Source: Cancer  |  Posted 5 years ago

By Louise Gagnon

TORONTO, CANADA -- September 25, 2006 -- Performing an adenoidectomy with Coblation(TM) technology does not impact a cochlear implant (CI) or auditory neurons in children, according to results of a small retrospective study presented here at the annual meeting of the American Academy of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNSF).

"We were able to perform the procedure in these children without doing any harm to the implant," said principal investigator Patrick Antonelli, MD, professor and chair, department of otolaryngology, University of Florida, Gainesville, Florida.

In a poster presentation, Dr. Antonelli described the outcomes in 5 children who underwent adenoidectomy in whom bleeding was managed using curettage and Coblation technology, standard curettage and nasopharyngeal packing, or curettage and monopolar electrosurgery.

Removal of adenoids is a very vascular procedure, so stopping bleeding is imperative in surgical candidates, Dr. Antonelli explained.

"The standard way [to stop the bleeding] has been to put gauze in the nasal pharynx to stop the bleeding," he said. "That may be sufficient, but if it is not, you have to control the bleeding some other way."

One of the ways to stop the bleeding that does not stop with gauze is with monopolar electrosurgery, which has come to be commonly employed in adenoidectomy, but has been contraindicated in children with cochlear implants because there is potential for damage to the implant and auditory neurons, due to the spread of electrical current, according to Dr. Antonelli.

In contrast, use of radiofrequency Coblation(R) bipolar electrosurgery for adenoidectomy and tonsillectomy has been associated with fewer reports of pain, attributed to a decreased spread of electrical current and decreased tissue temperatures, compared with monopolar electrosurgery. The decreased current spread theoretically imparts less risk of spread to the implant and auditory neurons.

"There is less risk that using Coblation technology will hit the [implant] because of its bipolar nature where monopolar is diffuse and there is a greater chance it will hit the device," he explained.

Of the 5 cases, 3 were managed with curettage and Coblation technology, 1 was managed with standard curettage and nasopharyngeal packing, and 1 was managed with curettage and monopolar electrosurgery.

Prior to this small study Dr. Antonelli employed both types of electrosurgery in cadaveric animal models that received hearing implants. The model demonstrated that the integrity of the device was maintained before and after treatment.

However, more and more implants are being placed in younger children, as young as 12 months. After implantation of the hearing device these children may develop illnesses such as obstructive sleep apnea or recurrent acute otitis media that will necessitate a post-implant adenoidectomy, which creates the need to study how to remove the adenoids without compromising the hearing device.

"There is a potential for life threatening conditions if the adenoids are not taken out," Dr. Antonelli said. "If a child has obstructive sleep apnea, they may have heart failure and die."

[Presentation title: Adenoidectomy in Children With Cochlear Implants. Abstract P162]