Fact-checked by Grok 2 weeks ago

Adenoidectomy

An adenoidectomy is a surgical procedure involving the removal of the adenoids, which are masses of lymphoid tissue located in the nasopharynx at the back of the nasal passage, serving as part of the body's immune system in children.^[1] This common pediatric operation, one of the most frequently performed surgeries in young patients, addresses conditions such as chronic nasal obstruction, recurrent ear infections, and sleep-disordered breathing caused by adenoid enlargement or infection.^[2] Pioneered in the 19th century by Danish physician Hans Wilhelm Meyer, the procedure has evolved with modern techniques to minimize risks and improve outcomes.^[1] The primary indications for adenoidectomy include obstructive sleep-disordered breathing (SDB) due to adenoid hypertrophy, otitis media with effusion persisting for more than three months, and recurrent acute otitis media (defined as at least three episodes in six months or four in twelve months).^[3] It may also be recommended for chronic rhinosinusitis lasting at least 90 days with symptoms like nasal obstruction and purulent discharge, though these are less common.^[3] Evidence from systematic reviews supports its efficacy: for instance, adenoidectomy, particularly when combined with tonsillectomy, resolves SDB in non-obese children under seven with moderate obstructive sleep apnea (OSA) and small tonsils, with adenotonsillectomy achieving a 79% success rate in reducing the apnea-hypopnea index below two events per hour; adenoidectomy alone has comparable long-term outcomes in select cases.^[3] For ear-related issues, it increases resolution of otitis media with effusion by 27% at six months and reduces the need for repeat tympanostomy tubes from 36% to 17% in children aged four and older.^[3] The procedure is typically performed under general anesthesia as an outpatient surgery lasting about 30 minutes, often using a mouth gag for access and techniques such as curettage, suction diathermy, microdebrider, coblation, or laser for precise removal while preserving surrounding structures like the Eustachian tube openings.^[1]^[2] Postoperatively, patients experience mild to moderate throat pain, nasal stuffiness, and bad breath for 1-2 weeks, with full recovery usually within that timeframe; children are advised to consume soft, cold foods and avoid strenuous activity.^[2] Complications are rare but can include postoperative bleeding (0.5-2% incidence), infection, velopharyngeal insufficiency (affecting speech in 1 in 1,500-10,000 cases, often transient), and adenoid regrowth requiring revision in a small subset of patients.^[3] Despite these risks, adenoidectomy does not significantly impair immune function, as the adenoids naturally atrophy by adolescence.^[2]

Anatomy and Pathophysiology

The Adenoids

The adenoids, also known as the nasopharyngeal tonsils, are a mass of lymphoid tissue located on the posterior wall and roof of the nasopharynx. They form a key component of Waldeyer's ring, a circular arrangement of lymphoid structures that also includes the palatine tonsils, tubal tonsils, and lingual tonsil, collectively serving as a first line of defense in the upper respiratory and digestive tracts.^[4]^[5] Adenoids undergo significant developmental changes throughout life. They begin to enlarge shortly after birth, reaching their peak size between ages 6 and 8 years, with a typical thickness of 12-14 mm at this stage. Following this period, the adenoids gradually atrophy after puberty, often becoming negligible or absent in adults by the late teens or early twenties.^[6]^[7]^[8] Physiologically, the adenoids play a crucial role in childhood immunity, particularly in the upper respiratory tract. Composed primarily of B and T lymphocytes, they trap inhaled pathogens, facilitate antigen presentation, and produce antibodies to support both mucosal and systemic immune responses. This function is most prominent during early childhood when exposure to environmental antigens is high.^[4]^[9]^[10] Anatomically, the adenoids are situated in close proximity to the Eustachian tube openings, the soft palate, and the nasal cavity, influencing airflow and middle ear ventilation. Their blood supply is primarily derived from the ascending pharyngeal artery, with contributions from the palatine and maxillary arteries, while venous drainage occurs via the pharyngeal plexus. Innervation is provided by branches of the glossopharyngeal (IX) and vagus (X) nerves through the pharyngeal plexus.^[4]^[11]^[6] Diagnostic imaging of the adenoids typically involves lateral nasopharyngeal X-rays, where the adenoidal-nasopharyngeal (A/N) ratio is calculated by dividing the adenoid thickness by the nasopharyngeal depth; a ratio greater than 0.8 suggests hypertrophy. Flexible nasopharyngoscopy provides direct visualization, allowing for detailed assessment of size, surface characteristics, and any obstructive effects on adjacent structures.^[6]^[12]^[13]

Conditions Leading to Adenoidectomy

Adenoid hypertrophy refers to the abnormal enlargement of the adenoid tissue in the nasopharynx, which can obstruct airflow and lead to various respiratory and auditory symptoms. This condition primarily affects children between the ages of 2 and 7 years, with a prevalence of approximately 34.5%, though it often regresses spontaneously by adolescence. The hypertrophy obstructs the nasopharynx, resulting in nasal congestion, chronic mouth breathing, snoring, and hyponasal speech due to impaired nasal resonance. Common causes include chronic inflammation from repeated upper respiratory infections, allergic rhinitis, and environmental irritants such as cigarette smoke, which promote lymphoid tissue proliferation and mucosal edema.^[6] Recurrent adenoid infections, or chronic adenoiditis, arise from persistent bacterial colonization and biofilm formation on the adenoid surface, creating a nidus for ongoing inflammation. Biofilms, composed of extracellular matrices harboring pathogens, shield bacteria from host defenses and antibiotics, leading to treatment-resistant infections lasting over 90 days. Predominant bacteria include Streptococcus pneumoniae and Haemophilus influenzae, which form polymicrobial communities and contribute to recurrent rhinosinusitis and adenoiditis through continuous exudation and tissue irritation. This pathophysiology is exacerbated in children with frequent viral upper respiratory infections, fostering superinfections and lymphoid hyperplasia.^[14]^[15] Adenoid hypertrophy is closely associated with otitis media through mechanical and infectious mechanisms involving the Eustachian tube. Enlarged adenoids physically block the nasopharyngeal openings of the Eustachian tubes, causing negative middle ear pressure, impaired mucociliary clearance, and accumulation of sterile or infected effusion. This leads to recurrent acute otitis media (AOM), defined as three or more episodes in six months, as well as persistent middle ear inflammation. Additionally, adenoids serve as a bacterial reservoir, with biofilms of H. influenzae and S. pneumoniae disseminating pathogens to the middle ear via retrograde migration, perpetuating the cycle of effusion and infection. Approximately 90% of children experience at least one episode of otitis media with effusion before school age, often linked to this adenoidal dysfunction.^[16]^[15] Obstructive sleep-disordered breathing (SDB) in children frequently stems from adenoid hypertrophy causing partial upper airway obstruction during sleep. The enlarged tissue narrows the nasopharynx, increasing upper airway resistance and leading to turbulent airflow, hypopnea, and apneic events characterized by oxyhemoglobin desaturation and hypercapnia. Diagnosis relies on polysomnography, the gold standard, which measures an obstructive apnea-hypopnea index (AHI) greater than 1 event per hour as indicative of obstructive sleep apnea within the SDB spectrum. This obstruction disrupts normal sleep architecture, contributing to daytime fatigue, behavioral issues, and growth delays in affected children.^[17]^[18] Beyond these primary associations, adenoid hypertrophy plays a role in otitis media with effusion (OME), commonly known as glue ear, where persistent Eustachian tube blockage results in viscous middle ear fluid accumulation without acute infection, affecting up to 80% of children by age four. The adenoids contribute by serving as a site for bacterial persistence and by mechanically impeding tube ventilation, leading to hearing impairment and developmental delays if chronic. Furthermore, prolonged nasopharyngeal obstruction prompts habitual mouth breathing, which alters craniofacial growth patterns over time, resulting in adenoid facies—a characteristic long, narrow face with an open mouth posture, high-arched palate, and mandibular retrusion due to dysfunctional perioral muscles and atypical tongue positioning. This vicious cycle of hypertrophy and mouth breathing exacerbates malocclusions and increases anterior facial height in susceptible children.^[19]^[20]

