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Safer Care Victoria’s Best Care resources support patients and healthcare providers to have conversations and make decisions together about the most appropriate pathways for care.

This resource, developed for clinicians, details a specific elective surgery procedure that should now only be done for specific indications. Evidence-based recommendations that detail ‘best care’ pathways should be discussed with your patient to determine the most appropriate pathway of care.

Advice

Obstructive sleep apnoea due to adenoidal hypertrophy is one indication for paediatric adenoidectomy, however, an adenotonsillectomy is preferred over adenoidectomy alone in this setting. The exception to this is in very young children or where tonsillectomy poses an unacceptable risk of post-operative complications in an individual child.

Adenoidectomy is also appropriate for nasal obstruction due to adenoidal hypertrophy, where obstructive symptoms (mouth breathing, hyponasal speech, impaired olfaction etc) have been present for a prolonged period and have not responded to conservative measures.

Adenoidectomy is a reasonable option for children with chronic sinusitis that has been refractory to medical therapy, and in whom endoscopic sinus surgery is being considered.

Adenoidectomy is not recommended for children with recurrent acute otitis media (AOM) or chronic otitis media with effusion (OME) as an isolated procedure.

For children with recurrent AOM or OME who are undergoing a second or subsequent middle ear ventilation tube placement, or for older children, we suggest adenoidectomy in addition to middle ear ventilation tube placement rather than middle ear ventilation tube placement alone.

Adenoidectomy may be performed as a biopsy procedure in the setting of concern about possible nasopharyngeal malignancy.

Best care recommendations

A child should be regularly reviewed by their healthcare practitioner to monitor and manage ongoing ear, nose and throat (ENT) symptoms. First line treatment options should be offered for most paediatric ENT symptoms. First line treatment options are to first have a period of observation of the symptoms. If symptoms do not resolve, a combination of medical therapies and simple therapies (depending upon the clinical presentation) should be trialled.

If first-line treatments have been trialed unsuccessfully or are contraindicated, a referral to a specialist for further management is indicated.

Evidence

American Academy of Family Physicians et al. Otitis media with effusion. Pediatrics. 2004; 113(5): 1412-29. 

Buchman CA, Yellon RF, Bluestone CD. Alternative to endoscopic sinus surgery in the management of pediatric chronic rhinosinusitis refractory to oral antimicrobial therapy. Otolaryngology–Head and Neck Surgery. 1999;120(2):219-24. 

Domany KA, Dana E, Tauman R, Gut G, Greenfeld M, Yakir BE, Sivan Y. Adenoidectomy for obstructive sleep apnea in children. Journal of Clinical Sleep Medicine. 2016 Sep 15;12(9):1285-91.

Felisati G, Ramadan H. Rhinosinusitis in children: the role of surgery. Pediatric Allergy and Immunology. 2007;18 Suppl 18:68-70. 

Mitchell RB, Archer SM, Ishman SL, Rosenfeld RM, Coles S, Finestone SA, et al. Clinical practice guideline: tonsillectomy in children (update). Otolaryngology–Head and Neck Surgery. 2019 Feb;160(1_suppl):S1-42.

National Institute for Health and Care Excellence. Otitis media with effusion in under 12s: Surgery. [cited 2012 Nov 8]. 

Robb PJ, Bew S, Kubba H, Murphy N, Primhak R, Rollin AM, et al. Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party. The Annals of The Royal College of Surgeons of England. 2009 Jul;91(5):371-3. 

van den Aardweg MT, Schilder AG, Herkert E, Boonacker CW, Rovers MM. Adenoidectomy for otitis media in children. Cochrane Database of Systematic Reviews. 2010;(1):CD007810. Published 2010 Jan 20. doi:10.1002/14651858.CD007810.pub2

Page last updated: 23 Dec 2020

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