Adenoidectomy - History

History

Adenoidectomy was first performed using a ring forceps through the nasal cavity by William Meyer in 1867. By the early 1930s the operation had become nearly universal in children of school age.

In the early 1900's, adenoidectomies began to be routinely performed combined with tonsillectomy. Initially, the procedures were performed by otolaryngologists, general surgeons, and general practitioners but over the past 30 years tonsillectomies and adenoidectomies have been performed almost exclusively by otolaryngologists.

Then, adenoidectomies were performed as treatment of anorexia nervosa, mental retardation, and enuresis or for one's general well-being and to promote good health. By current standards, these indications seem odd but may be explained by the hypothesis that children may fail to thrive if they have chronically sore throats or severe obstructive sleep apnea (OSA). Also, children who heard poorly because of chronic otitis media might have had unrecognized speech delay mistaken for mental retardation. Adenoidectomy might have helped to resolve ear fluid problems, speech delays, and consequent perceptions of low intelligence.

The relationship between enuresis and obstructive apnea, and the benefit of adenoidectomy by implication, is complex and controversial. On one hand, the frequency of enuresis declines as children grow older. On the other, the size of the adenoids, and again by implication, any obstruction that they might be causing, also declines with increasing age. These two factors make it difficult to distinguish the benefits of adenoidectomy from age-related spontaneous improvement. Further, most of the studies in the medical literature which appear to show benefit from adenoidectomy are case reports or case series. Such studies are prone to unintentional bias. Finally, a recent study of six thousand children showed no association between enuresis and obstructive sleep in general but an increase with advancing severity of obstructive sleep apnea, observed only in girls.

The frequency of the procedure declined starting in the 1930s as its use became controversial. Tonsillitis and adenoiditis requiring surgery became less frequent because of the development of antimicrobial agents and the decline in upper respiratory infections among older school-aged children. Also, several studies had shown that adenoidectomy and tonsillectomy was ineffective for many of the indications in effect as well as the suggestion of an increased risk of developing poliomyelitis after the procedure, later disproved. Prospective clinical trials, performed over the last 2 decades, have redefined the appropriate indications for tonsillectomy and adenoidectomy (T&A), tonsillectomy alone, and adenoidectomy alone.