The clinical value of tonsillectomy continues to cause much debate, despite tonsil disease representing a significant burden to patients, caregivers and healthcare systems. This study assessed the long-term effect of adenotonsillectomy or tonsillectomy on the Paediatric Throat Disorders Outcome Test (‘T-14’), a validated tool used to objectively assess obstructive and infective symptoms in paediatric throat disorders.

Patients aged under 16 years undergoing adenotonsillectomy or tonsillectomy were recruited consecutively from 2018 into our prospective observational study. The Paediatric Throat Disorders Outcome Test questionnaire was completed by the children's caregivers pre-operatively (n = 80), and at 21 days (n = 68) and 2 years (n = 66) post-operatively.

Significant reductions were noted in mean total Paediatric Throat Disorders Outcome Test scores at 21 days and 2 years post-operatively (p ≤ 0.003).

Our results provide supporting evidence that paediatric adenotonsillectomy or tonsillectomy significantly improves quality of life up to two years post-operatively, and therefore remains a valuable use of healthcare resources.

Post-tonsillectomy haemorrhage remains a significant complication despite modifications of technique and instrumentation. Intracapsular tonsillectomy spares the capsule as a protective barrier for underlying blood vessels and musculature. Its efficacy in children with sleep-disordered breathing has been established, along with lowered rates of haemorrhage and pain, but research pertaining to adults and for recurrent infections has been limited.

This retrospective study, encompassing 730 patients, compared post-operative haemorrhage rates between extracapsular (n = 379) and intracapsular tonsillectomy (n = 351) across all ages and indications using CoblationTM technology.

A significant difference in post-operative haemorrhage rate was observed between extracapsular and intracapsular tonsillectomy techniques (2.1 vs 0.3 per cent; p = 0.025). In addition, an age of 18 years or older was also found to be an independent risk factor for post-operative haemorrhage (p = 0.01).

CoblationTM intracapsular tonsillectomy was shown to be safe and effective across all ages and indications, with a low risk of bleeding and revision surgery.

There is limited understanding amongst patients and parents of paediatric patients regarding adenoidectomy. Most patients access health-related information online. The aim of this study was to assess the suitability of online information on adenoidectomy.

The term ‘adenoid’ was used to search Google, and the first 50 websites identified were screened. For each website, the readability and quality were assessed.

Of the 41 websites that met the inclusion criteria, the mean readability scores corresponded to ‘difficult to read’ and university-level reading categories. For the quality of the websites, the mean score corresponded to ‘fair’ with 39 per cent of the websites containing either ‘poor’ or ‘very poor’ quality data. The ENT UK information is one of the most readable and reliable online resources.

The online information on adenoidectomy is largely set at an inappropriate readability level and of variable quality. Surgeons should consider assisting their patients with online searches regarding adenoidectomy.

This study evaluated the quality of YouTube content focusing on common paediatric otolaryngology procedures, as this content can influence the opinions and medical decisions of patients.

A total of 120 YouTube videos were compiled to review using the terms ‘adenoid removal’, ‘adenoidectomy’, ‘ear tubes’, ‘tympanostomy’, ‘tonsil removal’ and ‘tonsillectomy’. The Discern criteria was used to rate the quality of health information presented in each video.

The mean bias Discern score was 3.18 and the mean overall Discern score was 2.39. Videos including US board certified physicians were rated significantly higher (p < 0.001) than videos without (bias Discern score = 3.00 vs 2.38; overall Discern score = 3.79 vs 1.55). The videos had been viewed a total of 176 769 549 times.

Unbiased, high quality videos on YouTube are lacking. As patients may rely on this information when making medical decisions, it is important that practitioners continually evaluate and improve this video content. Otolaryngologists should be prepared to discuss YouTube content with patients.

To compare endoscopic assisted powered adenoidectomy with conventional curettage adenoidectomy.

A randomised controlled trial was conducted at a tertiary care teaching hospital. Fifty patients with a symptom complex pertaining to adenoid hypertrophy and requiring adenoidectomy were chosen and divided into 2 groups of 25 each. Patients in group A underwent conventional curettage adenoidectomy and those in group B underwent endoscopic assisted powered adenoidectomy. Comparison was based on the parameters of surgical time, intra-operative bleeding, post-operative pain and completeness of adenoid removal.