Indications and Contraindications

Primary Indications

Adenoidectomy is primarily indicated for obstructive sleep apnea (OSA) in children when adenoid hypertrophy contributes significantly to nasopharyngeal airway obstruction, and conservative management such as watchful waiting or medical therapy has failed. According to the American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) clinical practice guidelines, surgery is recommended for pediatric OSA with symptoms including witnessed apneas, snoring, or daytime somnolence persisting for at least three months, particularly when adenotonsillar hypertrophy is the predominant factor.^[21] Polysomnography is advised to confirm diagnosis in high-risk cases before proceeding.^[21] For infectious indications, adenoidectomy is warranted in cases of recurrent or chronic rhinosinusitis unresponsive to maximal medical therapy, defined as symptoms lasting 90 days or more, or at least four episodes per year, following trials of antibiotics and intranasal corticosteroids.^[21] For recurrent acute otitis media (AOM), adenoidectomy may be considered when adenoid hypertrophy is a contributing factor, particularly after failure of medical management and often in conjunction with myringotomy tube placement, per general pediatric guidelines for recurrent infections (e.g., ≥3 episodes in 6 months or ≥4 in 12 months).^[22] These thresholds ensure intervention targets persistent adenoiditis contributing to infection cycles. Otologic indications include persistent otitis media with effusion (OME) lasting more than three months in children aged four years or older, where adenoid hypertrophy is the primary obstructing factor.^[21] The AAO-HNS guidelines recommend against routine adenoidectomy for OME in children under four years unless distinct nasal obstruction is present, prioritizing tympanostomy tubes or observation first (2016 guideline).^[23] Adenoidectomy is frequently combined with tonsillectomy for adenotonsillar hypertrophy causing OSA. Randomized controlled trials support 70-90% resolution of OSA symptoms post-adenotonsillectomy, though polysomnographic normalization may be lower at 60-80%, underscoring the procedure's efficacy after conservative approaches.^[24] The 2019 AAO-HNS tonsillectomy guidelines emphasize initial nonsurgical management for mild cases before considering combined procedures.^[25]

Contraindications

Adenoidectomy has no universally recognized absolute contraindications, though certain conditions may preclude the procedure due to excessive perioperative risks. These include uncontrolled bleeding disorders, such as hemophilia with factor VIII or IX levels below 50% despite replacement therapy, which significantly elevate the risk of intraoperative or postoperative hemorrhage.^[26]^[1] Active, untreated upper airway infections represent another absolute barrier, as they increase the likelihood of surgical site complications and dissemination of infection under anesthesia.^[1] Severe craniofacial anomalies that distort nasopharyngeal anatomy, such as Pierre Robin sequence with associated micrognathia and glossoptosis, also contraindicate the procedure due to challenges in airway management and access to the adenoid bed.^[27]^[28] Relative contraindications warrant careful risk-benefit assessment and may necessitate modifications or deferral of surgery. Significant bleeding diathesis, even if partially correctable, requires preoperative optimization but remains a cautionary factor given the vascularity of the adenoid tissue.^[29]^[1] Immunosuppressed states, such as those induced by active chemotherapy, heighten susceptibility to infection and impaired wound healing, making adenoidectomy relatively inadvisable without multidisciplinary input.^[25] Neuromuscular disorders that amplify anesthesia risks, including respiratory compromise, further qualify as relative contraindications, particularly in patients with baseline instability.^[25] Children under 2 years of age face higher complication rates, including bleeding and airway events, due to smaller anatomical structures and immature physiology, often leading to deferral unless benefits clearly outweigh risks.^[30]^[31] Preoperative evaluation employs specific tools to mitigate these risks. Coagulation studies, including prothrombin time (PT), partial thromboplastin time (PTT), and platelet count, are essential for patients with bleeding history to identify and address diatheses.^[26] For those with obstructive sleep apnea (OSA), the STOP-BANG questionnaire assesses perioperative respiratory risks, guiding anesthesia planning and potential inpatient monitoring.^[32] In special populations, additional caution applies. Adenoidectomy is rarely indicated in adults owing to natural adenoid atrophy after adolescence, limiting its utility beyond exceptional cases like persistent infection.^[29] Patients with a history of velopharyngeal incompetence (VPI), often linked to submucous cleft palate, short palate, or syndromes like velocardiofacial, risk exacerbation of hypernasal speech and nasal regurgitation post-removal; partial adenoidectomy or conservative management is preferred in such instances.^[1]^[29] The American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) emphasizes shared decision-making for borderline cases, recommending thorough discussion of benefits versus risks, particularly in high-risk groups like those with comorbidities or young age (as of 2019 guidelines).^[21]^[25]

