Current Otorhinolaryngology Reports

, Volume 6, Issue 1, pp 64–73 | Cite as

Adenoidectomy in Children: What Is the Evidence and What Is its Role?

  • Alexander J. Schupper
  • Javan Nation
  • Seth Pransky
Pediatric Otolaryngology (I Bruce, Section Editor)
Part of the following topical collections:
  1. Topical Collection on Pediatric Otolaryngology


Purpose of Review

Review the current state of the adenoidectomy procedure in the pediatric population with up-to-date indications for surgery, operative techniques, adverse events, non-surgical management of adenoid hypertrophy, and future directions.

Recent Findings

Adenoidectomy is indicated in children for the treatment of sleep-disordered breathing, nasal airway obstruction, recurrent acute otitis media, and chronic rhinosinusitis. A new recommendation was released in 2016, not supporting adenoidectomy for a primary indication of otitis media in children under 4 years old, including those with prior tympanostomy tubes, unless a distinct indication exists such as nasal obstruction or chronic adenoiditis. Although adenotonsillectomy is the mainstay of treatment for obstructive sleep apnea (OSA), recent studies have identified that non-obese patients with moderate OSA and small tonsils have comparable benefits with adenoidectomy alone with less complications. While conventional approaches such as indirect mirror-assisted curette and suction coagulation are still utilized, direct transnasal endoscope-assisted removal of the adenoids has proven to be a safe technique, with good short- and long-term outcomes. Novel non-surgical therapies including immunotherapy have been evaluated.


Adenoidectomy is a safe procedure in the pediatric population and leads to excellent outcomes. Adverse events are rare, and hospitalization is uncommon. Children with sleep disturbance from nasal airway obstruction, ear disease, or chronic rhinosinusitis are the best operative candidates for this procedure.


Pediatric adenoidectomy Pediatric tonsillectomy Surgical indications Surgical complications Surgical technique 


Compliance with Ethical Standards

Conflicts of Interest

The authors declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.


Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. 1.
    Ingram DG, Friedman NR. Toward adenotonsillectomy in children: a review for the general pediatrician. JAMA Pediatr. 2015;169(12):1155–61. Scholar
  2. 2.
    AAO/HNS Clinical Indicators: Adenoidectomy Available at: Updated.pdf?AWSAccessKeyId=AKIAJH5D4I4FWRALBOUA&Expires=1504509869&Signature=8MwBTzIygBOHcHM6auKZO2CA6oo%3D.
  3. 3.
    Haapkyla J, Karevold G, Kvaerner KJ, Pitkaranta A. Trends in otitis media surgery: a decrease in adenoidectomy. Int J Pediatr Otorhinolaryngol. 2008;72(8):1207–13. Scholar
  4. 4.
    Schilder AG, Lok W, Rovers MM. International perspectives on management of acute otitis media: a qualitative review. Int J Pediatr Otorhinolaryngol. 2004;68(1):29–36. Scholar
  5. 5.
    Thomas K, Boeger D, Buentzel J, et al. Pediatric adenoidectomy: a population-based regional study on epidemiology and outcome. Int J Pediatr Otorhinolaryngol. 2013;77(10):1716–20. Scholar
  6. 6.
    Dearking AC, Lahr BD, Kuchena A, Orvidas LJ. Factors associated with revision adenoidectomy. Otolaryngol Head Neck Surg. 2012;146(6):984–90. Scholar
  7. 7.
    van den Aardweg MT, Rovers MM, Kraal A, Schilder AG. Current indications for adenoidectomy in a sample of children in the Netherlands. B-ent. 2010;6(1):15–8.PubMedGoogle Scholar
  8. 8.
    Lee C-H, Hsu W-C, Ko J-Y, Yeh T-H, Chang W-H, Kang K-T.Google Scholar
  9. 9.
    Bhattacharyya N, Lin HW. Changes and consistencies in the epidemiology of pediatric adenotonsillar surgery, 1996–2006. Otolaryngol Head Neck Surg. 2010;143(5):680–4. Scholar
  10. 10.
    Gerhardsson H, Stalfors J, Odhagen E, Sunnergren O. Pediatric adenoid surgery in Sweden 2004–2013: incidence, indications and concomitant surgical procedures. Int J Pediatr Otorhinolaryngol. 2016;87:61–6. Scholar
  11. 11.
    Bitar MA, Birjawi G, Youssef M, Fuleihan N. How frequent is adenoid obstruction? Impact on the diagnostic approach. Pediatr Int. 2009;51(4):478–83. Scholar
  12. 12.
    Kubba H, Bingham BJ. Endoscopy in the assessment of children with nasal obstruction. J Laryngol Otol. 2001;115(5):380–4.PubMedCrossRefGoogle Scholar
  13. 13.
    Mlynarek A, Tewfik MA, Hagr A, et al. Lateral neck radiography versus direct video rhinoscopy in assessing adenoid size. J Otolaryngol. 2004;33(06):360–5. Scholar
  14. 14.
    Feres MF, Hermann JS, Cappellette M Jr, Pignatari SS. Lateral X-ray view of the skull for the diagnosis of adenoid hypertrophy: a systematic review. Int J Pediatr Otorhinolaryngol. 2011;75(1):1–11. Scholar
  15. 15.
    Gozal D KL. Disorders of breathing during sleep. In: Chernick V, Boat TF, Wilmott RW, Bush A, eds. Kendig’s Disorder of the respiratory tract in children. Elsevier Saunders, 2006.Google Scholar
  16. 16.
    Randall DA, Hoffer ME. Complications of tonsillectomy and adenoidectomy. Otolaryngol Head Neck Surg. 1998;118(1):61–8. Scholar
  17. 17.
    Domany KA, Dana E, Tauman R, et al. Adenoidectomy for obstructive sleep apnea in children. J Clin Sleep Med. 2016;12(09):1285–91. Scholar
  18. 18.
    Bodenner KA, Jambhekar SK, Com G, Ward WL. Assessment and treatment of obstructive sleep-disordered breathing. Clin Pediatr (Phila). 2014;53(6):544–8. Scholar
  19. 19.
    Bhattacharyya N, Lin HW.Google Scholar
  20. 20.
    • Marcus CL, Brooks LJ, Draper KA, et al. Diagnosis and management of childhood obstructive sleep apnea syndrome. Pediatrics. 2012;130:576–84. The revised clinical practice guideline with up-to-date recommendations for the diagnosis and management of the obstructive sleep apnea syndrome in children and adolescents. PubMedCrossRefGoogle Scholar
  21. 21.
