Adenoidectomy: current approaches and review of the literature

Year 2016, Volume: 26 Issue: 3, 181 - 190, 20.07.2016

Seda Türkoğlu Babakurban Erdinç Aydın

Abstract

Adenoid is a secondary lymphoid organ located in the nasopharynx. Due to its location, it plays an important role in the host defense of the upper respiratory tract. Immunoglobulin G3 and immunoglobulin A1 antibodies are prevalent antibodies in the adenoid tissue. Adenoidal hypertrophy is a common condition in children causing symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hyponasal speech. It also plays a role in the pathogenesis of rhinosinusitis, recurrent otitis media, and otitis media with effusion. Currently, adenoidectomy is one of the most commonly performed pediatric surgical procedures worldwide. Although there is still poor evidence in the literature, recurrent upper respiratory infections, otitis media with effusion, and obstructive sleep apnea syndrome are considered to be the main indications of adenoidectomy. Adenoidectomy can be carried out with several techniques and instruments. Although rare, surgery possesses some risks and may cause emotional distress both for the patient and the family. Nonsurgical treatments such as intranasal steroids are also used in the treatment of adenoid hypertrophy. In this review, we discuss the current literature on the adenoid function, adenoidectomy indications, and treatment of adenoid hypertrophy.

Keywords

Adenoidectomy, adenoidectomy indication, adenoidectomy technique, function of adenoid, immunology of adenoid

Adenoidektomi: Günümüz yaklaşımları ve literatür derlemesi

Abstract

Adenoid, nazofarenkste yer alan sekonder lenfoid organdır. Yerleşim yeri nedeniyle, üst solunum yolundaki konak savunmasında önemli bir rol oynar. Immünglobulin G3 ve immünglobulin A1 antikorları, adenoid dokusunda yaygın bulunan antikorlardır. Adenoid hipertrofisi çocuklarda ağız solunumu, burun akıntısı, horlama, uyku apnesi ve hiponazal konuşma gibi semptomlara neden olan yaygın bir durumdur. Bununla birlikte, rinosinüzit, tekrarlayan otitis media ve efüzyonlu otitis media patogenezinde rol oynar. Günümüzde adenoidektomi tüm dünyada en sık uygulanan pediatrik cerrahilerden biridir. Literatürde henüz yeterli kanıt mevcut olmamasına rağmen, tekrarlayan üst solunum yolu enfeksiyonları, efüzyonlu otitis media ve tıkayıcı uyku apnesi sendromunun adenoidektominin başlıca endikasyonları olduğu düşünülmektedir. Adenoidektomi birçok teknik ve araç ile uygulanabilmektedir. Nadir olmasına karşın, cerrahi bazı riskler taşımakta ve hem hasta hem de aile için duygusal stres yaratabilmektedir. Adenoid hipertrofisinin tedavisinde intranazal steroid gibi cerrahi dışı tedaviler de kullanılmaktadır. Bu derlemede adenoid fonksiyonu, adenoidektomi endikasyonları ve adenoid hipertrofisinin tedavisine ilişkin mevcut literatür tartışıldı

Keywords

Adenoidektomi, adenoidektomi endikasyonu, adenoidektomi tekniği, adenoid fonksiyonu, adenoid immünolojisi

