Adenoid removal in children

Adenotomy is one of the most common operations in ENT surgery. Removal of adenoids in children is performed when they are inflamed. Let's consider the features of this procedure.

The proliferation of lymphoid tissue of the nasopharyngeal tonsil is adenoids. As a rule, they occur with frequent colds, chronic runny nose and the inability to breathe normally through the nose. Surgical removal is one of the treatment methods. The operation is prescribed for severe tissue hypertrophy, which cannot be cured by medication.

The nasopharyngeal tonsils are an immune organ in the nasopharynx that performs protective functions. Adenoid vegetations (growth) are diagnosed in children aged 3-15 years. The disease is associated with age-related developmental features of the immune system. During this period, the tonsils actively grow and often become inflamed.

Features of adenoids and their removal:

• After the operation, the protective properties of the immune system in children are reduced. But after 2-3 months, the immunity is gradually restored.
• Enlarged tonsils indicate that the patient often suffers from infectious and viral diseases that provoke an increase in lymphoid tissue.
• The risk of relapse, i.e. secondary tissue proliferation, depends on the quality of the operation. If the procedure is performed almost blindly, then in 50% of cases, lymphoid tissue particles grow again. But modern endoscopic operations reduce this to a minimum, so relapses occur in 7% of patients.
• In adults, this pathology occurs due to prolonged exposure to unfavorable environmental factors. Treatment also includes adenotomy and medication.

Normally, the pharyngeal tonsils are several folds of lymphoid tissue that protrude above the surface of the mucous membrane of the back wall of the pharynx, which is part of the pharyngeal lymphatic ring. The glands contain lymphocytes - immunocompetent cells that participate in the formation of immunity.

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Indications for the procedure

Difficulty breathing through the nose, hearing impairment, sleep problems, night snoring, deformation of the facial bones, frequent otitis and sinusitis are the main signs of inflammation of the tonsils. Treatment depends on the stage of the pathological process. In the early stages of inflammation, drug therapy, i.e. conservative therapy, is carried out. Surgery is necessary with rapid growth of adenoid tissue and progression of painful symptoms.

General criteria for surgical treatment:

• Adenoids of the third degree.
• Adenoids of any degree with frequent exacerbation of inflammatory pathologies.
• Complications from other organs.
• Drug treatment does not produce the desired results.
• High risk of malignant degeneration of the tonsils.

Let's take a closer look at the indications for adenoid removal in children:

1. Difficulty breathing through the nose - due to the fact that the patient breathes through the mouth, the mucous membranes dry out, there are frequent acute respiratory viral infections and their complications. Restless sleep and disturbances in the psycho-emotional state are observed.
2. Sleep apnea syndrome is a delay in breathing during sleep. Hypoxia has a negative effect on the functioning of the brain and the growing body.
3. Otitis - frequent infections lead to chronic and exudative inflammation of the middle ear. Enlarged adenoids block the auditory tube, causing pathologies in the middle ear. Children suffer from otitis more than 4 times a year. Against this background, persistent hearing loss is observed.
4. Facial skeletal disorders – enlarged adenoids provoke abnormal deformations in the maxillofacial bones. In medicine, there is a term for the above-mentioned symptoms: “adenoid face”.
5. Malignant changes – hypertrophied tonsils can cause an oncological process.

Tonsil removal is performed after a set of diagnostic measures. Treatment is performed by an otolaryngologist and a surgeon. If necessary, if there are clear indications and serious reasons, the operation is performed even in infancy. Frequent acute respiratory viral infections are not an indication for surgery, nor is preserved nasal breathing.

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Preparation

Like any operation, adenoid removal in children requires careful preparation. Treatment is best done in early autumn, when the little patient's immunity is in good condition and the body is full of vitamins. The operation is not performed in the cold season, as there is a risk of developing acute respiratory viral infections and other diseases. In hot weather, the risk of purulent and infectious complications in the postoperative period is increased, as bacteria actively multiply during this period.