    Baugh RF, Archer SM, Mitchell RB, et al. Clinical practice guideline: tonsillectomy in children. Otolaryngol Head Neck Surg. 2011;144(1_suppl):S1–30. Scholar
  22. 22.
    Friedman M, Wilson M, Lin HC, Chang HW. Updated systematic review of tonsillectomy and adenoidectomy for treatment of pediatric obstructive sleep apnea/hypopnea syndrome. Otolaryngol Head Neck Surg. 2009;140(6):800–8. Scholar
  23. 23.
    Bhattacharjee R, Kheirandish-Gozal L, Spruyt K, et al. Adenotonsillectomy outcomes in treatment of obstructive sleep apnea in children: a multicenter retrospective study. Am J Respir Crit Care Med. 2010;182(5):676–83. Scholar
  24. 24.
    • Marcus CL, Moore RH, Rosen CL, et al. A randomized trial of adenotonsillectomy for childhood sleep apnea. N Engl J Med. 2013;368:2366–76. Important study to read and understand in detail, as this is the best study to date comparing outcomes of surgical intervention vs watchful waiting in children with OSA. PubMedPubMedCentralCrossRefGoogle Scholar
  25. 25.
    Viana Ada C Jr, Thuler LC, Araujo-Melo MH. Drug-induced sleep endoscopy in the identification of obstruction sites in patients with obstructive sleep apnea: a systematic review. Braz J Otorhinolaryngol. 2015;81(4):439–46. Scholar
  26. 26.
    Galluzzi F, Pignataro L, Gaini RM, Garavello W. Drug induced sleep endoscopy in the decision-making process of children with obstructive sleep apnea. Sleep Med. 2015;16(3):331–5. Scholar
  27. 27.
    He S, Peddireddy NS, Smith DFet al. Outcomes of drug-induced sleep endoscopy-directed surgery for pediatric obstructive sleep apnea. Otolaryngol Head Neck Surg 2017:194599817740332.Google Scholar
  28. 28.
    Boudewyns A, Saldien V, Van de Heyning P, Verhulst S. Drug-induced sedation endoscopy in surgically naive infants and children with obstructive sleep apnea: impact on treatment decision and outcome. Sleep Breath. 2017;
  29. 29.
    Wallace IF, Berkman ND, Lohr KN, Harrison MF, Kimple AJ, Steiner MJ. Surgical treatments for otitis media with effusion: a systematic review. Pediatrics. 2014;133(2):296–311. Scholar
  30. 30.
    • Mikals SJ, Brigger MT. Adenoidectomy as an adjuvant to primary tympanostomy tube placement: a systematic review and meta-analysis. JAMA Otolaryngol Head Neck Surg. 2014;140:95–101. Good study to read as it identified that adenoidectomy ≥ 4 years old reduced the rate of repeat tympanostomy tube insertion. However, no significant effect was found in children under 4 years old. As a result, adenoidectomy is no longer recommended for repeat tympanostomy tube placement in children under 4 years old with no nasal symptoms, which is a change from earlier recommendations. PubMedCrossRefGoogle Scholar
  31. 31.
    Boonacker CW, Rovers MM, Browning GG, Hoes AW, Schilder AG, Burton MJ. Adenoidectomy with or without grommets for children with otitis media: an individual patient data meta-analysis. Health Technol Assess. 2014;18(5):1–118. Scholar
  32. 32.
    Rosenfeld RM, Shin JJ, Schwartz SR, et al. Clinical practice guideline: otitis media with effusion executive summary (update). Otolaryngol Head Neck Surg. 2016;154(2):201–14. Scholar
  33. 33.
    Brietzke SE, Shin JJ, Choi S, et al. Clinical consensus statement: pediatric chronic rhinosinusitis. Otolaryngol Head Neck Surg. 2014;151(4):542–53. Scholar
  34. 34.
    Coticchia J, Zuliani G, Coleman C, et al. Biofilm surface area in the pediatric nasopharynx: chronic rhinosinusitis vs obstructive sleep apnea. Arch Otolaryngol Head Neck Surg. 2007;133(2):110–4. Scholar
  35. 35.
    Shin KS, Cho SH, Kim KR, et al. The role of adenoids in pediatric rhinosinusitis. Int J Pediatr Otorhinolaryngol. 2008;72(11):1643–50. Scholar
