Comparative analysis of cold curettage and coblation adenoidectomy: surgical and postoperative outcomes with 0° and 70° endoscopic techniques

BACKGROUND AND OBJECTIVES: Adenoidectomy is a common pediatric otolaryngologic procedure. While cold curettage remains widely practiced, endoscopic coblation has been developed to enhance precision, minimize intraoperative complications, and reduce residual tissue. This study compared outcomes of conventional cold curettage adenoidectomy and coblation-assisted adenoidectomy in pediatric patients. MATERIALS AND METHODS: This study was designed as a prospective, comparative, non-randomized clinical study. A total of 128 children aged 3-11 years who underwent adenoidectomy were included. The choice of surgical technique was determined by patient (family) preference after explanation of both procedures. Patients were allocated to Group 1 (cold curettage, n = 64) or Group 2 (endoscopic coblation using 0° or 70° endoscopes, n = 64). Evaluated parameters included operative time, intraoperative blood loss, postoperative pain (VAS), halitosis, peripheral tissue injury, and residual adenoid tissue assessed at 1-, 6-, and 12-month follow-up. RESULTS: Groups were comparable in demographics and baseline adenoid grades (p = 0.689). Mean operative time was longer with coblation (26.6 ± 5.3 min) than with cold curettage (20.6 ± 3.8 min; p < 0.001), although procedures with a 70° endoscope were shorter than with a 0° (p = 0.037). Blood loss was significantly lower in the coblation group compared to the cold curettage group (12.4 ± 2.1 mL vs 24.2 ± 3.3 mL; p < 0.001). Postoperative pain scores at 24 and 72 h were also reduced in the coblation group (p < 0.001). Halitosis was more frequent after coblation (75% vs. 31.3%; p = 0.00000173) but resolved spontaneously within one week. Minor peripheral tissue injuries occurred only with cold curettage (n = 4) without sequelae. Residual adenoid tissue was detected in 29.7% of cold curettage cases but in none of the coblation cases (p = 0.00000079). CONCLUSIONS: Endoscopic coblation adenoidectomy demonstrates advantages in reduced blood loss, less postoperative pain, and elimination of residual tissue compared to cold curettage, though it requires longer operative time and carries a higher incidence of transient halitosis. TRIAL REGISTRATION: ClinicalTrials.gov, NCT07417007, 10 February 2026. Retrospectively registered.