Different techniques of adenoidectomy and its impact on middle ear pressure: a randomized controlled study

European Archives of Oto-Rhino-Laryngology https://doi.org/10.1007/s00405-023-08188-2 HEAD AND NECK Different techniques of adenoidectomy and its impact on middle ear pressure: a randomized controlled study Ahmed Mohamed Seleim1 · Ahmed Nabil Elsamnody1 · Ahmed Fawzy Amer1 Received: 19 May 2023 / Accepted: 10 August 2023 © The Author(s) 2023 Abstract Objectives The aim of this work is to compare between different techniques of adenoidectomy: endoscopic microdebriderassisted, coblation and conventional adenoidectomy and its effect on middle ear pressure. Background Adenoidectomy, either alone or with tonsillectomy, is considered among the most performed procedures in pediatric otorhinolaryngology. This procedure usually related to the Eustachian tube function and middle ear status. Eustachian tube dysfunction is mainly caused by mechanical obstruction of the tubal orifice, insufficient swallowing and inflammation in the nasopharyngeal mucosa. Methods This prospective randomized study was conducted on 90 patients with symptomatic adenoid hypertrophy confirmed by nasopharyngeal X-ray and endoscopic grading preoperatively. Patients were admitted at Otorhinolaryngology department of our institute during the period from January 2022 to January 2023. They were divided into three groups that were operated either by conventional (Group I), endoscopic microdebrider (Group II), or coblation technique (Group III). Each group was assessed through the audiometric parameters plus postoperative bleeding, and VAS results for pain score and postoperative endoscopic grading for adenoid recurrence. Results Mean age in group A was 9.03 years and in group B was 8.99 years and was 8.99 years in group C with insignificant differences between three groups. There is significant improvement of tympanographic results comparing all groups of the patients at 6 months postoperatively. There is significant relation between the mean VAS comparing preoperative and postoperative results. Conclusion There are better results in tympanographic data at conventional adenoidectomy versus other techniques. However, there are also better postoperative results after either coblation or endoscopic microdebrider adenoidectomy over the conventional technique. Keywords Adenoidectomy · Coblation · Microdebrider · Tympanometry Background The adenoid also known as nasopharyngeal tonsils is a lymphatic tissue in the nasopharynx. It is situated in the midline on the roof and posterior wall of the nasopharynx. * Ahmed Fawzy Amer Ahmed Mohamed Seleim Ahmed Nabil Elsamnody 1 Department of Otorhinolaryngology, Al‑Azhar University Hospitals, Al-Azhar University, Cairo, Egypt The adenoids are midline structures situated on the roof and posterior wall of the nasopharynx [1]. Adenoid hypertrophy is one of the common causes of upper airway obstruction in children. Sleep-related breathing disorder due to adenoid is often seen in children aged 4–5 years, because at this age, the adenoid tissue and palatine tonsils have reached their largest size, untreated adenoid hypertrophy can lead to serious conditions such as maxillofacial anomalies, pulmonary hypertension and cor-pulmonale [2]. Adenoidectomy, either alone or with tonsillectomy, is considered among the most performed procedures in pediatric otorhinolaryngology. Classical adenoidectomy is referred to as the curette adenoidectomy or conventional adenoidectomy, which utilizes a curette for adenoids removal [1]. 13 Vol.:(0123456789) European Archives of Oto-Rhino-Laryngology Afterwards, many alternative techniques have been suggested, including suction electrocautery ablation, laser adenoidectomy, and microdebrider-assisted adenoidectomy. Curettage technique that is widely used currently, remains quite popular. However, it has various complications, such as incomplete removal, trauma to underlying tissues and hemorrhage [3]. Endoscopes began to be utilized in adenoidectomy operations to ensure full removal of the adenoid bulk, achieve better hemostatic control with enhanced visualization and prevent possible damage [4]. Eustachian tube dysfunction is most commonly caused by mechanical obstruction of the tubal orifice, insufficient swallowing and inflammation in the nasopharyngeal mucosa [5]. Eustachian dysfunction can develop due to surgical trauma, edema in surrounding tissues and clots in early period following adenoidectomy surgery performed with curettage technique. Middle ear pressure is affected in early period after adenoidectomy in adenoid hypertrophy patients with normal middle ear pressure. Our study aims to analyze the changes in middle ear pressure in early period after adenoidectomy in children with adenoid hypertrophy [6]. Our aim of this work is to compare between two different techniques of adenoidectomy: endoscopic microdebriderassisted, coblation, and conventional adenoidectomy and its effect on middle ear pressure. Methods This prospective randomized study was conducted on 90 patients with symptomatic adenoid hypertrophy such confirmed by nasopharyngeal X-ray and endoscopic grading preoperatively. Patients were selected from general population including patients reporting to Otorhinolaryngology outpatient clinics of Al-Azhar University hospitals during the period from January 2022 to January 2023. It is approved by the ethical committee of the University with ethical No. (412/ENT/2022). Inclusion criteria were only children aged from 3 to 12 years old with symptomatic adenoid hypertrophy, children with sleep disordered breathing due to adenoid hypertrophy, tonsillectomy candidates that were assessed for the presence of asymptomatic adenoid hypertrophy, and these patients had no history of attack of otitis media in the last 6 months. Exclusion criteria were patients having significant nasal obstruction due to other causes such as: (allergic rhinitis, septal deviation, hypertrophied inferior turbinates or sinonasal polyps), patients with congenital nasal or maxillofacial anomalies such as: cleft lip and palate, choanal atresia, retrognathia or macrognathia, or patients with coagulation 13 disorder, plus patients with past history of myringotomy, grommet tube, recurrent otitis media with effusion. Patients were subjected to the following: (1) detailed history taking and clinical examination. (2) radiological evaluation of the adenoid by X-ray lateral view on the nasopharynx. (3) endoscopic grading of adenoid size using flexible endoscopy (4) tympanometry for all patients. Preoperatively, before general anesthesia fiberoptic adenoid endoscopy was done with a 2.7 mm fiberoptic endoscope (Karl Storz, Germany). The aim of this examination is to detect the adenoid size grading as four grades as following: when only upper part of nasopharynx (free choanae) occupied by adenoid mass was classified as grade 1 (≤ 25%). Adenoid tissue occupied equal or less than 50% of nasopharynx with sufficient choanal opening and sufficient tubal visualization was clas (...truncated)