TRIO Best Practice articles are brief, structured reviews designed to provide the busy clinician with a handy outline and reference for day-to-day clinical decision making. The ENTtoday summaries below include the Background and Best Practice sections of the original article. To view the complete Laryngoscope articles free of charge, visit Laryngoscope.com.
Background
Adenoidectomy is one of the most common surgical procedures performed in children in the United States. Indications for adenoidectomy include chronic or recurrent otitis media, as well as subjective upper airway obstructive symptoms such as nasal obstruction with chronic mouth breathing, snoring, chronic rhinitis, and chronic or recurrent sinusitis. When the indication includes obstructive symptoms, tonsillectomy is often considered. Parents often ask if the tonsillectomy can also be done, “since you are already in there.” However, adding a tonsillectomy can contribute significantly to surgical morbidity and mortality. Specifically, the risk of postoperative hemorrhage following adenoidectomy alone is less than 1%. The rate of hemorrhage follow tonsillectomy can be up to 3%. The return to normal activity and school occurs the day after the adenoidectomy in most children, whereas the recovery period after tonsillectomy can last up to 14 days, requiring parents to take extended periods off from their jobs. In order to adequately council patients on when to perform an adenoidectomy alone, one may want to consider and discuss with the family the likelihood of their child needing a tonsillectomy in the future.
Best Practice
The majority of children undergoing adenoidectomy alone will not require subsequent tonsillectomy. However, there is the potential risk for further surgery that includes a tonsillectomy, particularly if the adenoidectomy was done for treatment of airway obstruction. Two to 29% of children undergoing adenoidectomy alone for airway obstruction will require subsequent tonsillectomy. Risk factors for subsequent tonsillectomy include age <2 years old, girls less than 3 years of age (28%), and tonsillar hypertrophy. Knowledge of these risk factors can improve preoperative family/patient counseling and surgical planning (Laryngoscope. 2015;124:6-7).