  36. 36.
    Brietzke SE, Brigger MT. Adenoidectomy outcomes in pediatric rhinosinusitis: a meta-analysis. Int J Pediatr Otorhinolaryngol. 2008;72(10):1541–5. Scholar
  37. 37.
    Anand V, Sarin V, Singh B. Changing trends in adenoidectomy. Indian J Otolaryngol Head Neck Surg. 2014;66(4):375–80. Scholar
  38. 38.
    Das AT, Prakash SB, Priyadarshini V. Combined conventional and endoscopic microdebrider-assisted adenoidectomy: a tertiary centre experience. J Clin Diagn Res. 2017;11:Mc05–mc07.PubMedPubMedCentralGoogle Scholar
  39. 39.
    Yang L, Shan Y, Wang S, Cai C, Zhang H. Endoscopic assisted adenoidectomy versus conventional curettage adenoidectomy: a meta-analysis of randomized controlled trials. Spring. 2016;5(1):426. Scholar
  40. 40.
    Pagella F, Pusateri A, Canzi P, et al. The evolution of the adenoidectomy: analysis of different power-assisted techniques. Int J Immunopathol Pharmacol. 2011;24(4_suppl):55–9. Scholar
  41. 41.
    Duval M, Chung JC, Vaccani JP. A case-control study of repeated adenoidectomy in children. JAMA Otolaryngol Head Neck Surg. 2013;139(1):32–6. Scholar
  42. 42.
    Huo Z, Shi J, Shu Y, Xiang M, Lu J, Wu H. The relationship between allergic status and adenotonsillar regrowth: a retrospective research on children after adenotonsillectomy. Sci Rep. 2017;7:46615. Scholar
  43. 43.
    Wei L, Wang M, Hua N, Tong K, Zhai L, Wang Z. Regrowth of the adenoids after adenoidectomy down to the pharyngobasilar fascial surface. J Laryngol Otol. 2015;129(07):662–5. Scholar
  44. 44.
    Agrawal V, Agarwal PK, Agrawal A. Defining the surgical limits of adenoidectomy so as to prevent recurrence of adenoids. Indian J Otolaryngol Head Neck Surg. 2016;68(2):131–4. Scholar
  45. 45.
    Sapthavee A, Bhushan B, Penn E, Billings KR. A comparison of revision adenoidectomy rates based on techniques. Otolaryngol Head Neck Surg. 2013;148(5):841–6. Scholar
  46. 46.
    Tweedie DJ, Skilbeck CJ, Wyatt ME, Cochrane LA. Partial adenoidectomy by suction diathermy in children with cleft palate, to avoid velopharyngeal insufficiency. Int J Pediatr Otorhinolaryngol. 2009;73(11):1594–7. Scholar
  47. 47.
    Askar SM, Quriba AS. Powered instrumentation for transnasal endoscopic partial adenoidectomy in children with submucosal cleft palate. Int J Pediatr Otorhinolaryngol. 2014;78(2):317–22. Scholar
  48. 48.
    Finkelstein Y, Wexler DB, Nachmani A, Ophir D. Endoscopic partial adenoidectomy for children with submucous cleft palate. Cleft Palate Craniofac J. 2002;39(5):479–86.<0479:EPAFCW>2.0.CO;2.PubMedCrossRefGoogle Scholar
  49. 49.
    Stern Y, Segal K, Yaniv E. Endoscopic adenoidectomy in children with submucosal cleft palate. Int J Pediatr Otorhinolaryngol. 2006;70(11):1871–4. Scholar
  50. 50.
    Lowe D, Brown P, Yung M. Adenoidectomy technique in the United Kingdom and postoperative hemorrhage. Otolaryngol Head Neck Surg. 2011;145(2):314–8. Scholar
  51. 51.
    Tomkinson A, Harrison W, Owens D, Fishpool S, Temple M. Postoperative hemorrhage following adenoidectomy. Laryngoscope. 2012;122(6):1246–53. Scholar
  52. 52.
    De Luca Canto G, Pacheco-Pereira C, Aydinoz S, et al. Adenotonsillectomy complications: a meta-analysis. Pediatrics. 2015;136(4):702–18. Scholar
  53. 53.
    Khami M, Tan S, Glicksman JT, Husein M. Incidence and risk factors of velopharyngeal insufficiency postadenotonsillectomy. Otolaryngol Head Neck Surg. 2015;153(6):1051–5. Scholar
  54. 54.
    Kassem F, Ebner Y, Nageris B, Watted N, DeRowe A, Nachmani A. Cephalometric findings among children with velopharyngeal dysfunction following adenoidectomy—a retrospective study. Clin Otolaryngol. 2017;42(6):1289–94. Scholar
