Failure of Adenoidectomy in Pediatric Chronic Adenoiditis and Rhinosinusitis Patients

Introduction: Adenoidectomy (AD) is first line surgical treatment for pediatric chronic adenoiditis (CA) and chronic rhinosinusitis (CRS). Up to 50% of children experience persistent symptoms and require further intervention via functional endoscopic sinus surgery (FESS). In this retrospective study, we aim to understand risk factors that portend AD to fail and require FESS to help refine surgical decision making and parental counseling.

Methods: We identified 50 children undergoing AD for CA or CRS by a single surgeon at our institution from 2015-2025 ultimately requiring FESS. These patients were cross-matched to roughly 200 patients who underwent AD from 2015-2018 and did not ultimately proceed to FESS. Only those with CA or CRS were included. Endpoints were pre-op symptoms, nasal steroid use, allergic rhinitis (AR) history, and time from AD to FESS. Significance was assessed using multivariable logistic regression.

Results: Of FESS cohort, 27 (54%) were male, and 23 female (46%). Average age at AD was 6.46 (SD 4.47). Average time from AD to FESS was 5.31 years (SD 4.23). 66% of children used pre-op nasal steroids and 54% had AR. Most commonly reported pre-op symptoms were nasal congestion (48%), SDB (44%), rhinorrhea (34%), recurrent illness (28%), and cough (26%). Pre-op cough was the only symptom independently associated with earlier progression to FESS (p = 0.049). Allergic rhinitis and pre-operative nasal steroid use were not (p= 0.15, p= 0.77). Further comparison between FESS and non-FESS groups will be performed.

Conclusions: There was an average of 5.3 years between patients requiring FESS after failure of AD to treat pediatric CRS. Persistent pre-op cough was associated with earlier progression to FESS. Additional comparison data will be reported.