Clinical outcomes of endoscopy assisted conventional adenoidectomy and endoscopic adenoidectomy with microdebrider: a prospective randomized control study

Background: Adenoidectomy is amongst common procedures in pediatric ENT. Conventional adenoidectomy is performed with traditional curettage method, which has limitations of visualization and incomplete tissue removal. This study aims to evaluate whether adding endoscopic visualization to traditional methods enhances outcomes, or if integrating a powered instrument with endoscopy is essential for improved efficacy. Methods: A prospective, randomized controlled trial was conducted from December 2012 to January 2015 at a tertiary care center, with IEC approval. Pediatric patients scheduled for adenoidectomy were randomized into two groups: endoscopy-assisted conventional adenoidectomy (EACCA) or endoscopic adenoidectomy with microdebrider (EAM). Data were collected on demographics and clinical parameters, and follow-up at two months was performed to assess efficacy, using a significance threshold of p<0.05. Results: The analysis included 50 patients (ages 5-13), with 25 in each group. No significant differences were observed in age, sex, surgical duration, blood loss, or pain scores. Both groups showed significant improvement in sleep-disordered breathing. However, the EAM group presented no residual adenoid tissue or eustachian tube injuries and had superior outcomes for otitis media with effusion (OME) compared to the EACCA group. Conclusions: While both techniques effectively alleviate sleep-disordered breathing, conventional adenoidectomy may leave residual tissue leading to OME. For patients primarily suffering from sleep issues, EACCA may suffice if cost is a concern; however, for otitis media cases, endoscopic powered adenoidectomy is recommended to prevent long-term complications.