Coblation Adenoidectomy Versus Conventional Adenoidectomy: A Comparative Study of two Different Techniques of Adenoidectomy

Original Article Iranian Journal of Otorhinolaryngology, Vol.37(4), Serial No.141, Jul-2025 Coblation Adenoidectomy Versus Conventional Adenoidectomy: A Comparative Study of two Different Techniques of Adenoidectomy * Dianitta-Devapriya Veronica1, Prabaakharan Jambunathan1 Abstract Introduction: Chronic nasal obstruction, frequent respiratory infections, recurrent ear blocks, earaches, and pediatric obstructive sleep apnea may indicate adenoid enlargement, one of the most common conditions encountered in pediatric otorhinolaryngology practice. Adenoidectomy is a simple procedure with certain limitations, which has led to various innovations in surgical techniques in the recent past. The study aimed to compare two different adenoidectomy techniques: the endoscopy-assisted coblation adenoidectomy and the conventional curettage adenoidectomy. Materials and Methods: In this prospective randomized interventional study involving 40 patients, 20 patients in Group A underwent curettage adenoidectomy, and 20 patients in Group B underwent endoscopic coblation adenoidectomy. Complete adenoid tissue removal, surgical blood loss, operative duration, postoperative pain, and recovery time are the outcome measures. Results: Endoscopy-assisted coblation adenoidectomy enabled complete adenoid removal better than conventional adenoidectomy, 15 patients (75%) had complete removal versus 3 patients (15%) in the conventional group (p-value of 0.0003). The mean blood loss was 30 ± 5.60 mL in Group A and 10.75 ± 2.93 mL in Group B (p = 0.0001). The pain score assessed using the visual analog scale was 4 ± 0.44 in Group A and 3 ± 0.36 in Group B (p = 0.0001). The mean time taken for recovery in Group A was 3.14 ± 0.62 days and that in Group B was 2.64 ± 0.64 days (p = 0.001). Conclusions: Coblation adenoidectomy under endoscopic guidance enabled complete adenoid removal, reduction in surgical blood loss and postoperative pain, and shortened recovery time. Keywords: Adenoidectomy, Radiofrequency ablation, Endoscopy, Curettage, Postoperative pain. Received date: 26 Dec 2024 Accepted date: 29 May 2025 *Please cite this article; Veronıca DD, Prabaakharan J. Coblation Adenoidectomy Versus Conventional Adenoidectomy: A Comparative Study of two Different Techniques of Adenoidectomy. Iran J Otorhinolaryngol. 2025:37(4):179-186. Doi: 10.22038/ijorl.2025.84811.3855 1 Department of Otorhinolaryngology and Head and Neck Surgery, ACS Medical College Hospital, Dr. MGR Educational and Research Institute, Chennai-India. *Corresponding Author: E-mail: Copyright©2025 Mashhad University of Medical Sciences. This work is licensed under a Creative Commons Attribution-Noncommercial 4.0 International License https://creativecommons.org/licenses/by-nc/4.0/deed.en 179 Veronıca DD and Prabaakharan J Introduction Symptoms such as persistent nasal obstruction, mouth breathing, snoring, and frequent ear blocks in pediatric patients may indicate adenoid enlargement. Chronic adenoiditis can lead to Eustachian tube dysfunction, resulting in otitis media with effusion. Additionally, chronic adenoiditis can act as a focal point for infections, contributing to recurrent respiratory issues and other dermatological conditions. These problems can lead to poor appetite, malnutrition, and growth retardation, which in turn can affect a child's concentration and school performance. Children with enlarged adenoids usually present with characteristic adenoid facies. In addition, high-grade adenoid hypertrophy can cause obstructive sleep apnea and eventually result in cor pulmonale (1). While adenoid enlargement is physiological, children with airway compromise or issues with facial skeleton development require it to be addressed surgically. Adenoid hypertrophy can be effectively treated with intranasal corticosteroids (2). However, surgery should be considered when medical treatments are unsuccessful. Simple curettage adenoidectomy has been a longstanding procedure, first pioneered by Hans Wilhelm Meyer in the 19th century, and has evolved significantly over the last century (3). The widespread use of endoscopes in ENT surgeries has led to coblation adenoidectomy under endoscopic guidance in recent days. Controlled ablation is the principle by which coblation technology works and the tissue volume is reduced by cellular disintegration at the molecular level (4). In contrast, conventional adenoidectomy is a blind procedure that can accidentally injure adjacent structures and may leave behind residual adenoid tissue, which can lead to recurrence (5). The endoscopic approach can mitigate this risk by enabling the clear visualization of adjacent structures, thereby minimizing the risk of injury during the complete removal of the adenoid. Endoscopy-assisted coblation technique is superior because it avoids tissue explosion; instead, it breaks down tissues at the molecular level into simpler hydrocarbons. The study aimed to compare endoscopy-assisted coblation adenoidectomy with conventional curettage adenoidectomy. Materials and Methods Upon ethical committee approval (21/2016), this prospective randomized interventional study was conducted over a duration of 12 months from July 2016 to June 2017 with a sample size of 40 patients, and the sample size was based on the study by Businco et al. (6). The flow of participants is shown in Fig 1. Fig 1: Consort Flow Chart 180 Iranian Journal of Otorhinolaryngology, Vol.37(4), Serial No.141, Jul-2025 Conventional and Coblation Adenoidectomy Patients aged over 5 years and under 15 years with characteristic symptoms such as mouth breathing and snoring were included in the study after ensuring that they did not have any tonsilrelated complaints and tonsillar enlargement was less than 25%. These patients underwent a softtissue X-ray of nasopharynx in the lateral view with their mouths open and endoscopic assessment of adenoid hypertrophy. The Clemens and McMurray scale helped to grade adenoid enlargement, as follows: Grade I adenoid tissue occupying 1/3 of the vertical height of the choana; Grade II - up to 2/3; Grade III - from 2/3 to nearly all but not complete choanal obstruction; Grade IV - complete choanal obstruction. The selected patients were categorized by systematic random sampling into two groups (A and B), with 20 patients in each group. Group A patients underwent conventional curettage adenoidectomy, and Group B patients underwent endoscopy-assisted coblation adenoidectomy. Syndromic children, children with a previous history of adenoidectomy, history of bleeding disorders, history of congenital heart diseases, and oromaxillofacial anomalies were excluded from the study. Surgical Technique: Conventional curettage adenoidectomy was performed with the patient positioned in Sister Rose’s position using St.Clair Thompson adenoid curette. With the patient in supine position, coblation adenoidectomy was performed using the coblation wand. During the procedure, a pediatric 0-degre (...truncated)