Surgical Procedure

Preoperative Evaluation and Preparation

The preoperative evaluation for adenoidectomy begins with a comprehensive history and physical examination conducted by an otolaryngologist (ENT specialist) to assess the necessity of surgery and identify any associated conditions. The history focuses on symptoms such as recurrent otitis media with effusion, obstructive sleep-disordered breathing, chronic rhinosinusitis, nasal obstruction, hyponasal speech, or sleep disturbances lasting at least three months, often corroborated by parental reports or sleep diaries.^[1]^[21] A detailed ENT physical exam includes inspection of the oral cavity, palate, tonsils, and nasal airway, with nasopharyngoscopy using a flexible fiberoptic endoscope to directly visualize adenoid hypertrophy and grade its size relative to the nasopharynx—commonly employing a scale from 0 (no obstruction) to 4+ (complete airway obstruction, occupying over 75-100% of the nasopharyngeal space).^[33]^[1] Additional components involve audiometry to evaluate for conductive hearing loss due to middle ear effusion and a sleep history to document snoring, apnea episodes, or daytime somnolence.^[21]^[1] Diagnostic tests are tailored to confirm adenoid enlargement and rule out alternative causes. Flexible fiberoptic nasopharyngoscopy remains the gold standard for direct assessment of adenoid size and position, often supplemented by cephalometric X-rays or lateral neck radiographs to quantify the adenoid-nasopharyngeal ratio (AN ratio), where values greater than 0.80 are often associated with significant hypertrophy.^[33]^[21]^[34] For patients with suspected obstructive sleep apnea (OSA), polysomnography is recommended to objectively measure apnea-hypopnea index and oxygen desaturation, particularly in cases of severe symptoms or comorbidities.^[1] If chronic rhinosinusitis or allergic contributions are suspected, allergy testing such as skin prick tests or serum IgE levels may be performed to guide management.^[21] Medical optimization is essential to verify that surgery is warranted after conservative measures fail. A trial of intranasal corticosteroids, such as mometasone or fluticasone, administered for 4-8 weeks, is often attempted to reduce adenoid size and alleviate symptoms like nasal obstruction, with studies showing significant improvement in up to 70% of cases without proceeding to surgery.^[35] Antibiotics (e.g., amoxicillin-clavulanate for β-lactamase stable coverage) are prescribed for documented bacterial infections or persistent adenoiditis following at least two prior courses, lasting 2-4 weeks each.^[21] Anesthesia planning involves a multidisciplinary approach to ensure safety, especially in pediatric patients. Preoperative laboratory tests are generally not required for healthy children but may be considered for screening anemia with a complete blood count (CBC) or coagulation studies (e.g., PT/PTT) if there is a personal or family history of bleeding disorders.^[33]^[36] For patients with comorbidities, such as those with Down syndrome who may have congenital heart defects, cardiology consultation is obtained to optimize cardiac status and assess perioperative risks.^[1]^[37] Patient education and informed consent are critical components of preparation to align expectations and reduce anxiety. Families receive detailed information on the procedure, including its indications (e.g., persistent adenoid hypertrophy causing airway obstruction or recurrent infections), potential risks such as bleeding or infection, and nonsurgical alternatives like ongoing medical therapy.^[21]^[1] Standard instructions cover preoperative fasting (typically nil per os after midnight for solids, clear liquids up to 2 hours prior), medication adjustments (e.g., avoiding aspirin for 7-10 days), and anxiety management strategies, such as oral premedication with midazolam (0.5 mg/kg) for children.^[36]^[38]

Intraoperative Techniques

Adenoidectomy is performed under general anesthesia with endotracheal intubation to secure the airway and facilitate surgical access to the nasopharynx.^[39]^[40] The standard transoral approach involves the use of an adenoid curette, such as the Blair or Parkinson model, to scrape and remove adenoid tissue from the nasopharynx under direct visualization with a laryngeal mirror or indirectly.^[41]^[42] Hemostasis is achieved through packing with gauze or the application of electrocautery to control bleeding from the surgical bed.^[43] The procedure typically lasts 15 to 30 minutes.^[2]^[44] Advanced techniques include endoscopic-powered adenoidectomy using a microdebrider, which allows for precise tissue removal under direct visualization and reduces the incidence of residual adenoid tissue to approximately 20% compared to higher rates with conventional methods.^[45]^[46] Coblation, employing radiofrequency ablation, minimizes thermal injury to surrounding tissues while achieving effective ablation.^[47]^[48] In selective cases, a transnasal endoscopic approach may be utilized for targeted removal, particularly when addressing specific anatomical challenges.^[49] Adjunctive procedures are commonly performed concurrently; myringotomy with tympanostomy tube placement addresses otitis media with effusion by ventilating the middle ear, and tonsillectomy is combined in adenotonsillectomy, which accounts for the majority of cases involving adenoid removal.^[50]^[51] Quality control during surgery involves intraoperative endoscopy to confirm complete adenoid removal, ensuring no visible tissue remnants and evaluating velopharyngeal closure to prevent postoperative issues.^[52]^[53]

Immediate Postoperative Management

In the immediate postoperative period following adenoidectomy, patients are typically monitored in a recovery room for 1 to 2 hours to assess vital signs, including heart rate, blood pressure, oxygen saturation, and respiratory effort, to ensure stability after anesthesia emergence. Adenoidectomy is commonly performed as outpatient day surgery, with studies as of 2025 confirming feasibility and low rates of unplanned admissions in appropriate candidates.^[54] Observation focuses on signs of bleeding, such as hematemesis or epistaxis, which can compromise the airway, and any respiratory distress; if bleeding occurs, immediate intervention by the surgical team is required.^[21] Pain management begins with scheduled doses of acetaminophen (10-15 mg/kg every 4-6 hours) or ibuprofen (5-10 mg/kg every 6 hours), alternating as needed, while avoiding aspirin due to the risk of bleeding; opioids like codeine are generally discouraged in children owing to potential respiratory depression.^[36]^[50] Airway management involves elevating the head of the bed to 30 degrees to minimize swelling and facilitate drainage, with humidified oxygen supplementation provided if oxygen saturation falls below 92%; suctioning of oral secretions may be necessary to maintain patency.^[50] Discharge criteria from the recovery area or same-day surgery unit include the patient being alert and oriented, maintaining stable vital signs for at least 1 hour, tolerating oral intake without vomiting, achieving adequate pain control, and demonstrating the ability to void. For younger children (under 3 years) or those with comorbidities, an overnight observation period may be warranted to monitor for delayed airway issues. Dietary instructions emphasize hydration to prevent dehydration, starting with clear liquids such as water, apple juice, or electrolyte solutions, and advancing to soft foods like applesauce or yogurt within the first 24 hours as tolerated; dairy products should be limited initially, as they can increase mucus production and exacerbate throat discomfort.^[55] Patients are encouraged to sip fluids frequently, aiming for at least 1-2 liters per day in children, to promote healing and reduce the risk of scab dislodgement.^[50] Common early symptoms in the first 24-48 hours include throat pain that typically peaks on postoperative days 1-2, managed with the aforementioned analgesics, a low-grade fever below 38.5°C (101.3°F) due to inflammatory response, and halitosis resulting from scab formation in the nasopharynx.^[50] These symptoms are self-limiting but warrant monitoring; persistent fever above 38.5°C or increasing pain should prompt contact with the healthcare provider.^[21] Follow-up is scheduled for 1-2 weeks postoperatively to evaluate wound healing, assess for residual infection or bleeding, and perform a hearing reevaluation if preoperative otitis media with effusion was present, ensuring optimal recovery outcomes.^[21]

