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Article Type

Original Study

Subject Area

Endoscopy and skull base

Abstract

Background: Adenoidectomy is a standard procedure for symptomatic adenoid hypertrophy. Conventional curettage remains common but is limited by blind excision and incomplete removal. Endoscopic guidance improves visualization and safety, yet optimal route, trans-oral or trans-nasal, remains uncertain. Aim: The aim of this study is to compare trans-oral versus trans-nasal endoscopic guided curettage adenoidectomy regarding operative efficiency, perioperative outcomes, and complications. Methods: This prospective randomized study included 50 patients aged 3–25 years with adenoidal hypertrophy treated between August and December 2024. Patients were allocated into two groups: Group A underwent curettage adenoidectomy with trans-oral 70° endoscopic guidance, and Group B with trans-nasal 0° guidance. Operative time, blood loss, pain score, postoperative bleeding, uvular edema, turbinate discomfort, and recurrence at three months were evaluated. Results: The trans-nasal approach achieved significantly shorter operative time (median 9 vs. 13 minutes, P < 0.001) and lower blood loss (33 vs. 40 mL, P < 0.001) compared to trans-oral route. Postoperative pain was lower in the trans-nasal group (VAS median 4 vs. 6, P < 0.001). Uvular edema was markedly higher in the trans-oral group (76% vs. 8%, P < 0.001), whereas turbinate-related discomfort was reported exclusively in the trans-nasal group (76% vs. 0%, P < 0.001). Postoperative bleeding and recurrence rates were comparable between groups (both P = 1). Conclusion: Both routes are effective and safe. The trans-nasal approach reduces operative time, blood loss, and pain but is associated with turbinate discomfort, while the trans-oral route carries a higher risk of uvular edema.

Keywords

Adenoidectomy; Endoscopy; Trans-oral; Trans-nasal

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