Contraindications to adenoidectomy

The operative indications for adenoidectomy should be based on a positive history, physical examination, and laboratory tests. There are three clear indications for adenoidectomy: first, proved obstruction of the eustachian tube resulting in recurrent otitis media; second, partial upper airway obstruction resulting in cor pulmonale; and third, proved choanal obstruction resulting in sinusitis and severe rhinitis, with or without epistaxis. The most common contraindications to adenoidectomy are major or minor palatal insufficiency. The indications for operation must be obtained in a positive manner. The operation should not be performed unless there is significant proof that the adenoids are the cause of the symptoms. All too often adenoidectomy is performed in the hope that it may help. Too many children have been left with velopharyngeal incompetence because the physician has not investigated palatal function and other systemic problems in each case. The technique for doing this is simple, and is in every physician's armamentarium. Conservative management is often wise, for the adenoid will involute spontaneously and the problem of recurrent otitis media can be managed adequately with ventilating tubes. On the other hand, the correction of velopharyngeal incompetence requires extensive rehabilitative therapy and major surgery.