References

• Di Rienzo Businco L, Angelone AM, Mattei A, Ventura L, Lauriello M. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage. Acta Otorhinolaryngol Ital 2012;32:124-9.
• Somani SS, Naik CS, Bangad SV. Endoscopic adenoidectomy with microdebrider. Indian J Otolaryngol Head Neck Surg 2010;62:427-31.
• Robb PJ. Adenoidectomy: does it work? J Laryngol Otol 2007;121:209-14.
• Dell’Aringa AR, Juares AJ, Melo Cd, Nardi JC, Kobari K, Perches Filho RM. Histological analysis of tonsillectomy and adenoidectomy specimens-- January 2001 to May 2003. Braz J Otorhinolaryngol 2005;71:18-22.
• van Kempen MJ, Rijkers GT, Van Cauwenberge PB. The immune response in adenoids and tonsils. Int Arch Allergy Immunol 2000;122:8-19.
• Boyaka PN, Wright PF, Marinaro M, Kiyono H, Johnson JE, Gonzales RA, et al. Human nasopharyngeal- associated lymphoreticular tissues. Functional analysis of subepithelial and intraepithelial B and T cells from adenoids and tonsils. Am J Pathol 2000;157:2023-35.
• Arita M, Kodama S, Suzuki M, Mogi G. Single cell analysis of adenoid CD5+ B cells and their protective contributions to nasopharyngeal immunity. Laryngoscope 2003;113:484-91.
• Ikincioğullari A, Doğu F, ikincioğullari A, Eğin Y, Babacan E. Is immune system influenced by adenotonsillectomy in children? Int J Pediatr Otorhinolaryngol 2002;66:251-7.
• Friday GA Jr, Paradise JL, Rabin BS, Colborn DK, Taylor FH. Serum immunoglobulin changes in relation to tonsil and adenoid surgery. Ann Allergy 1992;69:225-30.
• Pereira SR, Bakor SF, Weckx LL. Adenotonsillectomy in facial growing patients: spontaneous dental effects. Braz J Otorhinolaryngol 2011;77:600-4.
• El-Badrawy A, Abdel-Aziz M. Transoral endoscopic adenoidectomy. Int J Otolaryngol 2009;2009:949315.
• Modrzynski M, Zawisza E. An analysis of the incidence of adenoid hypertrophy in allergic children. Int J Pediatr Otorhinolaryngol 2007;71:713-9.
• Nguyen LH, Manoukian JJ, Sobol SE, Tewfik TL, Mazer BD, Schloss MD, et al. Similar allergic inflammation in the middle ear and the upper airway: evidence linking otitis media with effusion to the united airways concept. J Allergy Clin Immunol 2004;114:1110-5.
• Hamdan AL, Sabra O, Hadi U. Prevalence of adenoid hypertrophy in adults with nasal obstruction. J Otolaryngol Head Neck Surg 2008;37:469-73.
• Rout MR, Mohanty D, Vijaylaxmi Y, Bobba K, Metta C. Adenoid Hypertrophy in Adults: A case Series. Indian J Otolaryngol Head Neck Surg 2013;65:269-74.
• van den Aardweg MT, Boonacker CW, Rovers MM, Hoes AW, Schilder AG. Effectiveness of adenoidectomy in children with recurrent upper respiratory tract infections: open randomised controlled trial. BMJ 2011;343:5154.
• Yasan H, Dogru H, Tüz M, Candir O, Uygur K, Yariktaş M. Otitis media with effusion and histopathologic properties of adenoid tissue. Int J Pediatr Otorhinolaryngol 2003;67:1179-83.
• Nistico L, Kreft R, Gieseke A, Coticchia JM, Burrows A, Khampang P, et al. Adenoid reservoir for pathogenic biofilm bacteria. J Clin Microbiol 2011;49:1411-20.
• Ehrlich GD, Veeh R, Wang X, Costerton JW, Hayes JD, Hu FZ, et al. Mucosal biofilm formation on middle-ear mucosa in the chinchilla model of otitis media. JAMA 2002;287:1710-5.
• Hall-Stoodley L, Hu FZ, Gieseke A, Nistico L, Nguyen D, Hayes J, et al. Direct detection of bacterial biofilms on the middle-ear mucosa of children with chronic otitis media. JAMA 2006;296:202-11.
• Cirak MY, Ozdek A, Yilmaz D, Bayiz U, Samim E, Turet S. Detection of Helicobacter pylori and its CagA gene in tonsil and adenoid tissues by PCR. Arch Otolaryngol Head Neck Surg 2003;129:1225-9.
• Saki N, Samarbaf Zadeh AR, Sheikhpour Jonaky R, Noori SM, Kayedani GA, Nikakhlagh S. The Prevalence Rate of Helicobacter pylori Infection in, Chronic Otitis Media With Effusion Patients. Jundishapur J Microbiol 2014;7:15694.
• Lukes P, Astl J, Pavlík E, Potuzníková B, Sterzl I, Betka J. Helicobacter pylori in tonsillar and adenoid tissue and its possible role in oropharyngeal carcinogenesis. Folia Biol (Praha) 2008;54:33-9.
• Rosenfeld RM, Culpepper L, Doyle KJ, Grundfast KM, Hoberman A, Kenna MA, et al. Clinical practice guideline: Otitis media with effusion. Otolaryngol Head Neck Surg. 2004;130:95-118.