Complications and Recovery

Potential Complications

Adenoidectomy is generally a safe procedure with an overall postoperative complication rate of approximately 2-5%, primarily involving minor issues that resolve without intervention.^[56] Recent studies as of 2025 confirm overall low complication rates, with revision surgery for bleeding at 0.7% for isolated adenoidectomy, and emphasize the safety of day surgery approaches.^[57] Technique choice influences risks, with coblation associated with lower bleeding than curettage.^[47] Serious complications are uncommon, occurring in less than 2% of cases, and perioperative mortality is extremely rare, estimated at less than 1 in 10,000 procedures for pediatric ear, nose, and throat surgeries.^[58] Risk factors such as young age, concurrent tonsillectomy, and underlying conditions like vascular anomalies or immunosuppression can elevate specific risks.^[59] Hemorrhage represents the most frequent serious complication, divided into primary (intraoperative or within 24 hours postoperatively) and secondary (typically days 1-7). Primary hemorrhage occurs in less than 1% of cases and is usually managed with cautery or packing during surgery.^[60] Secondary hemorrhage affects 0.5-3% of patients, often requiring return to the operating room for control, with incidence rates as low as 0.1-0.2% in large cohorts necessitating readmission or reoperation.^[56]^[61] Risk factors include older age and anatomical variations like aberrant vessels.^[62] Postoperative infection, including wound infection or transient bacteremia, is infrequent at less than 1%, with rates around 0.3% leading to outpatient evaluation or readmission.^[56] It is managed conservatively with antibiotics, though incidence may rise in immunocompromised children.^[63] Velopharyngeal insufficiency (VPI), characterized by nasal regurgitation or hypernasal speech due to excessive adenoidal resection, carries a 1-5% risk, with transient symptoms appearing in up to 3-14% shortly after surgery but persisting in only about 1 in 1,500 cases.^[64]^[65] Approximately 50% of cases resolve spontaneously within 6 months, while persistent VPI may require speech therapy or secondary surgical correction such as pharyngeal flap reconstruction.^[66] Anesthesia-related complications, such as laryngospasm or aspiration, are rare, contributing to the low overall perioperative mortality.^[63] In higher-risk pediatric populations, respiratory adverse events occur in 2-3% but are mitigated by careful monitoring.^[67] Other complications include dental injury from the mouth gag (approximately 0.1%), nasopharyngeal stenosis (<1%), and adenoidal regrowth (1-2% in children under 5 years, often asymptomatic).^[68]^[69] These are managed supportively or with revision surgery if symptomatic, with regrowth more common after incomplete initial resection.^[70] Techniques like curettage may slightly increase certain risks compared to coblation, though overall rates remain low.^[47]

Recovery Process and Long-term Outcomes

Following adenoidectomy, patients typically experience short-term recovery involving pain management for 3 to 7 days, with discomfort often peaking around days 3 to 5 due to throat and ear soreness from referred pain.^[71]^[72] Analgesics such as acetaminophen or ibuprofen are recommended regularly during this period to control symptoms and promote rest. Most children can return to school or work within 5 to 10 days, provided they are no longer requiring frequent pain medication and feel generally well.^[2]^[73] Activity restrictions include avoiding strenuous exercise or contact sports for at least 2 weeks to prevent bleeding or strain on the surgical site.^[73] Symptom resolution occurs progressively, with improvements in nasal breathing and reduction in snoring often noticeable within 1 week as swelling subsides, though full resolution may take up to 2 weeks.^[74] In cases of otitis media with effusion (OME), hearing recovery is typically achieved by 1 month postoperatively, with success rates of 80% to 90% reported in clinical studies evaluating middle ear function restoration.^[75]^[76] Long-term outcomes demonstrate sustained benefits, including significant reductions in the apnea-hypopnea index (AHI), with mean decreases of approximately 3-14 events per hour reported in pediatric cohorts following adenoidectomy, though success rates vary and residual OSA may persist in many cases.^[77] Adenoidectomy also lowers the recurrence of acute otitis media (AOM) by about 40%, as evidenced by reduced episode frequency in follow-up evaluations.^[78] Persistent issues, such as minor voice changes due to hypernasality, are rare and usually resolve without intervention.^[79] Monitoring during recovery involves parental education on warning signs, including fever exceeding 39°C (102°F) or excessive bleeding from the nose or mouth, which warrant immediate medical attention to rule out dehydration or infection.^[80] Audiologic follow-up is recommended at 3 months to assess hearing improvements, particularly in OME cases.^[80]^[82] Longitudinal studies confirm these benefits persist up to 5 years, with significant quality-of-life enhancements, including improved sleep quality as measured by the OSA-18 questionnaire in affected children.^[83]^[84]

Epidemiology and History

Frequency and Demographics

Adenoidectomy is one of the most common pediatric surgical procedures in the United States, with an estimated 129,000 procedures performed annually.^[85] This figure reflects data from the early 2010s, though rates have shown variability, including temporary declines during the COVID-19 pandemic due to reduced elective surgeries.^[86] Worldwide, adenoidectomy rates among children vary significantly, though precise global estimates are challenging due to reporting differences.^[87] Demographically, adenoidectomy predominantly affects young children, with the highest incidence in the 3- to 5-year age group, accounting for the majority of cases.^[87] The median age at surgery is around 4 years, and over 80% of procedures occur in children under 7 years old.^[57] There is a slight male predominance, with a male-to-female ratio of approximately 1.5:1.^[57] As of 2025, large cohort studies confirm low complication and revision rates (1.4%), supporting its safety in this demographic.^[57] Rates are notably higher in populations with elevated prevalence of related conditions like otitis media, such as Indigenous communities, where adenoid hypertrophy is more pronounced and contributes to increased surgical needs.^[88] Historical trends indicate a peak in the 1970s, when over 1 million combined tonsillectomy and adenoidectomy (T&A) procedures were performed annually in the US.^[29] By the 2010s, rates had declined by about 50%, largely due to evidence-based guidelines that reduced overuse for infectious indications, dropping from 2.20 to 1.46 procedures per 1,000 children.^[89] As of the early 2020s, 70-80% of adenoidectomies are combined with tonsillectomy, reflecting overlapping indications like obstructive sleep apnea.^[90] Geographic variation is substantial, with higher frequencies in developed countries compared to lower rates in resource-limited settings where access to specialized care is restricted. Internationally, (adeno)tonsillectomy rates range widely across countries, for example from 23 to 293 per 100,000 in a review of 31 countries, highlighting disparities in healthcare infrastructure and diagnostic practices.^[91]^[92] Several factors influence adenoidectomy frequency, including socioeconomic status, which affects access to ear, nose, and throat (ENT) specialists and timely interventions.^[93] Seasonal peaks occur post-respiratory infections, particularly in fall and winter, when adenoid inflammation is more common.^[94] Epidemiologically, rising allergies contribute to increased indications, as allergic rhinitis promotes adenoid hypertrophy and related symptoms.^[21]

