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The operative indications for adenoidectomy should be based on a positive history, physical examination, and laboratory tests. There are three clear indications for adenoidectomy: first, proved obstruction of the eustachian tube resulting in recurrent otitis media; second, partial upper airway obstruction resulting in cor pulmonale; and third, prov...
Citations
Modern assessment of the tonsils and adenoids is based on an appreciation of new concepts pertaining to the pathogenesis of tonsil and adenoid disease. Recognition of the emergence of beta-lactamase-producing and encapsulated anaerobic bacteria in the tonsils and adenoids should lead to a reconsideration of present therapeutic recommendations for antibiotic therapy in infectious tonsil and adenoid disease. The performance of a precise history, use of a standardized physical examination, and judicious use of laboratory evaluation are all necessary for appropriate patient management and improved communication between the pediatrician and otolaryngologist. Thus, appropriate recommendation for tonsillectomy and adenoidectomy will enhance their benefits, and the result will be happier and healthier children.
The relationship between adenoidal-nasopharyngeal ratios (AN ratios) and sinusitis were evaluated in 404 children. The AN ratios of children with snoring, mouth breathing, or nasal obstruction (major symptoms of adenoidal enlargement) were significantly higher than those of children without these symptoms. However, the AN ratios of children with sinusitis were almost equal to those of normal children.
Of 242 children and teenagers treated surgically for chronic secretory otitis media in 1972, 212 presented for evaluation 5 years later. Although the pure-tone audiometric threshold was 20 dB HL or better in 87.7% of the ears, only 40.6% were judged to be otoscopically normal. The findings at the first myringotomy for insertion of tympanostomy tubes were of no prognostic value for the course of the disease, and the presence of characteristics of middle ear fluid at subsequent myringotomies varied unpredictably. Adenoidectomy performed at an early stage, and in the presence of nasal obstruction, resulted in a significant reduction in the need for re-insertion of tympanostomy tubes.
We sought to examine the relationship between adenoid volume and the stage of rhinosinusitis, as well as the relationship between age and adenoid size.
Forty-two children complaining of nasal discharge, whose paranasal sinus computed tomographic scans had been obtained, were involved in the study. The patients with adenoid enlargement underwent adenoidectomy. The volumes of adenoid vegetation were measured in square centimeters, and paranasal sinus computed tomographic scans were classified according to the Lund-Mackay staging system.
No statistically significant difference existed between patients whose Lund-Mackay scores were 0 and those with scores greater than 0. There seems to be no correlation between the Lund-Mackay score and the degree of adenoid vegetation.
Adenoid vegetation may cause nasal discharge that is not necessarily due to sinusitis. We could not find any supportive data for the statement "The greater the adenoid tissue, the more extensive the sinusitis."