Preparation for adenotomy:

• Dental examination and treatment.
• Relief of inflammatory processes in the body.
• Complex of laboratory studies.
• Instrumental diagnostics.
• Differential examinations.

Adenotomy is a fairly simple operation that is performed in an outpatient setting. The procedure lasts no more than 20 minutes under local or general anesthesia. Parents can take their baby home 4-5 hours after the treatment, provided there are no complications.

The recovery process takes a couple of months. Proper preparation minimizes the risk of complications, but parents should remember the risk of their occurrence. Immunity is reduced in the first period after surgery. Nasal congestion and discharge of mucus with bloody streaks also temporarily persist. After 2 weeks, the patient's condition normalizes.

Tests before adenoid removal in children

Before performing adenotomy, the patient is prescribed a set of laboratory tests. Tests before removing adenoids in children consist of:

• Blood test (general, biochemical).
• Urine analysis.
• Coagulogram is a study of blood clotting parameters.
• Analysis for hepatitis B and C viruses.
• Blood test for HIV and syphilis.
• Electrocardiogram.

The results of the tests are interpreted by a therapist or otolaryngologist. If necessary, additional studies are prescribed.

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Technique of adenoid removal in children

Today, there are several ways to treat adenoids. Despite the fact that the tonsils do not have nerve endings, anesthesia is used during the operation so that the patient does not feel discomfort during the procedure.

In ENT surgery, the following methods of removing adenoids in children are used:

1. The classic method - during the operation there is no possibility of visual observation of the procedure. An adenotome is inserted into the oral cavity - this is a ring-shaped knife. A laryngeal mirror is used to visualize the procedure. The main disadvantage of the operation is intense bleeding and the inability to completely remove lymphoid tissue. In some cases, doctors have to resort to the use of hemostatic drugs.
2. Endoscopic techniques are surgical interventions with the introduction of an endoscope with a camera into the nasopharynx. The image obtained during the operation significantly increases the accuracy of the procedure and its results.
   • Laser removal is a highly accurate and low-traumatic method. The sterility of the laser minimizes the risk of postoperative complications. The recovery period and healing are much faster.
   • Endoscopic treatment – using a video endoscope, the doctor removes hypertrophied tissues with high precision. This method gives high results.
   • Radio wave adenotomy – inflamed tissues are removed using a special device. The technique causes minimal pain and allows to minimize the risk of complications.
   • Cold plasma treatment is a combination of cryotherapy and plasma techniques. Tissue excision is performed using low temperatures. The advantages of the method include its bloodlessness and painlessness. The main disadvantage of this therapy is that scars may remain, causing problems in the throat.

Surgical intervention is recommended to be performed in early autumn, when the immune system's protective properties are at a high level. In order for recovery to be quick and without complications, a special diet and restorative breathing exercises should be followed.

How is adenoid removal performed in children?

The operation can be performed both in the inpatient department and in the outpatient clinic. The treatment method depends on the degree of the inflammatory process and other characteristics of the patient's body. The procedure is performed under general or local anesthesia. After the anesthesia has taken effect, the doctor determines where the deformed lymphoid tissues are located and begins their excision.

Basic surgical techniques and their specific features:

1. The classic operation - tonsil removal occurs through the oral cavity using a special scalpel. The procedure is performed under local anesthesia. Its main drawback is the lack of visualization of the surgical field. That is, the removal is done blindly and there is a high risk of recurrence.
2. Laser removal – a laser beam is used to excise tissue. It coagulates inflamed tissue or gradually evaporates it layer by layer. The advantage of this procedure is the absence of bleeding. The disadvantages include its duration, which is more than 20 minutes.
3. Microbreader – using a shaver (a device with a rotating scalpel), the doctor excises the adenoids. During the procedure, the surrounding mucous membranes are not affected. If there is bleeding, the wound is treated with a laser or radio waves.
4. Electrocoagulation – tonsils are removed by throwing special electrode loops on them. This method is completely bloodless, as the vessels are sealed during removal.
5. Cold plasma adenotomy – the tissue is affected by a plasma beam. This method is most often used when the tonsils are abnormally located. The doctor can adjust the depth of the beam penetration.