Historical Development

The adenoids, or pharyngeal tonsils, were first described anatomically in 1661 by German physician Conrad Victor Schneider, who referred to them as vegetations at the roof of the nasopharynx in his treatise De catarrhis. ^[95] Their clinical significance emerged later, with British aural surgeon James Yearsley noting in 1842 a connection between adenoidal hypertrophy and ear diseases, including deafness, after reporting a case where removal of posterior nasal tissue improved hearing. ^[96] The first adenoidectomy was performed in 1868 by Danish otolaryngologist Hans Wilhelm Meyer in Copenhagen, who used a nasal ring knife to remove "adenoid vegetations" in children suffering from nasal obstruction and related auditory issues, marking the procedure's origin as a targeted intervention for respiratory and ear complications. ^[97] Building on this, in 1885, German surgeon Jacob Gottstein introduced the transoral curette, a specialized instrument that allowed for more precise adenoid removal via the mouth, shifting the approach from purely nasal access and facilitating broader surgical adoption. ^[98] By the 1920s, adenoidectomy had achieved widespread use, frequently combined with tonsillectomy (T&A) and often performed without general anesthesia in staged operations to address recurrent infections, driven by the early 20th-century "focus of infection" theory linking tonsillar and adenoidal disease to systemic illnesses. ^[99] This peaked in the mid-1900s, when T&A became a routine procedure in the United States for managing chronic infections in children, reflecting its status as one of the most common surgeries until evidence began questioning its overuse. ^[99] Modern advancements refined the procedure's safety and efficacy, with powered instruments like microdebriders introduced in the 1990s for more controlled tissue removal, followed by endoscopic techniques that minimized complications such as bleeding and incomplete resection. ^[100] Guideline shifts, including the 2004 American Academy of Otolaryngology–Head and Neck Surgery (AAO-HNS) evidence review on otitis media with effusion, helped curb unnecessary procedures by emphasizing selective indications. Key milestones include a 1971 U.S. peak of approximately 50,000 isolated adenoidectomies amid high procedure volumes, and 2019 AAO-HNS updates that prioritized obstructive sleep apnea (OSA) as a primary indication while addressing antibiotic resistance concerns in infection management. ^[99]^[25]

References

[1]
Adenoidectomy - StatPearls - NCBI Bookshelf - NIH
Adenoidectomy is a common surgical procedure primarily performed in children for infectious or obstructive reasons.Continuing Education Activity · Indications · Preparation · Technique or TreatmentMissing: definition | Show results with:definition
[2]
Adenoidectomy (Adenoid Removal): Surgery & Recovery
An adenoidectomy is surgery to remove your child's adenoid glands. Your child may need this surgery if their adenoids have become swollen due to infection ...
[3]
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7100808/
[4]
Anatomy, Head and Neck: Adenoids - StatPearls - NCBI Bookshelf
The adenoids are midline structures situated on the roof and posterior wall of the nasopharynx. They form part of the Waldeyer ring.
[5]
Anatomy and physiology of the palatine tonsils, adenoids, and ... - NIH
The palatine tonsils, adenoids, tubal tonsils, and lingual tonsils are lymphoepithelial tissues that make up the components of Waldeyer's ring, named after the ...
[6]
Adenoid Hypertrophy - StatPearls - NCBI Bookshelf - NIH
May 1, 2023 · Similar to the tonsils, the adenoids are comprised of mucosal-associated lymphoid tissue that can contain germinal centers. The crypt structure ...
[7]
Development of adenoids: a study by measurement with MR images
The adenoids developed rapidly during infancy and reached a plateau between 2- and 14 years of age with a mean thickness ranging from 10.7 to 12.2 mm.
[8]
Age-specific size of the normal adenoid pad on magnetic ... - PubMed
The adenoids were largest in the 7-10 years age group (mean, 14.59 mm) and steadily declined to 4.83 mm by 60 years of age.
[9]
Adenoid hypertrophy in children: a narrative review of pathogenesis ...
Apr 12, 2023 · Adenoids (nasopharyngeal tonsils), being part of Waldeyer's ring, are masses of lymphoid tissues located at the junction of the roof and the ...Immunological Role · Otitis Media With Effusion · Chronic Sinusitis
[10]
Adenoids During Childhood: The Facts - PubMed
They play a major role in the upper airways immunity, being effector organs in both mucosal-type and systemic-type adaptive immunity.
[11]
Tonsil and Adenoid Anatomy - Medscape Reference
Apr 4, 2025 · The adenoid is formed by vertical folds of respiratory epithelium. These folds radiate forward and laterally from a median blind recess, the ...
[12]
Diagnostic Test Value of Assessment Adenoid Enlargement ... - NIH
Feb 3, 2017 · The ratio of adenoid (A) is then compared with nasopharynx (N): it is normal if A/N ratio ≤ 0.8 and is enlarged when A/N ratio > 0.8 [8].
[13]
Comparison Between Radiological Versus Endoscopic Assessment ...
Jun 8, 2019 · After birth, it initially grows rapidly, but usually undergoes a degree of involution and atrophy from the age of 8–10 years [1]. Growth ...Missing: development | Show results with:development
[14]
Adenoiditis - StatPearls - NCBI Bookshelf - NIH
Clinical Anatomy The adenoids receive their blood supply from the ascending pharyngeal, maxillary, and facial arteries. Venous drainage occurs through the ...
[15]
Adenoid Reservoir for Pathogenic Biofilm Bacteria - ASM Journals
Apr 1, 2011 · Haemophilus influenzae was present in more adenoids from the COM group (P = 0.005), but there was no significant difference between the two ...
[16]
Eustachian Tube Dysfunction - StatPearls - NCBI Bookshelf - NIH
Feb 13, 2023 · Patients should be considered for adenoidectomy if adenoid hypertrophy is thought to be the main contributing factor to ETD. This is more common ...Introduction · Etiology · History and Physical · Treatment / Management
[17]
Obstructive Sleep Apnea in Children - AAFP
Mar 1, 2004 · Clinical diagnosis of obstructive sleep apnea is reliable; however, the gold standard evaluation is overnight polysomnography. Treatment ...
[18]
Childhood Sleep Apnea Workup - Medscape Reference
Mar 26, 2024 · The only available tool for definitive diagnosis of obstructive sleep apnea is an overnight polysomnographic evaluation in the sleep laboratory.Approach Considerations · Polysomnography · Apnea Hypopnea Index
[19]
Adenoidectomy for otitis media with effusion (OME) in children - PMC
Adenoidectomy is recommended in particular for those who require repeat ventilating tube surgery (Rosenfeld 2016). For children under four years old, ...Missing: blockage | Show results with:blockage
[20]
Adenoid facies: a long-term vicious cycle of mouth breathing ...
The review summarizes the potential associations and mechanisms linking AH, mouth breathing, and the subsequent development of adenoid facies in children.Missing: glue | Show results with:glue
[21]
Clinical Indicators: Adenoidectomy
Aug 7, 2014 · Adenoid size is immaterial when the indication is sinusitis, adenoiditis, or otitis media with effusion. Allergic symptoms should have been ...Missing: Eustachian blockage
[22]
Clinical Practice Guideline - Rosenfeld - 2016
Feb 1, 2016 · A new recommendation against adenoidectomy for a primary indication ... clinical practice guideline from the AAO-HNS. Rather, discussions ...Differences from Prior Guideline · Purpose · Guideline Key Action Statements
[23]
Management of Persistent, Post-adenotonsillectomy Obstructive ...
Evidence suggests that OSA remission is seen in only 30% of children as they reach adulthood, thus contributing to the huge medical burden of OSA in adults (16) ...
[24]
Adenoidectomy for Obstructive Sleep Apnea in Children - PMC - NIH
Children with apnea-hypopnea index ≥ 10 and/or tonsil size ≥ 3 showed a higher failure rate after adenoidectomy compared to adenotonsillectomy (20% versus 9.8%, ...
[25]
Tonsillectomy and Adenoidectomy | Iowa Head and Neck Protocols
May 1, 2017 · The procedure peaked in the 1970's with approximately one million cases performed per year. In general, we have also witnessed a shift in the ...
[26]
Adenoid involvement in velopharyngeal closure in children with cleft ...
In cleft palate (CP) patients, adenoidectomy is almost universally contraindicated. ... Pierre Robin sequence, <50, +. 8, M, Pierre Robin sequence, 50–75, +. 9, M ...
[27]
Cleft Palate, Pierre Robin, and Tonsillectomy - Ask the Experts 985
Feb 1, 2010 · Every physician and dentist should know that an adenoidectomy is contraindicated in children with cleft palate since the adenoid mass serves as ...
[28]
Adenoidectomy: Background, History of the Procedure, Epidemiology
Nov 5, 2019 · Relative contraindications for total adenoidectomy. See the list below: A severe bleeding disorder, which could be overcome by preoperative, ...
[29]
Tonsillectomy and/or adenoidectomy in children
Mar 24, 2025 · CONTRAINDICATIONS · Cleft palate and other conditions predisposing to velopharyngeal insufficiency · Bleeding disorders and anemia · Acute upper ...
[30]
[PDF] Clinical Practice Guideline: Tonsillectomy in Children (Update)
Tonsillectomy is defined as a surgical procedure performed with or without adenoidectomy that completely removes the tonsil, including its capsule, by ...
[31]
Adenoidectomy Children - ENT Surgery London
Adenoidectomy is generally avoided in children under 15kg weight, approximately three years of age, because of the small risk of blood loss during or after the ...Missing: contraindications | Show results with:contraindications
[32]
[PDF] Tonsillectomy Adenoidectomy - Children's Minnesota
HEME: Non-hemophilia bleeding disorders (including von Willebrand's disease) must be reviewed on a case-by-case basis.
[33]
Pediatric Tonsillectomy and Adenoidectomy - OpenAnesthesia
Mar 8, 2023 · Patient-specific risk factors include a history of prematurity, younger age (1 year), reactive airway disease, and exposure to smoke. Surgeries ...