• Brook I, Shah K. Effect of amoxycillin with or without clavulanate on adenoid bacterial flora. J Antimicrob Chemother 2001;48:269-73.
• Brook I, Shah K. Effect of amoxicillin or clindamycin on the adenoids bacterial flora. Otolaryngol Head Neck Surg 2003;129:5-10.
• McClay JE. Resistant bacteria in the adenoids: a preliminary report. Arch Otolaryngol Head Neck Surg 2000;126:625-9.
• Aarts JW, van den Aardweg MT, Rovers MM, Bonten MJ, Schilder AG. Alterations in the nasopharyngeal bacterial flora after adenoidectomy in children: a systematic review. Otolaryngol Head Neck Surg 2010;142:15-20.
• Redline S, Amin R, Beebe D, Chervin RD, Garetz SL, Giordani B, et al. The Childhood Adenotonsillectomy Trial (CHAT): rationale, design, and challenges of a randomized controlled trial evaluating a standard surgical procedure in a pediatric population. Sleep 2011;34:1509-17.
• Lim J, McKean M. Adenotonsillectomy for obstructive sleep apnoea in children. Cochrane Database Syst Rev 2003;1:3136.
• Schechter MS. Technical report: diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics 2002;109:69.
• Ghorbanian SN, Paradise JL, Doty RL. Odor perception in children in relation to nasal obstruction. Pediatrics 1983;72:510-6.
• Delank KW. Olfactory sensitivity in adenoid hyperplasia. Laryngorhinootologie 1992;71:293-7. [Abstract]
• Konstantinidis I, Triaridis S, Triaridis A, Petropoulos I, Karagiannidis K, Kontzoglou G. How do children with adenoid hypertrophy smell and taste? Clinical assessment of olfactory function pre- and post-adenoidectomy. Int J Pediatr Otorhinolaryngol 2005;69:1343-9.
• Harari D, Redlich M, Miri S, Hamud T, Gross M. The effect of mouth breathing versus nasal breathing on dentofacial and craniofacial development in orthodontic patients. Laryngoscope 2010;120:2089-93.
• Yilmaz HB, Celebi S, Sahin-Yilmaz A, Oysu C. The role of mometasone furoate nasal spray in the treatment of adenoidal hypertrophy in the adolescents: a prospective, randomized, cross-over study. Eur Arch Otorhinolaryngol 2013;270:2657-61.
• Demain JG, Goetz DW. Pediatric adenoidal hypertrophy and nasal airway obstruction: reduction with aqueous nasal beclomethasone. Pediatrics 1995;95:355-64.
• Brouillette RT, Manoukian JJ, Ducharme FM, Oudjhane K, Earle LG, Ladan S, et al. Efficacy of fluticasone nasal spray for pediatric obstructive sleep apnea. J Pediatr 2001;138:838-44.
• Criscuoli G, D’Amora S, Ripa G, Cinquegrana G, Mansi N, Impagliazzo N, et al. Frequency of surgery among children who have adenotonsillar hypertrophy and improve after treatment with nasal beclomethasone. Pediatrics 2003;111:236-8.
• Cengel S, Akyol MU. The role of topical nasal steroids in the treatment of children with otitis media with effusion and/or adenoid hypertrophy. Int J Pediatr Otorhinolaryngol 2006;70:639-45.
• Berlucchi M, Valetti L, Parrinello G, Nicolai P. Long- term follow-up of children undergoing topical intranasal steroid therapy for adenoidal hypertrophy. Int J Pediatr Otorhinolaryngol 2008;72:1171-5.
• Papatziamos G, Van Hage-Hamsten M, Lundahl J, Hemlin C. IgE-positive plasma cells are present in adenoids of atopic children. Acta Otolaryngol 2006;126:180-5.
• Goldbart AD, Goldman JL, Veling MC, Gozal D. Leukotriene modifier therapy for mild sleep- disordered breathing in children. Am J Respir Crit Care Med 2005;172:364-70.
• Goldbart AD, Goldman JL, Li RC, Brittian KR, Tauman R, Gozal D. Differential expression of cysteinyl leukotriene receptors 1 and 2 in tonsils of children with obstructive sleep apnea syndrome or recurrent infection. Chest 2004;126:13-8.
• Zhang L, Mendoza-Sassi RA, César JA, Chadha NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008;3:006286.
• Ciprandi G, Varricchio A, Capasso M, Varricchio AM, De Lucia A, Ascione E, et al. Intranasal flunisolide treatment in children with adenoidal hypertrophy. Int J Immunopathol Pharmacol 2007;20:833-6.
• Varricchio A, Tortoriello G, Capasso M, De Lucia A, Marchisio P, Varricchio AM, et al. Prevention of surgery in children with adenoidal hypertrophy treated with intranasal flunisolide: a 12-month follow- up. J Biol Regul Homeost Agents 2009;23:95-101.
• Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B. Medical treatment of adenoid hypertrophy with “fluticasone propionate nasal drops”. Int J Pediatr Otorhinolaryngol 2010;74:773-6.