The surgical time was significantly longer with the powered instrument. Mean blood loss was greater in the powered group, but was statistically insignificant. The powered procedure fared significantly better, with lower pain scores and more instances of complete tissue resection.

A curved microdebrider blade can be used safely and precisely for adenoidectomy under endoscopic vision. It enables complete resection of adenoid tissue. This method also proves to be an excellent teaching aid.

To compare conventional cold curettage adenoidectomy with endoscopic assisted coblation adenoidectomy in terms of operative time, primary blood loss, post-operative residual tissue and post-operative pain.

This prospective non-randomised study was carried out on 60 patients aged 5–12 years. One group underwent conventional cold curettage adenoidectomy and the other underwent endoscopic assisted coblation adenoidectomy, with 30 patients per group.

Mean operation duration was significantly higher for endoscopic assisted coblation adenoidectomy. Mean blood loss was 44.33 ml in conventional cold curettage adenoidectomy and 32.47 ml in endoscopic assisted coblation adenoidectomy. The pain grade was significantly lower in endoscopic assisted coblation adenoidectomy. Forty per cent of patients who underwent conventional cold curettage adenoidectomy had adenoid tissue post-surgery, while it was completely absent in endoscopic assisted coblation adenoidectomy patients.

Coblation adenoidectomy has significant advantages over conventional adenoidectomy in terms of reduced blood loss, no post-operative residual tissue and lower pain grade on day 1 after surgery.

Adenoid hypertrophy is a common cause of upper airway obstruction, and adenoidectomy is one of the most frequently performed operations in children. Topical nasal steroids can act directly on nasopharyngeal lymphoid tissue to decrease its reactive inflammatory changes and potentially reduce its size.

To study the light microscopic changes in adenoidal lymphoid tissue after one month of topical steroid use.

Twenty-six children with adenoid hypertrophy grade 3 scheduled for adenoidectomy were randomly divided into two equal groups: one group received mometasone furoate aqueous nasal spray (Nasonex) 100 mcg/day for four weeks, and a control group received nasal normal saline 0.9 per cent for four weeks. The removed adenoids were examined histopathologically.

Adenoidal tissue from the mometasone group had less reactive germinal centres and less spongiosis compared to the control group. The latter showed proliferating, reactive, variable sized and shaped lymphoid follicles, with congested blood vessels in the interfollicular areas.

The use of intranasal mometasone furoate aqueous nasal spray (Nasonex) for one month reduced adenoidal tissue reactive cellular changes and its vascularity. This is, however, a pilot study; a longer treatment period is needed to assess the effect of treatment on adenoidal size.

To investigate choroidal thickness using enhanced-depth imaging optical coherence tomography in paediatric patients with adenotonsillar hypertrophy, with comparison to healthy children, three months after adenotonsillectomy.

The patients were assigned to three groups: an adenotonsillar hypertrophy group, an adenotonsillectomy group and a healthy control group. In all groups, subfoveal, temporal and nasal choroidal thickness measurements were taken.

In the subfoveal, temporal and nasal regions, choroidal tissue was found to be significantly thinner in adenotonsillar hypertrophy children than healthy children (p = 0.012, p = 0.027 and p = 0.020). The subfoveal and temporal choroidal thickness measurements of adenotonsillar hypertrophy group cases were significantly decreased compared to those in the adenotonsillectomy group (p = 0.038 and p = 0.048).

There was a significant association between decreased choroidal thickness and adenotonsillar hypertrophy. Adenotonsillar hypertrophy may play an important role in decreased choroidal thickness.

This review examined the efficacy of intranasal corticosteroids for improving adenotonsillar hypertrophy.

The related literature was searched using PubMed and Proquest Central databases.

Adenotonsillar hypertrophy causes mouth breathing, nasal congestion, hyponasal speech, snoring, obstructive sleep apnoea, chronic sinusitis and recurrent otitis media. Adenoidal hypertrophy results in the obstruction of nasal passages and Eustachian tubes, and blocks the clearance of nasal mucus. Adenotonsillar hypertrophy and obstructive sleep apnoea are associated with increased expression of various mediators of inflammatory responses in the tonsils, and respond to anti-inflammatory agents such as corticosteroids. Topical nasal steroids most likely affect the anatomical component by decreasing inspiratory upper airway resistance at the nasal, adenoidal or tonsillar levels. Corticosteroids, by their lympholytic or anti-inflammatory effects, might reduce adenotonsillar hypertrophy. Intranasal corticosteroids reduce cellular proliferation and the production of pro-inflammatory cytokines in a tonsil and adenoid mixed-cell culture system.

