Failures of Adenoidectomy for Chronic Rhinosinusitis in Children: For Whom and When Do They Fail?

Abstract

Those who fail adenoidectomy for CRS who require ESS are mainly children who are younger than 7 years of age and have asthma. They appear to require a salvage ESS at a mean of 24 months after the adenoidectomy.

The role of adenoids in pediatric rhinosinusitis

“…Ramadan et al [25] reported that adenoidectomy was effective in 50% of pediatric sinusitis patients and Vandenberg et al [3] reported that it was effective in 79% of pediatric sinusitis patients. Clary [29] and Lieser et al [30] also considered adenoidectomy as the first surgical choice for pediatric sinusitis patients unresponsive to medical therapy.…”

“…Adenoid hypertrophy may mimic sinusitis symptoms by causing obstruction and stasis of secretions. This stasis of secretion may in turn obstruct sinus ostium and cause sinusitis [25]. Although adenoid hypertrophy can cause mechanical obstruction, more reports show that adenoid volume has little correlation with sinusitis.…”

Adenoidectomy outcomes in pediatric rhinosinusitis: A meta-analysis

“…Subgroup analysis by age of subject, follow-up time, and adenoidectomy technique (curette versus cautery) was planned a priori but the small sample size and similar age and follow-up time precluded this type of analysis. Given three of the ten articles were published by the same author(s) [7,10,11], there was concern for a possible author bias that could have effected the results. The studies by Ramadan et al each reported a success rate for adenoidectomy that was considerably lower than most of the other studies.…”

“…Application of the inclusion criteria initially resulted in only six articles meeting the inclusion criteria. Hand searching of the references resulted in an additional three articles for a total of nine studies [3][4][5][6][7][8][9][10][11]. Table 1 is the evidence table that summarizes the general findings of the selected articles.…”

Antral lavage using the luma transilluminaton wire and vortex irrigator—A safe and effective advance in treating pediatric sinusitis

“…Adenoidectomy alone is widely accepted as a first surgical procedure in pediatric patients with CRS, but studies suggest that only 50-60% of patients will have long term improvement [5]. These refractory cases leave the surgeon few options before proceeding to FESS.…”