Effect of adenoidectomy in children with complex problems of rhinosinusitis and associated diseases
Introduction
The adenoid is a lymphoepithelial organ in the nasopharynx which plays an important role in the upper respiratory tract infection in children. The proximity of the adenoid to the eustachian tube and sinus ostia contributes to the infection of the middle ear and the paranasal sinus as the reservoir of infection [1], [2]. Adenoidectomy has long been proven as an effective surgical treatment of otitis media in conjunction with myringotomy and tube insertion [3]. For sinusitis, adenoidectomy was included in the stepwise protocol for the treatment of pediatric sinusitis proposed by Rosenfeld [4] and later proven effective by the study of Don et al. [5]. There are still doubts and controversy over this issue when compared to functional endoscopic sinus surgery (ESS) [6]. However, adenoidectomy is much less invasive and has less risk for complications. In this series, we studied the efficacy of adenoidectomy in pediatric patients with sinusitis by evaluating the frequency of sinusitis before and after adenoidectomy. We also looked at the other problems caused by the adenoid in the same population and study the advantages of adenoidectomy in these patients.
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Materials and methods
We did a prospective cohort of a group of children with sinusitis who were admitted for adenoidectomy in the Department of Otolaryngology, Faculty of Medicine, Siriraj Hospital, which is the tertiary care referral center from January 2000 to January 2002. Pre-operative diagnosis of sinusitis was made prospectively for a period of time before we identified the patients who had indications for adenoidectomy and then we recruited the patients into the study. Inclusion criteria was the patient with
Results
There were 37 patients, 24 boys (64.9%) and 13 girls (35.1%). Mean age was 6±2.8 years. Age range was 2.3–12.7 years. Age stratification is shown in Fig. 1. The peak age group of our patients was between 4 and 6 years (43.2%) and 30 cases (81%) were of those below 8 years in age. Mean duration of the pre-operative history review for previous infection was 436.7 days and mean duration for post-operative follow-up was 450.2 days. The problems of infection is shown in Table 1. Most of our patients
Discussion
Effect of adenoidectomy in pediatric rhinosinusitis has long been a controversial issue. The concept of adenoidectomy for sinusitis is to eradicate the reservoir of infection in the vicinity of the sinus ostia [4]. The presence of pathogenic bacteria in the adenoid and the association between bacterial load in the adenoid and sinonasal symptom scores was shown in the study of Lee and Rosenfeld [11]. Tosca et al. [12] did an endoscopic study in asthmatic children with sinusitis and found
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