Mayo Clinic Identifies Risk Factors for Repeat Adenoid Removal in Children

Monday, September 12, 2011

ROCHESTER, Minn. — It isn't unusual for children to have their tonsils and adenoids removed, and the younger those patients are, the greater the risk their adenoids will grow back and they will need to have them taken out again, Mayo Clinic researchers have found. Results of their study were presented today during the 2011 American Academy of Otolaryngology – Head and Neck Surgery Annual Meeting in San Francisco.

The retrospective study looked at data from 8,245 children ages birth to 18 who had their tonsils and adenoids removed at Mayo Clinic between 1980 and May 2009. Of those, 163 children experienced regrowth of adenoid tissue, and had to have it removed again, a procedure known as a revision adenoidectomy. Their age when their adenoids were initially removed was a significant factor: The younger the child, the greater the risk they needed the procedure again, especially for those under 4.

Children with ear problems such as middle ear disease and eustachian tube dysfunction were 20 times more likely to have a revision adenoidectomy than those with infections such as recurrent adenotonsillitis. Patients with reflux also had increased risk of revision. Patients whose adenoidectomies were performed by surgeons early in training were roughly 50 percent more likely to require a revision.

"We found that revision adenoidectomy was performed in less than 2 percent of the cases, but things that were actually shown to be associated with regrowth of adenoid tissue included age and diagnosis of gastroesophogeal reflux. And the more inexperienced the surgeon is, those patients were more likely to have regrowth," says lead author Laura Orvidas, M.D., a Mayo Clinic pediatric otolaryngologist.

"It appeared that we were getting more and more children that were having symptoms of regrowth of adenoid, and we were wondering if there was a trend," Dr. Orvidas says. "If children do redevelop symptoms of adenoid enlargement — things such as snoring or sleep-disordered breathing — they should be re-evaluated because we do now know that it's a possibility that adenoids can regrow."

The study's authors recommend that if symptoms redevelop after an adenoidectomy, parents should have those symptoms reinvestigated, especially if the patients were young, particularly under 4, at the time of removal or if they have symptoms of reflux.

Other members of the research team included Amy Dearking, M.D.; Brian Lahr; and Admire Kuchena, all of Mayo Clinic.

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