Regardless of the chosen method, the operation lasts no more than half an hour, after which the patient begins to recover from anesthesia. The doctor monitors his condition for 3-4 hours, then sends him home. If bleeding or other complications occur during or after the surgical intervention, the patient is left in the hospital for 1-3 days.

Removal of adenoids of the 2nd degree in children

A significant increase in tonsil tissue with closure of 2/3 of the nasal cavity is the second stage of adenoids. The pathological process is manifested by nasal breathing disorders. It is difficult for the child to breathe day and night, which leads to sleep disorders. Due to inadequate night rest, the baby becomes lethargic and irritable. Oxygen deficiency provokes severe headaches and developmental delays.

Inflamed tonsils can cause symptoms that at first glance are not associated with the nasopharynx:

• Urgent urinary incontinence.
• Bronchial asthma.
• Hearing impairment.
• High body temperature.
• Bloody discharge from the nose.
• Sleep apnea syndrome and night snoring.

In addition to the above symptoms, adenoids cause speech disorders. The patient begins to speak through the nose, that is, indistinctly.

Removal of adenoids of the 2nd degree in children is one of the methods of treatment. The following indications for surgical intervention are distinguished:

• Delay in mental and physical development.
• Frequent exacerbations of adenoiditis and sinusitis.
• Bronchial asthma, incontinence and other painful symptoms.
• Stopping breathing during sleep.

The main goal of the operation is to open the nasal passages while preserving the lymphoid tissue of the nasal tonsils to maintain normal immunity. The operation is performed with partial or complete removal of deformed tissues. Treatment is most often performed under general anesthesia using endoscopic methods. Surgery is contraindicated outside the acute phase of inflammation. In other cases, preventive measures are taken to suppress the growth of adenoid tissues.

Removal of adenoids of the 3rd degree in children

If the enlarged adenoid tissues completely block the nasal passage and the patient breathes only through the mouth, this indicates stage 3 adenoiditis, which is the most dangerous. Children are most susceptible to this disease. Adenoid growths are a source of infection that quickly spreads to the nasal sinuses, pharynx and bronchi. The pathological process is accompanied by allergization and bacterial contamination.

Removal of grade 3 adenoids in children is performed in the absence of positive results of drug therapy and with an increase in painful symptoms. The operation is performed using general anesthesia and takes no more than 20 minutes. Full recovery occurs within 1-2 months.

Without timely surgical treatment, adenoiditis leads to the following complications:

• Disturbances in the physiological characteristics of the middle ear.
• Chronic infectious processes in the body.
• Frequent colds.
• Inflammatory lesions of the respiratory tract.
• Deformations of the facial bones.
• Decreased performance.

The above complications are dangerous for a child's body. But timely surgery allows to minimize the risk of their development.

Endoscopic removal of adenoids in children

One of the methods of treating hypertrophied tissues of the pharyngeal tonsils is endoscopic removal of adenoids. In children, such an operation can be performed at any age. The procedure is performed in a hospital setting under general anesthesia.

Advantages of endoscopy:

• During the operation, the patient is in a drug-induced sleep, so he does not experience any discomfort.
• Tissue removal is performed using video endoscopic equipment, so the entire process is controlled by a doctor.
• To prevent recurrence, adenoid tissue is completely excised.

Endoscopic adenotomy is a minimally invasive procedure. It is especially effective for tonsils that are spread along the walls of the mucous membrane, rather than growing into the lumen of the respiratory tract. This tissue structure does not interfere with the respiratory process, but significantly disrupts the ventilation of the auditory tube. Against this background, frequent otitis occurs, and in advanced cases, conductive hearing loss.