[34]
Adenoidectomy Workup: Laboratory Studies, Imaging Studies ...
Nov 5, 2019 · No standard preoperative laboratory evaluation exists for adenoidectomy. Most surgeons do not order preoperative laboratory tests.
[35]
Intranasal corticosteroids for nasal airway obstruction in children ...
Five of the six trials demonstrated a significant efficacy of intranasal corticosteroids in improving nasal obstruction symptoms and in reducing adenoid size.
[36]
Preoperative Evaluation in Children | AAFP
A preoperative evaluation is advised for all children and adolescents having elective surgery with anesthesia.
[37]
Update on the safety of anesthesia in young children presenting for ...
May 30, 2021 · Admission after adenotonsillectomy should be considered for children less than 3 years old, patients with a medical co-morbidity, severe OSA, a ...Missing: labs | Show results with:labs
[38]
Tonsillectomy and/or adenoidectomy - WikiAnesthesia
Jun 12, 2024 · 1 Preoperative management. 1.1 Patient evaluation; 1.2 Labs and studies; 1.3 Operating room setup · 2 Intraoperative management. 2.1 Monitoring ...
[39]
Anesthesia for tonsillectomy with or without adenoidectomy in children
Sep 4, 2024 · Outline · Anesthetic strategy · Preparation for anesthesia · - Reducing anxiety · - Preoperative analgesics · Induction of anesthesia · - IV versus ...
[40]
Anaesthesia for adenotonsillectomy: An update - PMC
Magnesium sulphate 15 mg/kg over 20 min after tracheal intubation has shown to reduce the incidence of post-adenotonsillectomy laryngospasm. Use of IV propofol ...
[41]
Current techniques of adenoidectomy | Clinical Gate
May 5, 2015 · The curette may be passed blindly into the nasopharynx, or the laryngeal mirrors may be used to guide the cutting edge into position.
[42]
[PDF] Adenoidectomy: current approaches and review of the literature
[51]. The standard technique is carried out with adenoid curettes/an adenotome under general anesthesia. Total excision of the tissue is the most important ...
[43]
3.9: Pediatric Adenoidectomy Technique - Medicine LibreTexts
Dec 10, 2021 · An adenoid curette and/or suction diathermy are commonly used to perform adenoidectomy. Advantages of suction diathermy include targeted, ...
[44]
[PDF] Adenoidectomy - Atrium Health
there are no incisions on the face or neck. The operation usually takes less than thirty minutes.<|control11|><|separator|>
[45]
Endoscopic Adenoidectomy with Microdebrider - PMC - NIH
Endoscopic power assisted adenoidectomy is a safe, precise and quick procedure with minimal blood loss. It gives a complete clearance of obstructive adenoids ...
[46]
Comparing endoscopic microdebrider assisted adenoidectomy with ...
Adenoidectomy by curette group showed more residual nasopharyngeal adenoid tissue (43.33%) than by endoscopic microdebrider assisted adenoidectomy (20%).
[47]
Comparison of the efficacy and safety of conventional curettage ...
Mar 4, 2023 · This systematic review and network meta-analysis found that conventional curettage, suction diathermy, endoscopic-assisted coblation ...
[48]
Coblator adenoidectomy in pediatric patients: a state-of-the-art review
Jul 26, 2023 · [10] is a high quality review and network meta-analysis comparing different adenoidectomy techniques assessing pain, blood loss, intraoperative ...
[49]
Transoral Endoscopic Adenoidectomy - PMC - NIH
Transoral endoscopic adenoidectomy is the recent advancement of classic curettage adenoidectomy with direct vision of the nasopharynx.Missing: standard Blair Parkinson
[50]
Tonsillectomy and Adenoidectomy - StatPearls - NCBI Bookshelf - NIH
Jun 26, 2023 · Several complications can occur with a tonsillectomy and include bleeding, velopharyngeal insufficiency, and dehydration. This activity ...Technique Or Treatment · Complications · Enhancing Healthcare Team...
[51]
Surgical Treatments for Otitis Media With Effusion: A Systematic ...
Feb 1, 2014 · One RCT found that adenoidectomy and myringotomy were superior to myringotomy alone for reducing time with effusion and for improving hearing at ...
[52]
A 7-year experience in adenoidectomy with endoscopic ... - Nature
Oct 2, 2025 · To evaluate the effectiveness, safety, and postoperative outcomes of endoscopic radiofrequency adenoidectomy in pediatric patients over ...
[53]
Residual Adenoid Tissue After Conventional Adenoidectomy ... - NIH
Oct 16, 2025 · What are the main findings? Residual adenoid tissue was detected in 61.8% of patients after conventional curettage adenoidectomy.
[54]
Tonsil and adenoid removal - discharge Information - Mount Sinai
Dairy products that are high in fat. They may increase mucus and make it hard to swallow. Your child's health care provider will probably prescribe pain drugs ...
[55]
Postoperative morbidity and mortality after adenoidectomy
Complications that based on the ICD coding could be directly attributed to adenoidectomy were postoperative infections, with 109 (0.3%) outpatient visits and 11 ...
[56]
Current thinking on tonsillectomy and adenoidectomy - PubMed
Risk of mortality is approximately 0.006%. Mortality and morbidity can be minimized by appropriate preoperative evaluation, complete control of the airway with ...Missing: perioperative rate
[57]
Postoperative complications following tonsil and adenoid removal in ...
Sep 24, 2018 · Nearly 4% of the patients developed bleeding after adenotonsillectomy and only 2% of the patients had only bleeding after adenoidectomy.Missing: incidence | Show results with:incidence
[58]
Postoperative hemorrhage following adenoidectomy - PubMed
The rate of R1 hemorrhage following adenoidectomy is one in 200 (0.5%) and is similar to the R1 hemorrhage rate for tonsillectomy.
[59]
Surgical revision of hemorrhage in 8388 patients after cold-steel ...
Main findings: Hemorrhage occurred in 114 patients (1.78%) after tonsillectomy and in seven patients (0.35%) after adenoidectomy. After tonsillectomy 85.09% of ...
[60]
Postoperative morbidity and mortality after adenoidectomy - PubMed
Oct 4, 2022 · No deaths related to adenoidectomy were found. Severe complications, such as late postoperative haemorrhage after adenoidectomy, were rare, and ...Missing: perioperative | Show results with:perioperative
[61]
Complications of adenotonsillectomy - PubMed
The most common complications, namely, anesthesia risks, pain, otalgia, and bleeding, should be discussed with patients' caregivers. Publication types. Review ...
[62]
Incidence and Risk Factors of Velopharyngeal Insufficiency ...
Jul 24, 2015 · Results: The VPI risk at 3 weeks postoperatively was 13.6% (95% CI: 9.0%, 18.2%) for adenotonsillectomies, 3.2% (95% CI: 1.2%, 7.6%) for ...
[63]
Hypernasality following adenoid removal - PubMed
Persistent hypernasality after adenotonsillectomy is not an uncommon complication, occurring in approximately 1 in 1500 procedures.
[64]
Adenoidectomy and persistent velopharyngeal insufficiency - PubMed
Persistent velopharyngeal insufficiency (VPI) is a rare but well-recognized complication of adenoidectomy. VPI can have a significant impact on the ...Missing: incidence | Show results with:incidence
[65]
Post-operative complications following adenotonsillectomy in ...
In the whole group, complications occurred in 3.5% of children, 2.2% corresponding to respiratory complications. Children with sleep apnea (3.23% vs 1.47%, P=.
[66]
Complications of tonsillectomy and adenoidectomy - PubMed
Sore throat, otalgia, fever, dehydration, and uvular edema are more common postoperative complaints. Less common complications include atlantoaxial subluxation, ...Missing: incidence | Show results with:incidence
[67]
