Adenoidectomy. A prospective study to show clinical and radiological changes two years after operation.

Introduction The adenoids have been said to cause a variety of symptoms. These include nasal obstruction, which gives rise to mouth breathing and snoring. Reduction of nasal resonance or hyponasality results from obstruction of the posterior choanae by enlarged adenoids. In a very small number of children, obstruction may be severe and prolonged enough to cause the hypersomnolent' sleep apnoea' syndrome and very rarely pulmonary hypertension and cor pulmonale. Middle-ear disease, including both middle-ear effusion and recurrent acute suppurative otitis media, has been traditionally related to eustachian tube dysfunction resulting from enlargement or infection of the adenoids (Ballantyne, 1976) but there are still differences of opinion regarding concomitant reduction of aural symptoms following adenoidectomy (McKee, 1963 a and b; Roydhouse, 1970; Sade, 1979). Furthermore, there is evidence that adenoids are no larger in children with middle-ear effusion than in controls (Hibbert, 1980). It is difficult to define objective criteria by which to judge many of the other less specific symptoms previously attributed to enlargement and infection of the adenoids. If adenoid enlargement is responsible for snoring, mouth breathing and hyponasality, the operation of adenoidectomy should produce relief of these signs and symptoms. Similarly, if eustachian tube dysfunction is due to adenoidal enlargement or infection, resolution of middle-ear effusion should follow adenoid removal. Furthermore if the size of the adenoid is related to the symptoms one would expect greater improvement after removal to occur in those cases with larger adenoids. This study reports the effects of adenoidectomy on a group of children assessed clinically and radiologically, at the same time of the year, immediately before operation and subsequently 24 months post-operatively.