  55. 55.
    Veerapandiyan A, Blalock D, Ghosh S, Ip E, Barnes C, Shashi V. The role of cephalometry in assessing velopharyngeal dysfunction in velocardiofacial syndrome. Laryngoscope. 2011;121(4):732–7. Scholar
  56. 56.
    Gross IT, Bahar-Posey L. Atlanto-axial subluxation after adenoidectomy. Pediatr Emerg Care. 2017;33(6):416–7. Scholar
  57. 57.
    Spennato P, Nicosia G, Rapana Aet al. Grisel syndrome following adenoidectomy: surgical management in a case with delayed diagnosis. World Neurosurg 2015; 84:1494.e1497–1412.Google Scholar
  58. 58.
    Wan DC, Kumar A, Head CS, Katchikian H, Bradley JP. Amelioration of acquired nasopharyngeal stenosis, with bilateral Z-pharyngoplasty. Ann Plast Surg. 2010;64(6):747–50. Scholar
  59. 59.
    Abdel-Fattah G. Palatal eversion: a new technique in treatment of nasopharyngeal stenosis. Int J Pediatr Otorhinolaryngol. 2012;76(6):879–82. Scholar
  60. 60.
    Garg A, Singh Y, Singh P, Goel G, Bhuyan S. Carotid artery dissection following adenoidectomy. Int J Pediatr Otorhinolaryngol. 2016;82:98–101. Scholar
  61. 61.
    Baker LL, Bower CM, Glasier CM. Atlanto-axial subluxation and cervical osteomyelitis: two unusual complications of adenoidectomy. Ann Otol Rhinol Laryngol. 1996;105(4):295–9. Scholar
  62. 62.
    Mathew R, Asimacopoulos E, Walker D, Gutierrez T, Valentine P, Pitkin L. Analysis of clinical negligence claims following tonsillectomy in England 1995 to 2010. Ann Otol Rhinol Laryngol. 2012;121(5):337–40. Scholar
  63. 63.
    Moreno-Luna R, Cardenas Ruiz-Valdepenas E, Tato JI, Rivero-Garvia M, Marquez-Rivas J, Mochon Martin A. Basiespinal cerebrospinal fluid leak as a complication after adenoidectomy: case report and literature review. World Neurosurg 2016; 93:484.e489–484.e412.Google Scholar
  64. 64.
    Chadha NK, Zhang L, Mendoza-Sassi RA, Cesar JA. Using nasal steroids to treat nasal obstruction caused by adenoid hypertrophy: does it work? Otolaryngol Head Neck Surg. 2009;140(2):139–47. Scholar
  65. 65.
    Zhang L, Mendoza-Sassi RA, Cesar JA, Chadha NK. Intranasal corticosteroids for nasal airway obstruction in children with moderate to severe adenoidal hypertrophy. Cochrane Database Syst Rev 2008:Cd006286.Google Scholar
  66. 66.
    Chohan A, Lal A, Chohan K, Chakravarti A, Gomber S. Systematic review and meta-analysis of randomized controlled trials on the role of mometasone in adenoid hypertrophy in children. Int J Pediatr Otorhinolaryngol. 2015;79(10):1599–608. Scholar
  67. 67.
    Demirhan H, Aksoy F, Ozturan O, Yildirim YS, Veyseller B. Medical treatment of adenoid hypertrophy with “fluticasone propionate nasal drops”. Int J Pediatr Otorhinolaryngol. 2010;74(7):773–6. Scholar
  68. 68.
    Sakarya EU, Bayar Muluk N, Sakalar EG, et al. Use of intranasal corticosteroids in adenotonsillar hypertrophy. J Laryngol Otol. 2017;131(05):384–90. Scholar
  69. 69.
    Yildirim YS, Senturk E, Eren SB, Dogan R, Tugrul S, Ozturan O. Efficacy of nasal corticosteroid in preventing regrowth after adenoidectomy. Auris Nasus Larynx. 2016;43(6):637–40. Scholar
  70. 70.
    Jazi SM, Barati B, Kheradmand A. Treatment of adenotonsillar hypertrophy: a prospective randomized trial comparing azithromycin vs. fluticasone. J Res Med Sci. 2011;16(12):1590–7.PubMedPubMedCentralGoogle Scholar
  71. 71.
    Shokouhi F, Meymaneh Jahromi A, Majidi MR, Salehi M. Montelukast in adenoid hypertrophy: its effect on size and symptoms. Iran J Otorhinolaryngol. 2015;27(83):443–8.PubMedPubMedCentralGoogle Scholar
  72. 72.