Features of the procedure:

1. The patient is given general anesthesia, which makes the operation absolutely safe and painless. Anesthesia is also administered into the nasal cavity.
2. The doctor inserts an endoscope through the lower nasal passage and examines the surgical field.
3. Removal of hypertrophied pharyngeal tissues is performed using various endoscopic instruments: an electric knife, a resection loop or forceps. The choice of instrument depends on the structural features of the pharyngeal tonsils.

The surgical intervention lasts no more than 20 minutes. The risk of complications is minimal. The severity of the postoperative period depends on the type of anesthesia used. Many patients experience such painful symptoms as nausea and vomiting, headaches and dizziness, nosebleeds. In most cases, the baby is sent home 2-3 days after the resection.

In order for the recovery to be quick and with minimal complications, the doctor gives a number of recommendations. First of all, a special diet is prescribed. In the first days after the operation, only soft, chopped food is allowed: puree, porridge, soups. After a week, the menu can be expanded. In addition to the diet, a gentle regime of physical activity is recommended. Full recovery occurs within 1-3 months.

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Removal of adenoids in children with a shaver

One of the types of endoscopic adenotomy is the removal of hypertrophied tissues with a shaver.

Features of the procedure:

• The operation is performed using a micro-mill, which is similar to a drill and is located in a hollow tube.
• There is a hole on the side of the tube through which the cutter rotates, grabs and cuts the tissue.
• The shaver is connected to a suction device that removes the removed tissue and prevents it from entering the respiratory tract, significantly reducing the risk of aspiration.

The surgical intervention is performed under general anesthesia with artificial ventilation of the lungs. To control the surgical field, an endoscope is inserted through the oral cavity or nasal passage.

The postoperative period lasts for 1-3 days. In the following 10 days, the patient is prescribed limited physical activity and diet therapy. Normal nasal breathing appears on the 2-3 day after the operation. Special breathing exercises and a course of physiotherapy are prescribed to speed up recovery.

Laser removal of adenoids in children

A modern method of treating inflamed tissue of the pharyngeal tonsils is laser removal of adenoids. In children, laser technology is a minimally invasive procedure with minimal complications.

Benefits of laser treatment:

• Minimal trauma to the operated area.
• High precision of the surgeon's actions.
• Minimal blood loss and complete sterility.
• Short recovery period.

Laser adenotomy can be performed in the following ways:

1. Valorization - the upper layers of adenoid tissue are burned with steam heated by carbon dioxide. This method is used in the early stages of the disease, when the adenoids are not very large.
2. Coagulation is performed for stage 3 adenoids; a focused laser beam is used to affect the tissue.

The procedure is performed under a small amount of anesthetic, which significantly reduces the risk of complications from anesthesia, and makes it easier to come out of anesthesia. Despite all the advantages of laser treatment, some surgeons do not recommend using it. This is explained by the fact that the laser beam does not remove, but burns inflamed tissues, restoring their normal size.

Removal of adenoids in children using radio waves

Another popular method of treating adenoiditis is the radio wave method. The procedure is performed in a hospital setting using a special device - Surgitron. Hypertrophied nasopharyngeal tonsils are excised with a radio wave attachment.

Advantages of adenoid removal in children using radio waves:

• Minimal blood loss due to coagulation of blood vessels.
• Use of general anesthesia for children under 7 years of age and local anesthesia for older patients.
• Recovery period with minimal complications.

Radio wave treatment is indicated in the following cases: decreased hearing acuity, difficulty breathing through the nose, frequent viral diseases, chronic otitis, lack of effect from drug therapy. The operation is recommended for severe pathological processes that affect the upper respiratory tract, as well as for deformation of the facial skeleton and malocclusion due to adenoids.

In order for the treatment to be effective, special preparation is carried out. The patient is examined by a pediatrician and an otolaryngologist, a set of laboratory and instrumental studies is prescribed. A diet is recommended a couple of days before the operation.

