Endoscopic assisted powered adenoidectomy versus conventional adenoidectomy – a randomised controlled trial

Author for correspondence: Dr Ruchika Juneja, B-7/5 Mianwali Nagar, Rohtak Road, New Delhi 110087, India E-mail: [email protected] Fax: [phone]

Dr R Juneja takes responsibility for the integrity of the content of the paper

Introduction

Adenoid hypertrophy is the most common cause of nasal obstruction in children.¹ Macleod Yearsley performed the first adenoidectomy in 1842.² Conventionally, adenoidectomy is performed with a curette, without visualising the nasopharynx. The use of a laryngeal mirror to visualise the nasopharynx has been mentioned in the literature; however, the use of an endoscope has revolutionised the technique of adenoidectomy. This was popularised by Canon et al.³ Multiple other methods have evolved since the inception of curettage adenoidectomy, such as a suction diathermy, laser ablation and radiofrequency ablation, using equipment including a molecular resonance tool, a coblation wand and a microdebrider. The aim of adenoidectomy is complete adenoid removal, with minimal morbidity and quick recovery. In 1996, David S Parsons described the use of powered instruments in the paediatric population and explained the precision of the microdebrider system.⁴

Given the range of methods available, there is a quest for the most optimal method for complete adenoid removal and better relief of symptoms, with the least number of post-operative complications. This study aimed to compare endoscopic assisted powered adenoidectomy with conventional adenoidectomy on the basis of surgical time, intra-operative bleeding, post-operative pain and completeness of adenoid removal.

Materials and methods

A randomised controlled trial was designed to carry out this comparative study. It was conducted from October 2014 to March 2016, on patients visiting the ENT department at a tertiary care teaching hospital. Fifty patients (aged 4–12 years) with nasal and/or aural signs and symptoms due to adenoid hypertrophy, who required adenoidectomy, were chosen. The selection also included patients who required tonsillectomy or myringotomy (with or without grommet insertion) along with adenoidectomy. Patients with congenital anomalies, submucosal cleft palate and bleeding diathesis were excluded from the study.

Patients were examined clinically and radiologically. The adenoidal–nasopharyngeal ratio was calculated from the lateral radiograph of the neck.⁵ Endoscopic assessment was conducted and the adenoid tissue graded according to the scale by Clemens et al.⁶ Grade I signifies adenoid tissue filling one-third of the...