Direct adenoidectomy is a method of removing hypertrophied tonsillar tissue in the epipharynx under a direct view for restoring conductive hearing loss due to tubal stenosis. The method was originally evolved by Guggenheim in 1941, but recently it was almost forgotten and paid little attention. The author performed a modified method of Guggenheim's direct adenoidectomy in 76 children (51 males and 25 females) with conductive hearing loss mostly ranged between 15 and 40dB. In all cases, the surgery was performed under general anesthesia and hypertrophied pharyngeal tonsil was removed. After complete hemostasis, exessive adenoid tissue lying on the posterior lip of the tubal ostium (torus tubarius) was carefully removed using Hartmann's cutting forceps.
Postoperative hearing improvement was satisfactory. Average gain of hearing reached 15 to 17dB in a period of 4 weeks after the operation. A follow-up study one year after the operation revealed that the improved hearing was maintained in more than 72% of the cases tested. No scar tissue formation which would interfere with the tubal function was observed one year after the operation.