chronic suppurative otitis media

8 OTOLARYNGOLOGY
proportion in relation to the size of the airway. This is not always accurate and some children will still need
an examination of the postnasal space under general anaesthetic. If enlarged adenoids are present they can
then be curetted.
Indications for adenoidectomy
Generally speaking, an adenoidectomy is only indicated if troublesome symptoms can be attributed to
abnormal adenoid hypertrophy. The indications for adenoidectomy are as follows:
• Nasal obstruction.
• Otitis media with effusion (glue ear).
• Recurrent acute otitis media.
• Chronic rhinosinusitis.
• Sleep apnoea.
Contraindications for adenoidectomy
• Recent upper respiratory tract infection.
• An uncontrolled bleeding disorder.
• Cleft palate. The adenoids assist in closure of the nasopharynx from the oropharynx during speech and
deglutition. They should never be removed in a child who has had a cleft palate repair or a congenitally
short palate. All children who have a bifid uvula should have a submucous cleft excluded.
1. Immediate.
• Anaesthetic complications.
• Soft palate damage.
• Dislocation of the cervical spine.
• Reactionary haemorrhage.
2. Intermediate.
Complications
• Secondary haemorrhage.
• Subluxation of the atlanto-occipital joint (secondary to infection).
3. Late.
• Eustachian tube stenosis.
• Hypernasal speech (rhinolalia aperta).
• Persistence of symptoms.