Pediatric Otolaryngology — MCQs

Question 81: Which of the following is the MOST appropriate indication for adenoidectomy in children?

• A. Recurrent respiratory tract infections
• B. Enlarged adenoids causing obstructive sleep apnea (Correct Answer)
• C. Chronic nasal obstruction due to allergies
• D. Middle ear infections requiring surgical intervention

Explanation: ***Enlarged adenoids causing obstructive sleep apnea*** - **Adenoidectomy** is a primary treatment for **obstructive sleep apnea (OSA)** in children when enlarged adenoids are the cause, as surgical removal can alleviate airway obstruction. - OSA can lead to serious health issues, including **neurocognitive impairment** and **cardiovascular problems**, making surgical intervention important. *Recurrent respiratory tract infections* - While enlarged adenoids can contribute to recurrent infections, particularly **otitis media**, their removal solely for recurrent upper respiratory tract infections is generally not the primary indication. - Other factors like **immune status** and **exposure to pathogens** are often more significant contributors to recurrent respiratory infections. *Chronic nasal obstruction due to allergies* - **Allergic rhinitis** is typically managed with medical treatments such as **antihistamines** and **nasal corticosteroids**, not adenoidectomy. - Adenoid enlargement in allergic children is often a secondary effect of inflammation, and addressing the underlying allergy is key. *Middle ear infections requiring surgical intervention* - While a contributing factor, **recurrent acute otitis media** or **chronic otitis media with effusion** that fails medical management often leads to the consideration of **tympanostomy tube insertion** rather than adenoidectomy alone. - Adenoidectomy can be considered as an adjunctive procedure in cases of recurrent otitis media, especially if adenoid hypertrophy is significant, but it is not the sole indication for "surgical intervention" for middle ear infections.