A child with inflammatory indication for tonsillectomy, and the adenoids was detected as early non-obstructing, with no aural symptoms i.e. no eustachian dysfunction, would you plan for adenoidectomy?
G 1 or 2 asymptomatic adenoids, i will not touch & tonsillectomy is only indicated in the above mentioned case..
since it asymptomatic adenoids ...no need t\o touch adenoids in above case. Also there is risk damage to Eustachian tube while adenoid curettage.
Dear Meher and Abdelwahed; Greetings
But it is an inflammatory indication, would you like to change your suggestion?
As regard trauma to the ET, curettage can be performed under vision (e.g. simple mirror guidance, or even endoscopc -assisted),
inflammatory indications for adenoidectomy is decreasing and now we perform adenotonsillectomy more for obstructive (OSA) indications. since in above case there is no symptoms and adenoids are not obstructive i will leave them as such. whats the age of the child? if its old and above 8 to 10years i will not touch adenoids as they are going to atrpohy with age... in lower age we might consider for adenoidectomy
I think there is no need for adenoidectomy if adenoyds are asymptomatic, I agree with Ravi Meher that the main indication for adenotonsillectomy is OSAS
In the absence of symptoms I would not perform adenoidectomy.
In any case if consent is only for tonsillectomy it is not appropriate to perform adenoidectomy without informed consent from parents or guardians.
Incidental findings of grade 1 or 2 adenoids is not an indication for adenoidectomy.
There is a dearth of good published data to address this question. It is a good question, and practioner dependent tendencies are clearly manifest in the answers. In older patients (typically > 12 years) with a history of recurring tonsillitis, I would likely not perform the adenoidectomy. In younger (pre-pubertal) patients I tend to perform the adenoidectomy less selectively and more consistently. Incidentally, the complication rate and the post-operative morbidity for adenoidectomy is exceedingly low (much less than tonsillectomy)
Childs age is important for my decision. If child is older than 10 years old and has no sign for osas I do not do adenoidectomy but if child is younger and has osas i Will do it. Between Thèse ages and have not osas , decision is Not clear. If three is no sign for contraindication i usually do adenoidectomy
I will go with those who will not touch adenoids if there are no symptoms related to it. Though I had to do tonsillectomy in a few patients who had adenoidectomies earlier. So i don't think we can have generalisation, it depends upon case to case.
Will not perform adenoidectomy. From medico legal point performing adenoidectomy without informed consent can result in serious disciplinary action.
If child is asymptomatic no middle ear pathology found grade 1 or 2 detected on x ray need not be removed. It can be managed by medical line of treatment also from medicolegal point of view and to avoid surgery related complications.
No tissue should be removed from body if cause or expect to cause no problem or complications including adenoid.
its better not to remove the adenoids specially the indication for this child is a chronic tonsillitis with no obstructive symptoms