Intranasal corticosteroids have been used in adenoidal hypertrophy and adenotonsillar hypertrophy patients, decreasing rates of surgery for adenotonsillar hypertrophy.

To assess cardiac functions in adenotonsillar or tonsillar hypertrophy.

A prospective, interventional, academic centre based study was conducted on 25 children with adenotonsillar or tonsillar hypertrophy. All patients underwent pulsed 2-dimensional Doppler echocardiography, pulse oximetry and 12-lead electrocardiography. These assessments were repeated three months later to determine the impact of adenotonsillectomy.

There were significant differences in mean arterial oxygen saturation, pulmonary flow acceleration time and mean pulmonary artery pressure post-operatively. Adenotonsillectomy led to significant improvements in pulmonary flow acceleration time and pulmonary flow velocity time index, while tonsillectomy resulted in right ventricular early and late diastolic velocity index improvement.

Upper airway obstruction in children affects cardiac functioning and this can subsequently lead to morbidity and delayed growth. Hence, revision of surgical indications is advocated in adenotonsillar hypertrophy to avoid irreversible damage to cardiopulmonary functions.

This study aimed to explore adenoid regrowth after transoral power-assisted adenoidectomy down to the pharyngobasilar fascial surface.

Transoral adenoidectomy down to the pharyngobasilar fascia surface was performed on 39 patients under endoscopic guidance, using a power-assisted system. The operation time, amount of blood loss and iatrogenic injury, presence of complications, and success and regrowth rates were recorded to assess the feasibility, safety and effectiveness of our surgical technique.

In this adenoidectomy procedure, the pharyngobasilar fascia was left intact. The estimated blood loss was 5–50 ml (mean 15 ml), and the success rate was 97.3 per cent. Early complications occurred in 2.3 per cent of patients, while no long-term complications occurred in the cohort. No regrowth was found in the follow-up assessments, which were performed for 18–36 months after surgery.

Adenoid regrowth was rare after adenoidectomy down to the pharyngobasilar fascial surface. The pharyngobasilar fascia can therefore be considered a surgical boundary for adenoidectomy.

To study the role of mometasone furoate aqueous nasal spray for the management of adenoidal hypertrophy in children with more than 50 per cent obstruction, and to assess its impact on change in quality of life.

A prospective, randomised, double-blind, interventional placebo-controlled study was conducted. A total of 100 children aged 2–12 years completed treatment and follow up. The symptoms and degree of obstruction were evaluated by nasopharyngoscopy conducted pre-treatment and 24 weeks post-treatment. Subjects received mometasone furoate nasal spray at a daily dose of 200 µg for 8 weeks, followed by a dose of 200 µg on alternate days for 16 weeks. Results were compared with those of a matched control group who were given saline nasal spray.

With mometasone treatment, there was an 89.8 per cent reduction in clinical symptom score, and the degree of obstruction dropped from 87 to 72 per cent (p < 0.0001). A statistically significant change in quality of life scores was seen in patients treated with the mometasone nasal spray (score change of 37.47) as compared with those given saline nasal spray (score change of 11.25) (p = 0.0001).

Mometasone nasal spray appears to be effective in treating children with obstructive adenoids.

To compare narrow-band images of nasopharyngeal carcinoma with those of normal adenoidal tissue.

Patients with a nasopharyngeal mass were evaluated using both conventional white light and narrow-band light. Biopsies were performed and Epstein–Barr viral serology was tested for all patients.

Thirty consecutive patients were recruited. Twenty-one patients had normal adenoidal tissue and seven had nasopharyngeal carcinoma. One patient with papillary adenocarcinoma was excluded. The features of narrow-band imaging in normal adenoidal tissue were: (1) a regularly arranged follicular pattern, and (2) each ‘follicle’ comprising a pale centre with surrounding dark periphery. The features of narrow-band imaging in nasopharyngeal carcinoma were: (1) absence of surface patterns (n = 7), and/or (2) ‘reverse’, haphazard follicular pattern comprising a dark brown centre and pale periphery (n = 3).

