Kids Younger Than 5 Years at Risk for Repeat Adenoidectomy

Norra MacReady

December 27, 2012

Young age and adenoidectomy without tonsillectomy are risk factors for repeat adenoidectomies, results from a new study suggest.

The data come from one of the largest studies of its kind yet conducted, involving more than 10,000 children followed up over the course of 20 years who had the surgery at a single hospital in Canada. The study was published online December 17 in the Archives of Otolaryngology–Head & Neck Surgery.

Obstructive sleep apnea and use of curettage for the first adenoidectomy also were associated with the need for repeat procedures, although they did not attain statistical significance.

The investigators advise clinicians to warn parents that adenoid regrowth is possible, particularly if the child is younger than 5 years, and to keep especially close watch over children who only undergo adenoidectomy.

The researchers performed a retrospective cohort review of all adenoidectomies and adenotonsillectomies performed at the Children's Hospital of Eastern Ontario in Canada between 1990 and 2010. There were 10,948 cases in all, including 168 confirmed repeat procedures (1.5%).

The authors also performed a nested, case-control study in which each child undergoing a repeat adenoidectomy was age-matched with a child who had undergone a single adenoidectomy within 5 years.

Of the 168 children who required repeated adenoidectomies, 52 (31.0%) were 2 years of age or younger and 127 (75.6%) were 5 years of age or younger compared with 736 (6.9%) and 5060 (47.8%) of 10,591 children included in the analysis for single adenoidectomy (P < .001 for both comparisons).

"Children younger than 2 years were 5.6 times more likely and children younger than 5 years were 3.2 times more likely to require a repeated adenoidectomy," lead author Melanie Duval, MD, from the Department of Otolaryngology at the University of Ottawa, Ontario, and colleagues write.

"Possible explanations include a greater difficulty to perform a complete removal because of a small nasopharynx and persistence of the etiologic factors that led to adenoid hypertrophy initially," they report.

A conditional logistic regression analysis associated with the nested case-control study showed that compared with children who had undergone tonsillectomy as well as adenoidectomy, children who had an adenoidectomy alone were 4 times as likely to have a repeat procedure (P < .001). Those children "were also more likely to have undergone an adenoidectomy with the curettage technique," the authors state.

To account for developments in surgical technique, the authors conducted a separate analysis of cases performed between 1992 and 2002. Of 128 children having repeated adenoidectomies, 82 (64.0%) had adenoidectomy alone compared with 1993 (30.4%) of 6566 patients who needed only a single procedure (P < .001).

Repeat procedures may have been more prevalent in the study's earlier decade because of the inability to perform direct visualization, the authors write. "It has previously been suggested that performing an adenoidectomy without visualization with a mirror or endoscope could lead to adenoid regrowth because of incomplete tissue removal at the torus tubarius or at the choanae." However, they note, surgeons of that era may simply have had a lower threshold for recommending repeat procedures. Relatively few patients in the study underwent electrocautery, so more research is necessary to assess the effect of that technique on the thoroughness of adenoid removal.

Study limitations include the inability to evaluate the recurrence of adenoid hypertrophy that did not require surgery or to assess the clinical benefit of the repeated adenoidectomies.

Nevertheless, the authors conclude, "[t]hese findings confirm that adenoid regrowth is a relatively common phenomenon, especially in patients younger than 5 years at the time of surgery."

The authors have disclosed no relevant financial relationships.

Arch Otolaryngol Head Neck Surg. Published online December 17, 2012. Abstract