    Goldbart AD, Greenberg-Dotan S, Tal A. Montelukast for children with obstructive sleep apnea: a double-blind, placebo-controlled study. Pediatrics. 2012;130(3):e575–80. Scholar
  73. 73.
    Kar M, Altintoprak N, Muluk NB, Ulusoy S, Bafaqeeh SA, Cingi C. Antileukotrienes in adenotonsillar hypertrophy: a review of the literature. Eur Arch Otorhinolaryngol. 2016;273(12):4111–7. Scholar
  74. 74.
    Antos-Bielska M, Lau-Dworak M, Olszewska-Sosinska O, Zielnik-Jurkiewicz B, Trafny EA. Utility of antimicrobial susceptibility testing of multiple Haemophilus influenzae isolates from throat swabs of children with adenoid hypertrophy. Diagn Microbiol Infect Dis. 2014;79(3):396–8. Scholar
  75. 75.
    Trafny EA, Olszewska-Sosinska O, Antos-Bielska M, et al. Carriage of antibiotic-resistant Haemophilus influenzae strains in children undergoing adenotonsillectomy. Int J Med Microbiol. 2014;304(5-6):554–64. Scholar
  76. 76.
    Gunel C, Kirdar S, Omurlu IK, Agdas F. Detection of the Epstein-Barr virus, human bocavirus and novel KI and KU polyomaviruses in adenotonsillar tissues. Int J Pediatr Otorhinolaryngol. 2015;79(3):423–7. Scholar
  77. 77.
    Proenca-Modena JL, Paula FE, Buzatto GP, et al. Hypertrophic adenoid is a major infection site of human bocavirus 1. J Clin Microbiol. 2014;52(8):3030–7. Scholar
  78. 78.
    Buzatto GP, Tamashiro E, Proenca-Modena JL, et al. The pathogens profile in children with otitis media with effusion and adenoid hypertrophy. PLoS One. 2017;12(2):e0171049. Scholar
  79. 79.
    Bielicka A, Zielnik-Jurkiewicz B, Podsiadly E, Prochorec-Sobieszek M, Rogulska J, Demkow U. Role of chlamydia pneumoniae in the pathogenesis of hypertrophy and adenoid tissue inflammation in children. Otolaryngol Pol. 2016;70(5):7–12. Scholar
  80. 80.
    Bielicka A, Zielnik-Jurkiewicz B, Podsiadly E, Rogulska J, Demkow U. Chlamydia pneumoniae and typical bacteria occurrence in adenoid in children qualified for adenoidectomy. Int J Pediatr Otorhinolaryngol. 2014;78(5):828–31. Scholar
  81. 81.
    Yoruk O, Alp H, Yuksel S, Bakan E. DNA damage in children with obstructive adenotonsillar hypertrophy. J Craniofac Surg. 2014;25(6):2156–9. Scholar
  82. 82.
    Kiroglu AF, Noyan T, Oger M, Kara T. Oxidants and antioxidants in tonsillar and adenoidal tissue in chronic adenotonsillitis and adenotonsillar hypertrophy in children. Int J Pediatr Otorhinolaryngol. 2006;70(1):35–8. Scholar
  83. 83.
    Ni K, Zhao L, Wu J, Chen W, HongyaYang LX. Th17/Treg balance in children with obstructive sleep apnea syndrome and the relationship with allergic rhinitis. Int J Pediatr Otorhinolaryngol. 2015;79(9):1448–54. Scholar
  84. 84.
    Qu XP, Huang ZX, Sun Y, et al. Expression of innate immunity genes in epithelial cells of hypertrophic adenoids with and without pediatric chronic rhinosinusitis: a preliminary report. Chin Med J. 2015;128(21):2913–8. Scholar
  85. 85.
    Ratomski K, Zelazowska-Rutkowska B, Wysocka J, Skotnicka B, Kasprzycka E, Hassmann-Poznanska E. [Expression CD27 on T and B lymphocytes in hypertrophied adenoids at children with otitis media with effusion]. Otolaryngol Pol 2009; 63:264–270, Ekspresja receptora CD27 na limfocytach T i B w tkance przerosłych migdałków gardłowych u dzieci chorych na wysiękowe zapalenie ucha środkowego, 3, DOI:

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Authors and Affiliations

  • Alexander J. Schupper
    • 2
  • Javan Nation
    • 1
    • 2
  • Seth Pransky
    • 1
    • 2
  1. 1.Rady Children’s Hospital - San DiegoSan DiegoUSA
  2. 2.UC San Diego School of MedicineSan DiegoUSA

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