Role of endoscopic nasal examination in reduction of nasopharyngeal adenoid recurrence rates Waleed F. Ezzat * Otolaryngology Head and Neck Surgery Dept, Faculty of Medicine, Ain-Shams University, Ramsis St, Abbaseya Square, Cairo, Egypt 1. Introduction Adenoidectomy is one of the most common worldwide performed otolaryngologic procedures, whether alone or in association with tonsillectomy or ventilation tube insertion, with rates reaching 65 per 10,000 children in England and 50 per 10,000 children in the United States [1]. Although various techniques have been described, the ‘‘blind technique’’ is still widely performed in various countries. There is a recurrence rate with the surgical procedure which no literature has agreed upon, nor even reached comparable incidences, historically, literature shows extreme variations. According to Lundgren, the recurrence rate is 4–8%, in Hill’s investigation it was 23.7–50%, Crowe found the recurrence rate of adenoid tissue to be over 75% [2]. More recent studies record markedly lower incidences, reaching down to 0.5% [3,4], which might be contributed to better techniques. Historically, Tolczynski [2] attributed various causes to recurrence of adenoid enlargement, namely: (1) anatomical difficulties. (2) Though adenoidectomy is regarded as a simple procedure and is carried out by everybody, it is more difficult to perform a clean adenoidectomy than tonsillectomy. Very often remnants will be found where either the casual operator or the qualified otolaryngologist has been satisfied that the operation was complete. (3) Adenoidectomy is often performed in a hurry, and the inadequate anesthesia is responsible for insufficient relaxation of the palato-pharyngeal muscles, whose contracture interferes with the manipulations of the adenoid curette and nasal biting forceps. (4) In many cases it is an ‘‘Operation in the dark’’. One of the explanations of such recurrence is ‘‘missing’’ adenoid tissue, especially if there are choanal adenoids, at this site; the adenoid tissue is difficult to access by the regular curette, and is difficult to visualize by the mirror. Tubal tonsillar hyperplasia, as opposed to regrowth of residual adenoid tissue previously removed, accounts for some cases. Extraesophageal reflux is also a possible cause [4]. Endoscopic adenoidectomy has been described by Uc¸ar [6], and it is stated that there is almost zero rate of recurrence, but this procedure is relatively time consuming and costly, in comparison to other methods used. International Journal of Pediatric Otorhinolaryngology 74 (2010) 404–406 ARTICLE INFO Article history: Received 4 December 2009 Received in revised form 18 January 2010 Accepted 19 January 2010 Available online 16 February 2010 Keywords: Nasal fiberoptic endoscopy Adenoidectomy Adenoid recurrence ABSTRACT Objectives: To evaluate the benefit of endoscopic examination after adenoidectomy in detecting residual adenoid tissue that would need completion surgery, in ultimate aim to reduce rates of adenoid recurrence. Methods: A total of 312 children were included in the study conducted at Ain-Shams University Hospital from January till December 2007, following routine adenoidectomy, 118 had a nasal and nasopharyngeal rigid fiberoptic examination and 194 did not, randomly according to the surgical subunit that performed the surgery. Patients were followed up for a minimum of 2 years for recurrence of symptoms of adenoid enlargement. Results: Endoscopic examination revealed that 14.5% of patients undergoing adenoidectomy had residual adenoid tissue that needed further removal, of these the most common site was at the lateral walls of the nasopharynx (47%). The recurrence rate of adenoid hypertrophy needing re-surgery with endoscopic examination (0.85%) approaches that of the lowest recorded (0.5%) with more expensive and costly methods, and statistically significant lower than rates when endoscopy is not performed (5.6%). Additional time needed for such examination was negligible in terms of cost–benefit relationship. Conclusion: Rigid fiberoptic endoscopy of the posterior choana and nasopharynx at the end of adenoidectomy provides the benefit of detecting unremoved adenoid tissue without significantly extra cost, time, nor expertise, and helps reduce significantly the rates of recurrence of adenoid enlargement, which might be attributed to residual ‘‘missed’’ adenoid tissue. ß 2010 Elsevier Ireland Ltd. All rights reserved. * Tel.: +20 182994041; fax: +20 226182227. E-mail address: wfezzat@yahoo.com. Contents lists available at ScienceDirect International Journal of Pediatric Otorhinolaryngology journal homepage: www.elsevier.com/locate/ijporl 0165-5876/$ – see front matter ß 2010 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijporl.2010.01.016