Efficacy and Safety of Microdebrider Assisted Adenoidectomy Over Conventional Adenoidectomy”- A 1 Year Randomized Control Trial in KLES Dr. Prabhakar Kore Hospital, Belagavi

Abstract

Background: The adenoids are a mass of lymphoid tissues located in the super posterior area of the nasopharynx and affect breathing in the upper airway. It is known that, in general, the adenoids are tiny in size at birth and consistently grow during several years’ after birth due to the hyperactivity of the immune system. Adenoidectomy forms a valuable treatment option in management of sleep disordered breathing, middle ear pathologies, pediatric chronic rhino-sinusitis and recurrent adeno-tonsillitis. It is conventionally performed using the curettage method which is not only crude but also blind. Damage to Eustachian tube opening is known and the completeness of procedure is difficult to assess but with the advent of endoscopes this area has become more accessible and more procedures are presently performed using nasal endoscopes. Microdebriders are powered instruments which provide an excellent, safe and thorough surgical clearance in endoscopic nasal surgery. They provide atraumatic dissection with minimal complications and faster postoperative healing. Objectives: To study the variation between the safety and efficacy of adenoidectomy done by the conventional curettage method versus the microdebrider assisted method. Material and methods: This is a randomised controlled trial and was conducted in the department of Otorhinolaryngology and Head and Neck Surgery of KLE’s Dr. Prabhakar Kore Hospital, Belagavi, from January 2018 to December 2018. Patients were allocated into 2 groups i.e. conventional curettage adenoidectomy(group A) and microdebrider assisted adenoidectomy(group B). Preoperatively endoscopic adenoid grading was recorded. Adenoidectomy was done and parameters such as amount of bleeding, operative time and post-operative endoscopic grading of adenoid were recorded. Results: 45 patients were included in the study, 25 patients in group A and 20 patients in group B. 25 were male and 20 were female. The mean age among the sample was 9.24 years. The most common presenting complaint was mouth breathing and snoring. Following adenoidectomy operation the percentage of reduction of adenoid grading in microdebrider group was 63.79 % and 30.29% in conventional curettage group, The average time taken by microdebrider assisted surgery was 16.45 mins as compared to 13.28 mins in conventional curettage. The average amount of blood loss in conventional group was 44.76 ml whereas in microdebrider group was 77.30 ml. Conclusion: Adenoidectomy is a routine Otolaryngologic surgery done in Paediatric age group for various indications and often after conventional curettage there is remnant adenoid tissue which doesn’t alleviate the symptoms. Microdebrider assisted adenoidectomy has proven to deliver completeness of clearance at the expense of slight increase in bleeding and the operative time. Though the cost of surgery is higher but precise dissection under vision, lesser complications and better disease clearance makes this technique a safe and efficacious alternative over the blind curettage method.