Can nasal endoscopy be used to predict residual symptoms after adenoidectomy for nasal obstruction?

Background: the efficacy of adenoidectomy in relieving nasal symptoms has b een questioned. Although enlarged adenoids are often blamed for nasal obstr uction, other causes can he missed if examination is not thorough. We sugge st that endoscopy at the time of adenoidectomy may be useful to confirm lar ge adenoids and exclude other causes, and the findings may help predict res idual symptoms 2 years after adenoidectomy. Method: a prospective study of a consecutive series of children undergoing adenoidectomy for nasal obstruc tion was performed. All underwent endoscopy with a 4-mm rigid endoscope wit hout decongestants under GA immediately prior to adenoidectomy. Two years l ater a postal symptom questionnaire was sent, with telephone follow up for non-responders. The findings on endoscopy were compared with residual sympt oms at 2 years. Results: Forty-eight children aged 2-9 (mean 4) years were enrolled, 16 of them female. At 2 years follow up, data were available for 34 children (71%). Complete obstruction of the posterior choanae of the nos e by adenoids was seen in 21 (62%). Additional findings (e.g. septal deviat ion, hypertrophic mucosa on the turbinates) were present in 22 (65%). Of th em 9 (26%) had residual nasal symptoms. Of the children with less than occl usive adenoids, six (50%,) out of 12 had residual symptoms, compared with t hree (14%) out of 21 with occlusive adenoids (chi (2) = 4.91, P < 0.05). Al though residual symptoms were more common in those with additional findings on the original endoscopy (32 vs. 17%), this did not reach statistical sig nificance. Conclusions: residual nasal symptoms are common when children ar e followed up in the medium term. The findings on endoscopy may predict the success of adenoidectomy in relieving the symptoms, and may help to guide further treatment. (C) 2001 Elsevier Science Ireland Ltd. All rights reserv ed.