Narrow-band imaging of the surface of adenoidal tissue and nasopharyngeal carcinoma appears to identify distinct, characteristic features as described. Narrow-band imaging may be a useful adjunct in differentiating normal adenoidal tissue from malignancy. Further studies are needed to evaluate its diagnostic accuracy.

To assess the correlation between bacterial pathogens in the adenoid core and the middle meatus, in children with hypertrophied adenoids and chronic or recurrent sinusitis.

The study was conducted at Alexandria University Hospitals. We included 103 children aged four to 12 years who were scheduled for adenoidectomy and who had clinical and/or radiological evidence of chronic or recurrent sinusitis. Adenoid core specimens and middle meatal swabs were obtained from every patient and were sent for bacteriological evaluation using standard qualitative and quantitative microbiological techniques. The results were statistically analysed.

The bacterial species isolated most frequently from the adenoid core were coagulase-negative staphylococci (40.8 per cent), Staphylococcus aureus (22.3 per cent), Streptococcus pneumoniae (18.4 per cent), Haemophilus influenzae (16.5 per cent) and group A streptococci (15.5 per cent). The bacterial species isolated most frequently from the middle meatus were coagulase-negative staphylococci (41.7 per cent), S aureus (32 per cent), S pneumoniae (28.1 per cent), H influenzae (21.6 per cent) and group A streptococci (19.4 per cent). The adenoid core and middle meatal cultures were both positive for at least one bacterial species in 63 cases, and were both negative in 25 cases. In six cases, a positive adenoid core culture was associated with a negative middle meatal culture. In five cases, a negative adenoid core culture was associated with a positive middle meatal culture (for one or more pathogenic species). Thus, adenoid core culture had a positive predictive value of 91.5 in forecasting the middle meatal culture result, and a negative predictive value of 84.3.

Apart from its effect on nasal airway patency, adenoidal tissue may function as a bacterial reservoir initiating and maintaining sinus infection in children. These study findings support a potential role for adenoidectomy in the treatment of chronic or recurrent paediatric sinusitis.

Enlarged tonsils and adenoids (part of Waldeyer's ring) are responsible for obstructive sleep disordered breathing. Obstructive sleep disordered breathing episodes lead to hypoxaemia, hypercapnia and a state of arousal, all of which affect normal development of the nervous system. In this study, two hypotheses were tested: (1) obstructive sleep disordered breathing is caused by adenotonsillar hypertrophy and is associated with hypoxia and brain dysfunction; and (2) children with obstructive sleep disordered breathing more commonly display emotional lability, depressive behaviour and anxiety.

A total of 225 children were examined. The study group consisted of 121 children with adenotonsillar hypertrophy (87 aged six to nine years and 34 aged 10 to 13 years) and with obstructive sleep apnoeas and hypopnoeas confirmed by polysomnography. Patients were compared with 104 children with no obstructive sleep disordered breathing and no adenotonsillar hypertrophy (74 aged six to nine years and 30 aged 10 to 13 years). The following tests were used to measure the children's emotional disorders: the children's depression inventory; the state-trait anxiety inventory for children; and the emotional instability scale. The average values and standard deviations were calculated for all results. Student's t-test was used to compare differences in all groups of children. The minimum level of p < 0.05 was set as statistically significant.

Children with adenotonsillar hypertrophy are more likely to experience poor brain development and sleep problems. They also have emotional disturbances. In the sick and healthy children aged six to nine years, mean results for the emotional instability scale were statistically significantly different in the two groups, being higher in children with adenotonsillar hypertrophy than in healthy children. Mean values for the children's depression inventory test were higher in children with adenotonsillar hypertrophy, but the differences were not statistically significant. In the state-trait anxiety inventory for children test, the mean T score was T = 1.760 and the level of significance was p = 0.08 for both groups. Since the standard level of significance was p < 0.05, the differences in mean values for the state-trait anxiety inventory for children test bordered on statistical significance. There were no differences between tests results in the older children (10 to 13 years).

Recent studies have confirmed the negative emotional effect of adenotonsillar hypertrophy induced obstructive sleep disordered breathing in children aged six to nine years. The main problems are emotional lability, and anxiety and depressive disturbances. Such emotional problems subside in older children (aged 10 to 13 years).