotonsillectomy performance was 2.3 years [1.4, 4.0]. Overall, revision adenoidectomy resulted in significant improvements in multiple respiratory parameters, including AHI 6.6 [1.4, 13. 7] vs 14.8 [7.4, 20.7], p = 0.02; oxygen desaturations nadir 88.0 [84.0, 93.0] vs 80.0 [72.2, 88.9], p = 0.01; supine AHI 8.6 [1.5, 14.3] vs 17.6 [8.3, 30.2], p = 0.02; and arousal index 12.2 [9.6, 15.7] vs 18.9 [13.4, 24.9], p = 0.04.

CONCLUSIONS

Children with recurrent/residual adenoidal hypertrophy after adenotonsillectomy who undergo revision adenoidectomy experience improvements in respiratory event, gas exchange, and arousal index.

Adenoidectomy: Anatomical variables as predictive factors of intraoperative adenoid residues

OBJECTIVES

Adenoid hypertrophy is a common cause of upper airway obstruction in children. However, after adenoidectomy, nasal obstructive symptoms may persist or recur, requiring surgical revision. The aim of this study is to evaluate if individual patient features can influence the efficacy of the traditional technique.

METHODS

A retrospective observational study was conducted by recruiting patients from candidates for adenoidectomy. All children underwent conventional transoral curettage adenoidectomy with endoscopic control at the end of procedure, and in presence of adenoid residues, a concomitant revision adenoidectomy was performed. For each patient, the following data were collected: age, sex, weight, height, length of the soft palate and surgical technique used.

RESULTS

In 18% of patients (113/612), the most critical areas of the nasopharynx were not reached by standard surgery, making a complete adenoidectomy difficult. In this group, the average length of the soft palate was 3.1 cm, 5 mm more than the average of the sample, and 6 mm more than the average length of patients undergoing standard surgery alone (p < 0.001).

CONCLUSION

Our study confirms the hypothesis that a greater length of the soft palate conditions the results of the intervention. The length of the soft palate can be considered an intraoperative criterion to select the cases in which perform endoscopic control after the standard procedure.

Incidence and potential risk factors for adenoid regrowth and revision adenoidectomy: A meta-analysis

AIMS

To examine the potential risk factors for adenoid regrowth and the incidence of revision adenoidectomy.

METHODOLOGY

The English-language literature published from January 1995 to January 2020 regarding adenoid regrowth and revision adenoidectomy was reviewed. The keywords used were 'adenoids', 'adenoid regrowth' and 'revision adenoidectomy'. The inclusion criteria were English language, sample size greater than five and presentation of extractable data on risk factors for adenoid regrowth and rates of revision adenoidectomy. Random-effects modelling was used to estimate summary outcomes.

RESULTS

Twenty studies met the inclusion criteria. There was a total of 143369 cases of baseline adenoidectomies. The mean age at primary surgery was 4.62 years (SD = 1.47 years, range of 2.3-7.3 years) and the mean age at revision adenoidectomy was 5.43 years (SD = 1.80 years, range of 2.5-7.6 years). Six studies reported on adenoid regrowth and a total of 4950 baseline adenoidectomies were examined. The prevalence of adenoid regrowth was 8%. Fifteen studies examined the rate of revision adenoidectomy and a total of 119369 baseline adenoidectomies were analysed. The revision adenoidectomy rate was 2%. Of the patients with revision adenoidectomy, 14% had allergic rhinitis and 9% had asthma. With regards to indications for revision adenoidectomy, 26% had OSA, 86% were snorers, 63% had nasal obstruction, 32% had recurrent AOM and 73% had OME.

CONCLUSION

The combined revision adenoidectomy rate from this study is 2%. Young age at first surgery was prevalent as well as co-morbidities of allergic rhinitis and asthma and indications for primary adenoidectomy like upper airway obstructive symptoms and middle ear disease. However, given the heterogeneity of these studies, direct cause and effect could not be concluded.

Outcomes of adenoidectomy-alone in patients less than 3-years old

OBJECTIVES

1. Determine the percentage of patients under the age of 3 undergoing adenoidectomy-alone who require subsequent management of residual sleep disordered breathing (SDB).2. Characterize complications following adenoidectomy and determine if any perioperative factors are associated with intra-operative or post-operative complications and outcomes.

METHODS

Case series with chart review was conducted including children seen at a tertiary care children's hospital between 2008 and 2012. Consecutive patients under the age of 3 who underwent adenoidectomy-alone were identified by billing codes. After excluding those with syndromes, partial adenoidectomies, and those without follow-up, 148 patients were included. Predictors of requiring additional surgery for SDB were evaluated using log-rank tests or Cox proportional hazards regression.

RESULTS

Median age at time of initial adenoidectomy was 27.5 months (range 11-36 months) and the patient population was comprised of 66.2% males (n = 98/148) and 89.2% Caucasians (n = 132/148). 56.5% (n = 74/131) of patients continued to have residual symptoms of SDB and 34.5% (n = 51/148) underwent additional surgical intervention. Multivariable survival analysis revealed GERD (HR, 6.21; CI, 1.29-29.77, p = .022) and tonsil size (HR, 4.07; CI, 1.57-10.51, p = .004) were significant predictors of additional surgery in this group of patients under the age of 3. There was no observed difference in intra- and post-operative complication rates between patients with and without additional operative intervention.

CONCLUSIONS

Residual SDB symptoms following adenoidectomy in patients less than 3 years of age are common and require additional surgery at a high rate. Medical comorbidities such as GERD and large tonsil size may help predict the need for additional surgery.

Incidence and factors associated with revision adenoidectomy: A retrospective study

INTRODUCTION

Adenoidectomy is one of the most commonly performed pediatric operations worldwide. There are a proportion of children who require revision adenoidectomy. Yet there is little in the literature about the incidence, associated factors and etiology of adenoidal regrowth. The aim of this retrospective cohort study was to determine incidence and factors associated with revision adenoidectomy.

METHODS

An extraction of all hospital morbidity records belonging to patients under the age of 18 years who underwent one or more adenoidectomy procedures (with or without tonsillectomy) between January 1, 2000 and June 2016 at a tertiary care children's hospital was performed. Demographic, diagnostic, and procedural data were included in the analysis. Community prescribing information was examined for the number of courses of antibiotics prescribed to each patient prior to initial adenoidectomy.

RESULTS

There were 8260 patients under the age of 18 years who underwent primary adenoidectomy from 2000 to 2016 at a tertiary pediatric hospital. 2.5% (n = 212) of patients underwent revision adenoidectomy in our cohort during the same time period. A higher proportion of females underwent revision adenoidectomy when compared to male counterparts (p = 0.007). Patients who were prescribed more than five courses of antibiotics prior to initial adenoidectomy were more likely to undergo revision adenoidectomy (p = 0.003). Patients with a diagnosis of otitis media with effusion were more likely to undergo revision adenoidectomy (p=<0.001). A diagnosis of asthma (p=<0.001), gastroesophageal reflux disease (GERD) (p=<0.001), and allergic rhinitis (p=<0.001) was associated with revision adenoidectomy. An age of over 4 years at the time of initial adenoidectomy was associated with revision adenoidectomy (p=<0.001). Adenoids that obstructed over 75% of the nasal choanae were associated with revision adenoidectomy in this cohort (p=<0.001).

CONCLUSION

This study has identified several factors associated with revision adenoidectomy.