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Chronic adenoid disease — Clinical Guidelines

Overview

Chronic adenoid disease refers to persistent enlargement or inflammation of the adenoid tissue, often leading to recurrent respiratory issues such as nasal obstruction, snoring, and sleep-disordered breathing. 3

Diagnosis

Clinical Symptoms: Nasal obstruction, mouth breathing, snoring, and sleep apnea.

Imaging: CT scans can assess nasopharyngeal dimensions and identify structural changes post-adenoidectomy 1.

Endoscopic Evaluation: Transoral suction diathermy adenoidectomy under direct vision using a 45-degree endoscope can aid in precise visualization and assessment 5.

Management

Primary Treatment: Adenoidectomy, often performed using suction diathermy for effective tissue removal and hemostasis 4 5.

Revision Surgery: Indicated for recurrence or persistent symptoms; revision rates vary by age and surgeon experience 2.

Post-Operative Care: Monitoring for complications such as post-operative bleeding (low incidence with suction diathermy) 4.

Rehabilitation: Logopedic instruction programs may be considered to address post-adenoidectomy oral posture issues, though efficacy varies by age 6.

Special Populations

Pediatrics: Higher revision rates observed in younger children (0-4 years) compared to older age groups 2.

Comorbidities: No specific guidelines provided in abstracts regarding comorbidities, but careful consideration of patient-specific risks is advised 2.

Key Recommendations

Utilize suction diathermy for adenoidectomy to minimize post-operative hemorrhage and manage recurrence effectively (Evidence: Moderate 4 5).

Consider patient age as a risk factor for revision adenoidectomy, with younger children (0-4 years) having a higher risk 2 (Evidence: Moderate).

Implement logopedic instruction programs cautiously, particularly noting limited efficacy in very young children (<3.6 years) 6 (Evidence: Weak).

References

1 Kim BY, Lim JH, Lee S, Hwang Y. 3D-structural change of nasopharynx following adenoidectomy: 10-year serial data in a single hospital. European archives of oto-rhino-laryngology : official journal of the European Federation of Oto-Rhino-Laryngological Societies (EUFOS) : affiliated with the German Society for Oto-Rhino-Laryngology - Head and Neck Surgery 2020. link 2 Lin DL, Wu CS, Tang CH, Kuo TY, Tu TY. The safety and risk factors of revision adenoidectomy in children and adolescents: A nationwide retrospective population-based cohort study. Auris, nasus, larynx 2018. link 3 Ruben RJ. The adenoid: Its history and a cautionary tale. The Laryngoscope 2017. link 4 Skilbeck CJ, Tweedie DJ, Lloyd-Thomas AR, Albert DM. Suction diathermy for adenoidectomy: complications and risk of recurrence. International journal of pediatric otorhinolaryngology 2007. link 5 Lo S, Rowe-Jones J. How we do it: Transoral suction diathermy adenoid ablation under direct vision using a 45 degree endoscope. Clinical otolaryngology : official journal of ENT-UK ; official journal of Netherlands Society for Oto-Rhino-Laryngology & Cervico-Facial Surgery 2006. link 6 Lembrechts D, Verschueren D, Heulens H, Valkenburg HA, Feenstra L. Effect of a logopedic instruction program after adenoidectomy on open mouth posture: a single-blind study. Folia phoniatrica et logopaedica : official organ of the International Association of Logopedics and Phoniatrics (IALP) 1999. link

Chronic adenoid disease