Revision adenoidectomy - A retrospective study

Background: Adenoid "re-growth" is a poorly understood phenomenon. While parents often express concerns regarding the potential for adenoid "re-growth", little information exists in the literature about its incidence and causation. Purpose: To establish the incidence and possible contributing factors leading to adenoid re-growth in children. Design: Retrospective case series review. Setting: Tertiary care children's hospital. Methods: The charts of 106 patients who underwent revision adenoidectomy between 1995 and 2006 were reviewed. Thirty-four patients were excluded because the primary adenoidectomy was performed elsewhere or initially only a partial adenoidectomy was performed. In the remaining 72 patients, demographic data, clinical presentation, associated medical conditions and findings at surgery were studied. Results: During the 11-year study period. 13,005 adenoidectomies or adenotonsillectomies were performed; 72/13,005 (0.55%) underwent revision adenoidectomy. The mean (+/- S.D.) age at presentation for primary adenoidectomy was 3.68 +/- 2.9 and 7.69 +/- 4.04 years for secondary ("revision") adenoidectomy with an average time interval of 4.3 years between surgeries. Age at initial adenoidectomy was not a significant factor in predicting revision adenoid surgery. 29/72 (40%) underwent a reflux work up including scintiscan with gastric emptying, 24 h pH probe, or laryngoscopy. 28/29 (96%) were diagnosed with reflux. At least 15/72 (21%) were reported to have symptoms consistent with adenoid re-growth which were found to be caused by tubal tonsil hyperplasia. Conclusions: Revision adenoidectomy rarely needs to be performed. Tubal. tonsillar hyperplasia, as opposed to re-growth of residual adenoid tissue previously removed, accounts for some cases. Extraesophageal reflux is a possible cause in some and requires further study. (C) 2008 Elsevier Ireland Ltd. All rights reserved.