Objectives

To describe the incidence and indications of adenoid surgery and concomitantly performed ENT surgical procedures in a nationwide cohort covering several years of practice.

Methods

A retrospective study based on data from the National patient registry in Sweden. All children born from 1st of January 2004 to December 31st, 2013 who underwent adenoidectomy for the first time in Sweden during 2004–2013 were included in the study. Patient characteristics (age and gender), indications for surgery and performed ENT surgery were evaluated.

Results

40,829 children underwent adenoid surgery during the studied period. Of these, 24,537 (60%) were boys. Mean and median age at surgery in the studied population was 4 years and 3.5 years respectively for both boys and girls. The most frequently performed surgical procedure was adenotonsillar surgery 43% (n = 17,434) followed by solitary adenoid surgery 26% (n = 10,749). The most frequent registered indication was hypertrophy 60% (n = 24,422) followed by hypertrophy and otitis media 21% (n = 8425). The highest age related incidence for all types of adenoid surgery taken together was 2–4 years of age for both genders. Boys had higher incidence rates than girls for all ages and all types of surgery except at eight years of age.

Conclusions

The main findings were that adenoidectomy most commonly was performed together with surgery of the tonsils on the indication hypertrophy, that adenoid- and adenoid related ENT surgery were most commonly performed between 2 and 5 years of age and that the incidence in surgical rates was higher for boys than girls. There seem to be large unwarranted variations between countries regarding incidence rates and we believe that there is a need for further studies in order to establish recommendations for best practice regarding adenoid and related ENT surgeries.

Objectives: To investigate postoperative morbidity and mortality after paediatric adenoidectomy. Methods: This was a retrospective national population-based cohort study of data from the Swedish National Patient Register (NPR) and The Swedish Cause of Death Register (CDR). All patients aged 0-18 years who underwent adenoidectomy from 2007 to 2017 (without concomitant tonsil surgery) were included in this study. To evaluate postoperative morbidity and mortality, all diagnostic and surgical codes registered in the NPR for health care contacts within 30 days of surgery were analysed. The patients retrieved from the NPR were matched with the CDR to identify any deaths occurring within 30 days of the surgery. Results: A total of 51 746 adenoidectomies were included in this study. No deaths related to adenoidectomy were identified. All types of haemorrhagic complications were rare. Only 0.1% of the surgeries resulted in an outpatient contact due to postoperative haemorrhage and only 0.1% of the adenoidectomies resulted in a readmission due to haemorrhage. The rarest haemorrhagic complication was RTT (return to theatre), with only 4 events (0.01%). Postoperative haemorrhage was most frequent on the first day after surgery. Other complications were rare as well, requiring a total of 922 (2.6%) outpatient visits and 75 (0.2%) readmissions in the adenoidectomy group, with postoperative infection being the most commonly reported. Conclusions: Overall, adenoidectomy should be considered a safe surgical procedure associated with few postoperative complications. No deaths related to adenoidectomy were found. Severe complications, such as late postoperative haemorrhage after adenoidectomy, were rare, and haemorrhage resulting in RTT was even rarer. The highest rate of postoperative haemorrhage was observed the first day after surgery, and most haemorrhagic complications occurred within a week. Comparisons with studies on tonsil surgery show that adenoidectomy is associated with substantially lower postoperative morbidity.

Objective To evaluate the safety and clinical outcomes (bleeding rate, requirement for revision surgery, and patient-reported symptom relief) of pediatric cold steel tonsillotomy with or without adenoidectomy (TT/TTA). Methods Patients aged <= 18 years who underwent cold steel TT/TTA for the management of upper airway obstruction in Region Jonkoping County, Sweden, between October 1, 2013, and September 31, 2023, were included in this single center, retrospective, cohort study. Data regarding postoperative bleeding and revision surgery were extracted from electronic medical records. Patient-reported outcomes were obtained from the Swedish Quality Register of Tonsil Surgery. Results Among the 1810 cold steel TT/TTA procedures included in the analysis, 36 (2.0%) bleeding events were identified, comprising 12 (0.7%) and 24 (1.3%) cases involving tonsils and adenoid beds, respectively. Four (0.2%) and seven (0.4%) patients with tonsil and adenoid bleeding, respectively, required surgical intervention. No significant risk factors for postoperative bleeding were identified. The rate of revision surgery owing to regrowth of tonsil tissue or recurrent infections was 5.1%. Younger age at the time of the first surgery was a significant risk factor for revision surgery (p < 0.001). Complete (64.9%) or almost complete (29.5%) resolution of symptoms was reported in 94.4% (n = 868) of the patients 6 months postoperatively. Conclusion Cold steel TT/TTA is a safe and efficient surgical procedure for pediatric patients with upper airway obstruction owing to tonsil and adenoid hypertrophy.

Purpose: This study aimed to translate the T-14 questionnaire into Swedish and validate it in a Swedish pediatric population with tonsil-related disease. Methods: A prospective validation study was conducted across five Swedish otorhinolaryngology departments from October 2022 to June 2024. Translation followed a standardized forward-backward procedure. Caregivers of patients (< 16 years) scheduled for tonsil surgery completed the Swedish T-14 and EQ-5D-Y VAS (EuroQol five-Dimensional questionnaire for Youth, Visual Analog Scale [VAS]) at baseline, 2weeks later, and 6months postoperatively. A healthy control group was included for comparison. Psychometric evaluation included known-groups validity (Mann-Whitney U), construct validity (confirmatory factor analysis), convergent validity (Spearman's correlation), internal consistency (Cronbach's alpha), test-retest reliability (intraclass correlation coefficient), and responsiveness (Wilcoxon signed-rank, Cohen's d). Results: A total of 249 participants were included (case group 169, control group 80). Known-groups validity was confirmed, with significantly higher baseline T-14 scores in the case group (p < 0.001). Confirmatory factor analysis supported the predefined two-factor model (comparative fit index = 0.94, Tucker-Lewis index = 0.92, standardized root mean square residual = 0.061), although root mean square error of approximation (0.099) indicated some misfit. Convergent validity was demonstrated by a weak but significant negative correlation with EQ-5D-Y VAS (rs = -0.32; p < 0.001). Internal consistency was good (alpha= 0.83), and test-retest reliability showed good stability (ICC = 0.77). Responsiveness was strong, with a large reduction in T-14 scores 6 months after surgery (p < 0.001; Cohen's d = 1.89). Conclusion: T-14 demonstrated good validity, reliability, and responsiveness, effectively distinguishing patients from healthy controls. It is suitable for clinical use and enables comparisons with international studies.