Best of five
- A. Routine septoplasty
- B. Inferior turbinectomy alone
- C. Adenoidectomy alongside grommets
- D. Tonsillectomy solely to improve middle-ear ventilation
- E. No additional discussion because adenoids never influence OME
FRCS (ORL-HNS) · SECTION 1 SBA
OME surgery and adenoids
A 6-year-old with persistent bilateral OME-related hearing loss is proceeding to grommet insertion. The child also has chronic nasal obstruction and enlarged adenoids. What additional procedure should be discussed?
C. Adenoidectomy alongside grommets
NICE recommends considering adjuvant adenoidectomy when planning grommets, particularly when adenoid symptoms are present, while discussing haemorrhage and velopharyngeal risks.
Why every option is right or wrong
A. Routine septoplasty: Septal surgery does not address adenoid-related obstruction or OME in this setting.
B. Inferior turbinectomy alone: Turbinate surgery is not the usual treatment for documented adenoid hypertrophy associated with OME.
C. Adenoidectomy alongside grommets: NICE recommends considering adjuvant adenoidectomy when planning grommets, particularly when adenoid symptoms are present, while discussing haemorrhage and velopharyngeal risks.
D. Tonsillectomy solely to improve middle-ear ventilation: Tonsil removal does not directly address Eustachian-tube obstruction from the adenoids.
E. No additional discussion because adenoids never influence OME: Adenoidectomy can reduce persistence or recurrence in selected children.
What if the scenario changed?
If a submucous cleft or velopharyngeal dysfunction were suspected, adenoidectomy would require particular caution and specialist speech assessment.
Independent Clinora educational preparation material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank