Does my son need endoscopic surgery for adenoid removal?

Dr (Prof) D Balakrishnan
Consultant Paediatric ENT Surgeon,
Kanchi Kamakoti Child Trust Hospital, Chennai

Q: My 6 and a half years old son has been advised to undergo surgery for adenoids removal. I have heard about endoscopic surgery for removal of adenoids. How far is this successful? Is it better than normal surgery?

A:The adnoids are tissues which are similar to the tonsils in function. They are situated behind and above the palate. Hence, they are hidden from view. Removal of adnoids is conventionally done with instruments called adenoid curettes, no incision is necessary. The child lies supine i.e. head facing upwards on the operating table. Through the open mouth, the adenoid curette is introduced behind the palate and with a deft twisting movement of the surgeon's wrist, the adenoid cushion is shaved away. Usually, a mirror is held over the gap between the palate and the throat, in order to see the curetting procedure.

In endoscopic adenoidectomy, this visualisation is done with a nasal telescope (endoscope). Hence, a better control is expected to be achieved. However, we should keep in mind that several million adenoidectomies had been done by the conventional method and had been found satisfactory over the years, all over the world.

Recently, a newer tool called debrider is available for the shaving procedure. The combination of an endoscope and the debrider is claimed toresult in a better and more complete procedure. But the cost is pushed up. Whether such increased cost is justified is debated endlessly. If you can afford the cost, you can go for endoscopic adenoidectomy. Most of the ENT surgeons have a personal telescope and a debrider. Most others would have an easy access to the equipment. Hence, you can have it in any good hospital, in your city. I am one of the persons who feels that newer is not necessarily the better.