The incidence of adenoidal regrowth after adenoidectomy ... - PubMed
Dec 18, 2008 · Objective of the study is to evaluate the effectiveness of adenoidectomy for children, to asses the rates of adenoidal regrowth and find out ...
[68]
Incidence and potential risk factors for adenoid regrowth ... - PubMed
Jul 11, 2020 · The prevalence of adenoid regrowth was 8%. Fifteen studies examined the rate of revision adenoidectomy and a total of 119369 baseline ...
[69]
Tonsillectomy and Adenoidectomy Recovery Tips
Mar 24, 2025 · Returning to school: Your child should be able to safely return to school after 1-2 weeks. However, if your child is requiring a lot of pain ...
[70]
[PDF] After Tonsillectomy/Adenoidectomy - Mass Eye and Ear
Expect the pain to WORSEN before it starts to improve, peaking between 3-6 days after the surgery. It is very important to take pain medication consistently ...
[71]
Tonsillectomy and Adenoidectomy
An adenoidectomy is a surgery to remove the adenoids when a child has had breathing problems or ear and sinus problems that won't go away with antibiotics. A ...
[72]
Adenoidectomy Care - ENT for Children Dallas & Fort Worth
Jun 7, 2013 · Snoring, runny, or stuffy nose and bad breath can occur after surgery and last for about 2 weeks. This is normal and will resolve with the ...
[73]
The Efficacy of Adenoidectomy on Otitis Media with Effusion ...
Oct 19, 2025 · AT with myringotomy proved to be effective in 706 (82%) ears. In children up to 4 years of age, surgery was effective in 343 (81%) ears, in ...
[74]
Effectiveness of Adenoidectomy as a Standalone Procedure in ...
Jan 23, 2024 · A pure tone audiometry shown a 35dB hearing loss and tympanogram was showing Type B curve. Myringotomy with grommet insertion was done for this ...<|separator|>
[75]
Treatment of Residual OSA in Children
Feb 9, 2023 · The success rate of adenotonsillectomy in obese children with OSA is less than that of nonobese children with OSA (24%-46% versus 80%).
[76]
Management of recurrent acute otitis media in children - PubMed
Adenoidectomy reduced otitis media recurrence; results on otitis media recurrence frequency differed but on average there was a reduction; however, the two ...
[77]
Effect of adenoid size on the post-adenoidectomy hypernasality in ...
Jun 10, 2023 · Three months postoperatively, all patients had gained normal nasality except one (1.4%) who was subjected to a longer follow-up period.
[78]
Caring for Your Child After an Adenoidectomy, Myringotomy and ...
Your child will need a hearing test and ENT follow-up visit 1-3 months after surgery at the Pediatric ENT Clinic. Then, your child will see ENT every 6 months ...
[79]
What is Adenoiditis: Causes, Symptoms and Diagnosis - WebMD
Nov 10, 2024 · Adenoidectomy: Warning Sign. If you notice bright red blood coming from your child's mouth or nose, call the doctor right away or take your ...Adenoiditis Symptoms · Adenoiditis Causes · Recovery From Adenoidectomy<|separator|>
[80]
[PDF] Hearing Improvement After Adenoidectomy Alone In Children With ...
Jan 10, 2022 · Post-operative audiometric assessment showed mean hearing gain at 3rd month being 5.32 dB. At 3rd month follow up, 22 ears had type A curve, ...
[81]
Adenoidectomy: long-term follow-up - PubMed
Abstract. Objective: To assess the long-term (3-5 years) success of adenoidectomy and reasons for unsatisfactory results. Study design and ...
[82]
Long-term Impact of Adenotonsillectomy on the Quality of Life ... - NIH
Our results show adenotonsillectomy has a positive impact in children's QoL. Keywords: sleep-disordered breathing, quality of life, tonsillectomy, adenoidectomy ...
[83]
Pediatric adenoidectomy in the very young child and indications for ...
Adenoidectomy without tonsillectomy has a role in the management of select children with upper airway obstruction. Although postoperative respiratory events are ...<|control11|><|separator|>
[84]
Impact of COVID-19 on nationwide pediatric otolaryngology practice
Tonsillectomies have long been one of the most common surgical operations in pediatrics with over 500,000 operations performed each year in the United States ...
[85]
Adenoidectomy in Children: What Is the Evidence and What Is its ...
Mar 2, 2018 · The most common indications for adenoid surgery have been recurrent upper airway infections, acute otitis media, otitis media with effusion, and ...Adenoidectomy For Ear... · Adenoidectomy For Pediatric... · Adenoid Regrowth And...
[86]
Pediatric adenoidectomy is safe surgery with a low complication rate
Jul 31, 2025 · ... Adenoidectomy is very safe surgery. Main risk factor for bleeding complications is additional tonsillectomy, not adenoidectomy itself.Missing: contraindications | Show results with:contraindications<|control11|><|separator|>
[87]
Indigenous disparities in adenotonsillar disease: a case series of ...
Mar 30, 2022 · Tonsils and adenoids were significantly larger in the Māori population (tonsil grade 4±0.04 vs. 3±0.04, P<0.001 and adenoid grade 3±0.06 vs. 2± ...
[88]
Changes and consistencies in the epidemiology of pediatric ...
Nov 1, 2010 · Moreover, the larger decline in the rate of adenotonsillectomy for infectious indications from 2.20 per 1000 to 1.46 per 1000 was significant (P ...<|separator|>
[89]
The Indications of Tonsillectomy Among Pediatric Patients
Dec 16, 2023 · The most common combined procedure was adenotonsillectomy (71.7%; n = 259). Additionally, adenotonsillectomy and insertion of grommets in other ...
[90]
Adenotonsillectomy and adenoidectomy in children: The impact of ...
Jun 3, 2022 · There is wide variation in tonsillectomy rates with a 13-fold difference reported across 31 countries, ranging from 23 to 293 per 100 000 ...<|separator|>
[91]
Sociodemographic associations of geographic variation in ... - Nature
Aug 5, 2021 · This study aimed to describe the geographical distribution of paediatric A/T surgery in the Australian state with the highest variation, Victoria,
[92]
The Impact of the Thermal Seasons on Adenoid Size, Its Mucus ...
Nov 28, 2021 · The purpose of this study is to analyze seasonal differences in adenoid size and related mucus levels via endoscopy, as well as to estimate changes in middle ...Missing: atrophy | Show results with:atrophy
[93]
History of otorhinolaryngology in Germany before 1921 - PMC
Konrad Victor Schneider (1614–1680) from Bitterfeld played a key role, when he wrote that, “catarrhal matter is not an excrement from the brain, but a ...
[94]
The adenoid: Its history and a cautionary tale - PubMed
James Yearsley reported in 1842 one case in which he improved hearing by removal of a mucus membrane from behind the uvula, which indicates some appreciation ...
[95]
[PDF] Adenoidectomy- A Historical Review - Juniper Publishers
Jun 28, 2017 · Adenoidectomy was first performed using a ring knife through the nasal cavity by William Meyer in 1867 [1]. Since then the surgical approach to ...
[96]
[PDF] Adenoid Hypertrophy & Adenoidectomy | SBORL
❑ In 1885 the first adenoid curette was described by. Gottstein. ❑ Crowe-Davis mouth gag in 1911. ❑ Initial recommendations for this procedure included.
[97]
The rise and decline of tonsillectomy in twentieth-century America
Apr 10, 2007 · Between 1915 and the 1960s, T&A was the most frequently performed surgical procedure in the United States. Its rise was dependent on novel ...
[98]
[PDF] Evolution of the Adenoidectomy in the Endoscopic Era - IntechOpen
Nov 25, 2011 · The introduction of powered instrumentation for sinus surgery prompted the use of a shaver system with an overbent cannula for a, power-assisted ...Missing: 1980s | Show results with:1980s