Conflict of interestNothing to disclose Adenoid Background Adenoid

Conflict of interest：Nothing to disclose

Adenoid Background

Adenoid Vegetation 1 Repeated acute otitis media 2 Otitis media with effusion 3 Chronic rhinosinusitis 4 Sleep disordered breathing

Ways of adenoidectomy Curettage Mirror laryngoscopy Power-assisted Endoscopic-guided the choice of adenoidectomy

Purpose Objective parameters short-term efficacy of adenoidectomy done by Endoscope + energy device with suction capability Subjective parameters

Adenoid Materials and Methods

Patients inclusion and surgical technique Patients Between Sep. 2017 and Sep. 2018, 15 pediatric patients with adenoid hypertrophy, surgically treated by single surgeon. Soft palate suspended via Nelaton tube 70 -degree rigid sinuscope PEAK Tn. A (Medtronic®) with power setting 4/2 Transoral Endoscopic-Assisted Adenoidectomy

Operation video

Subjective and objective measurements Subjective symptom scores Objective measurements Inquire primary caring person Graphic measured by about active symptoms pre- Image. J® of adenoid tissue and post- operation, scoring: between skull base and C 2 0 = never occured 1 = occasionally occured 2 = frequently occured Transoral Endoscopic-Assisted Adenoidectomy

Adenoid Results

Demographics of patients Characteristics Age, mean (range), year Gender Male Female Active symptoms Otitis media with effusion Runny nose Cough Snoring Type of surgery Adenoidectomy alone Adenoidectomy with ventilation tube Adenoidectomy and tonsillectomy Count (percentage) 6. 6 (3 -13) 9 (60%) 6 (40%) 5 (33%) 12 (80%) 4 (27%) 12 (80%) 2 (13%) 3 (20%) 10 (67%) No bleeding, fever or infection episode

Change of symptom scores and graphic measurements Parameters Active symptom scores Aural fullness Runny nose Cough Snoring Area of adenoid, mm 2 Pre-operation Post-operation P value 0. 7 ± 0. 9 1. 1 ± 0. 7 0. 3 ± 0. 5 1. 6 ± 0. 8 521. 6 ± 140. 5 0 0. 1 ± 0. 4 0 0. 1 ± 0. 3 259. 6 ± 65. 1 . 019* <. 001**. 041* <. 001** Active symptom scores: 0 (never), 1 (occasionally), 2 (frequently); *<0. 05; **<0. 01

Adenoid Discussions

Evolution of the Adenoidectomy Curette or adenotome Laryngeal mirror EG-Power-assisted Trans-oral Trans-nasal EG-PEAK-assisted Kuo et al. 2017

Endoscope + energy device with suction capability A clear view Complete resection Low complications Visual-protection Less residual tissue No bleeding event a better control on the depth of the tissue resection and careful tissue removal easier to achieve especially when there is an intranasal extension, or a bulky mass in the rhinopharynx or peritubaric region provides a faster and more precise adenoid resection with less blood loss