• Berlucchi M, Salsi D, Valetti L, Parrinello G, Nicolai P. The role of mometasone furoate aqueous nasal spray in the treatment of adenoidal hypertrophy in the pediatric age group: preliminary results of a prospective, randomized study. Pediatrics 2007;119:1392-7.
• Goldbart AD, Veling MC, Goldman JL, Li RC, Brittian KR, Gozal D. Glucocorticoid receptor subunit expression in adenotonsillar tissue of children with obstructive sleep apnea. Pediatr Res 2005;57:232-6.
• Pagella F, Pusateri A, Canzi P, Caputo M, Marseglia A, Pelizzo G, et al. The evolution of the adenoidectomy: analysis of different power-assisted techniques. Int J Immunopathol Pharmacol 2011;24:55-9.
• Öztürk Ö, Polat Ş. Comparison of transoral power- assisted endoscopic adenoidectomy to curettage adenoidectomy. Adv Ther 2012;29:708-21.
• Costantini F, Salamanca F, Amaina T, Zibordi F. Videoendoscopic adenoidectomy with microdebrider. Acta Otorhinolaryngol Ital 2008;28:26-9.
• Demirbilek N, Evren C, Altun U. Postadenoidectomy hemorrhage: how we do it? Int J Clin Exp Med 2015;8:2799-803.
• Pagella F, Pusateri A, Matti E, Giourgos G. Transoral endonasal-controlled combined adenoidectomy (TECCA). Laryngoscope 2010;120:2008-10.
• Pagella F, Matti E, Colombo A, Giourgos G, Mira E. How we do it: a combined method of traditional curette and power-assisted endoscopic adenoidectomy. Acta Otolaryngol 2009;129:556-9.
• Yaman H, Memis M, Ilhan E. Comparison of Transoral/ Transnasal Endoscopic-Guided Adenoidectomy with Endoscopic Nasopharyngeal Inspection at the End of Curettage Adenoidectomy. Indian J Otolaryngol Head Neck Surg 2015;67:124-7.
• Wright ED, Manoukian JJ, Shapiro RS. Ablative adenoidectomy: a new technique using simultaneous liquefaction/aspiration. J Otolaryngol 1997;26:36-43.
• Sethi N, Egan P, Ward VM. Suction diathermy adenoidectomy performed in the district general hospital. J Laryngol Otol 2014;128:78-81.
• National Institute for Health and Clinical Excellence. Suction Diathermy Adenoidectomy. Interventional Procedure Guidance 328. London: NICE; 2009.
• Skilbeck CJ, Tweedie DJ, Lloyd-Thomas AR, Albert DM. Suction diathermy for adenoidectomy: complications and risk of recurrence. Int J Pediatr Otorhinolaryngol 2007;71:917-20.
• Lowe D, Brown P, Yung M. Adenoidectomy technique in the United Kingdom and postoperative hemorrhage. Otolaryngol Head Neck Surg 2011;145:314-8.
• Reed J, Sridhara S, Brietzke SE. Electrocautery adenoidectomy outcomes: a meta-analysis. Otolaryngol Head Neck Surg 2009;140:148-53.
• Casserly P, Kieran S, Phelan E, Smyth E, Lacy P. Bacteremia during adenoidectomy: a comparison of suction diathermy adenoid ablation and adenoid curettage. Ann Otol Rhinol Laryngol 2010;119:526-9.
• Di Rienzo Businco L, Angelone AM, Mattei A, Ventura L, Lauriello M. Paediatric adenoidectomy: endoscopic coblation technique compared to cold curettage. Acta Otorhinolaryngol Ital 2012;32:124-9.
• Özkiriş M, Karaçavuş S, Kapusuz Z, Saydam L. Comparison of two different adenoidectomy techniques with special emphasize on postoperative nasal mucociliary clearance rates: coblation technique vs. cold curettage. Int J Pediatr Otorhinolaryngol 2013;77:389-93.
• Ida JB, Worley NK, Amedee RG. Gold laser adenoidectomy: long-term safety and efficacy results. Int J Pediatr Otorhinolaryngol 2009;73:829-31.
• Worley NK, Abdalkhani A, Hagmann MA, Belafsky PC, Amedee RG. Gold laser versus curettage adenoidectomy: incidence of complications and otorrhea after concurrent pressure-equalization tube placement. Laryngoscope 2007;117:2026-9.
• Dearking AC, Lahr BD, Kuchena A, Orvidas LJ. Factors associated with revision adenoidectomy. Otolaryngol Head Neck Surg 2012;146:984-90.
• Duval M, Chung JC, Vaccani JP. A case-control study of repeated adenoidectomy in children. JAMA Otolaryngol Head Neck Surg 2013;139:32-6.
• Bast F, Uecker K, Chadha P, Göbel D, Schrom T. Is there a need for a histological examination of the adenoid tissue after adenoidectomy? Int J Pediatr Otorhinolaryngol 2015;79:821-4.
• Windfuhr JP. Malpractice claims and unintentional outcome of tonsil surgery and other standard procedures in otorhinolaryngology. GMS Curr Top Otorhinolaryngol Head Neck Surg 2013;12:8.