Version:
1.0
Implementation date:
1 July 2017
Review Date:
1July 2018
Category:
- Adenoidectomy alone – Not Routinely Funded
- Adenoidectomy in conjunction with Tonsillectomy or Grommet Insertion - Restricted
An adenoidectomy is an operation to remove the adenoids – small lumps of tissue at the back of the nose, behind the palate. It is performed under general anaesthesia and takes approximately 15 minutes. The mouth is kept open by using an instrument called a gag. It can be performed using a curette to sharply “scrape out” the adenoids or using a cautery technique with “electrical” diathermy excision of the adenoids while suctioning under direct vision.
Conditions
Adenoids are part of the immune system, which helps fight infection and protects the body from bacteria and viruses. Adenoids are only present in children. They start to grow from birth and are biggest when your child is approximately three to five years old. But by age seven to eight they start to shrink and by the late teens, are barely visible. By adulthood, the adenoids will have disappeared completely.
The adenoids disappear because – although they may be helpful in young children – they are not an essential part of an adult's immune system.
Indications for Adenoidectomy:
- Significant symptomatic adenoid hypertrophy “enlargement”- this could lead to:
- Severe nasal blockage, mouth breathing, nasal speech and snoring.
- Combined with large tonsils can cause severe obstruction to airflow (obstructive sleep apnoea)
- Glue ear / recurrent ear infections- adenoidal infection and inflammation can cause inflammation within the Eustachian tube (the tube connecting the middle ear to the back of the nose, ventilating the middle ear). This can cause a build-up of fluid within middle ear, and even recurrent bouts of ear infections. In this circumstance adenoidectomy may be performed together with insertion of grommets.
Adenoidectomy will only be funded if performed in conjunction with:
- Tonsillectomy
- Grommet insertion
An adenoidectomy as a standalone procedure has been categorised as Not Routinely Funded and will only be funded if an Individual Funding Request (IFR) application proves exceptional clinical need.
Treatments which are undertaken without prior approval will not be funded.
Evidence / Royal College of Surgeons Commissioning Guide for Rhinosinusitis (2013): The Royal College of Surgeons of England and ENT UK (2013). Commissioning Guide Rhinosinusitis This guide has been prepared for commissioners by the Royal College of Surgeons following a review of the latest research evidence.
Robb PJ et al (2009), Tonsillectomy and adenoidectomy in children with sleep-related breathing disorders: consensus statement of a UK multidisciplinary working party, Annals of the Royal College of Surgeons of England, 91, 371-373.
Procedure Codes / E201 / Total adenoidectomy
With Grommet Insertion:
D151 / Myringotomy with insertion of ventilation tube through tympanic membrane
D152 / Suction clearance of middle ear
D153 / Incision of ear drum NEC
D158 / Other specified drainage of middle ear
D159 / Unspecified drainage of middle ear
D202 / Maintenance of ventilation tube through tympanic membrane
D203 / Removal of ventilation tube from tympanic membrane
D208 / Other specified other operations on middle ear
D209 / Unspecified other operations on middle ear
With Tonsillectomy:
F341 / Bilateral dissection tonsillectomy
F342 / Bilateral guillotine tonsillectomy
F343 / Bilateral laser tonsillectomy
F344 / Bilateral excision of tonsil NEC
F345 / Excision of remnant of tonsil
F346 / Excision of lingual tonsil
F347 / Bilateral coblation tonsillectomy
F348 / Other specified excision of tonsil
F349 / Unspecified excision of tonsil
F361 / Destruction of tonsil
F362 / Biopsy of lesion of tonsil
F368 / Other specified other operations on tonsil
F369 / Unspecified other operations on tonsil