Endoscopic Assisted Cold Steel adenoidectomy - A Cost Effective Modification for Better Outcome.

Introduction: Adenoidectomy is most commonly performed in children to alleviate the symptoms pertaining to adenoid hypertrophy. The conventional cold steel method utilizing adenoid curette is the most commonly performed method in the world even after the invention of endoscopes & powered instruments like coblator & microdebrider due to the cost & time factors. The conventional method being a blind procedure, carries higher rate of recurrence due to remnant tissues. The visualization of the adenoid tissue in nasopharynx through the nasal endoscope helps in better engagement of adenoids into the curette & adequate tissue clearance with reduced recurrence of symptoms.

Aim: To study the effect of visualization of adenoid tissue for better tissue clearance in conventional adenoidectomy.

Objectives: To compare the duration of surgery, blood loss & recurrence rate following conventional cold steel adenoidectomy (CSA) & endoscope assisted cold steel adenoidectomy (EACSA).

Method: 50 patients who underwent adenoidectomy with various indications were grouped into two groups with 25 patients each. Group A underwent (CSA)with or without tonsillectomy & Group B underwent (EACSA) with or without tonsillectomy were followed up for the duration of 3 months. The patients were evaluated for duration of surgery & post operatively for the recurrence at 3rd month of follow up.

Results: In our study, it was found that the tissue clearance in Group A was significantly low. The recurrence rate of 48% was observed in CSA group compared to 0% in group B with EACSA. The duration of surgery in both the procedures were comparable.

Conclusion: EACSA is an effective modification to CSA. It adds the benefits of endoscopic visualization of adenoid for the conventional curettage. The high recurrence rates of CA can be effectively reduced with no significant variation in duration of surgery.