Immediately before the operation, an anesthetic is administered. As soon as the anesthesia takes effect, the doctor begins treatment. The excision of the affected tissue is carried out using radio waves. The procedure lasts no more than 20 minutes. After the tonsils are removed, the patient is transferred to a general ward and his condition is monitored.

Contraindications to radio wave adenotomy:

• Age under 3 years.
• Oncological diseases.
• Severe blood clotting disorders.
• Deformation of the facial skeleton.
• Recent prophylactic vaccination (less than 1 month).

After the operation, the patient is prescribed plenty of fluids and, if necessary, medications for symptomatic therapy. Particular attention is paid to nutrition and minimal physical activity. It is forbidden to take a hot bath and sunbathe in direct sunlight.

Contraindications to the procedure

Difficulty breathing through the nose, frequent colds, hearing loss and a number of other painful symptoms are signs of inflammation of the tonsils. Treatment depends on the stage of the pathological process. In the early stages, drug therapy is carried out, and in case of severe hypertrophy - surgical treatment.

Let's look at the main contraindications to adenoid removal in children:

• 1-2 degree adenoiditis.
• Diseases affecting blood clotting levels.
• Frequent infectious pathologies in the acute stage.
• Tuberculosis.
• Diabetes mellitus in the decompensation stage.
• Acute inflammation in the nasopharynx.
• The patient is under two years of age (surgery is possible only for vital indications).
• Severe cardiovascular pathologies.
• Allergic diseases.
• Tumor lesions (benign, malignant).
• Anomalies in the development of the hard or soft palate
• The period of the influenza epidemic.

In addition to the above contraindications, various surgical treatment methods also have certain prohibitions on their implementation.

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Complications after the procedure

Surgical treatment of inflamed tissues of the pharyngeal tonsils can cause various complications. After removal of adenoids in children, a temporary decrease in the immune system, development of secondary infection, snoring, runny nose and other problems are most often observed.

Particular attention is paid to complications after anesthesia:

• Problems at the stage of intubation and induction of anesthesia: damage to the mucous membranes of the trachea, larynx, oropharynx, pneumothorax due to the insertion of a tube into one of the main bronchi.
• A sharp decrease in cardiac activity while maintaining anesthesia.
• Hypoxia and hemodynamic disturbances.
• Pain shock due to an incorrectly selected dose of painkiller.
• Choking due to premature removal of the endotracheal tube and inadequate patient monitoring.

Selecting the most appropriate method for removing adenoids and proper preparation for surgery reduces the risk of complications.

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Bleeding after adenoid removal in children

A fairly common complication of surgical treatment of adenoiditis is bleeding. After removal of adenoids, this symptom most often occurs in the first day after surgery. To prevent it, it is recommended to pay attention to the following contraindications:

• Overheating of the child.
• Staying in a stuffy room.
• Eating hot or spicy foods.
• Increased physical activity.

Patients are advised to stay in bed and use vasoconstrictor nasal drops. Regular wet cleaning and airing of the room should also be done to facilitate nasal breathing. If a nosebleed occurs, you should contact the ENT department for treatment and prevention of the disorder.

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Care after the procedure

The speed of a child's recovery after adenotomy depends on compliance with the doctor's instructions. Recommendations after surgery are reduced to the following rules:

• Diet for 1-2 weeks. Patients are recommended to eat vitamin-rich, high-calorie food. In the first days, the dishes should be soft (mashed potatoes, porridge, soup).
• Drink plenty of fluids – purified water, herbal teas made from natural ingredients, fruit drinks, compotes.
• Use of medications – children are prescribed vasoconstrictor drops to prevent reflex swelling of the mucous membrane.
• Exemption from physical activity for 3-4 weeks and bed rest for 1-2 weeks.

In addition to the above recommendations, after the operation, any contact with virus carriers should be avoided. Also, the patient should not be allowed to become overcooled or overheated.

What should not be done after adenoid removal in children?

The postoperative period is as important a stage of treatment as the operation itself. That is why parents should know what is prohibited after adenoid removal in children and how to speed up the recovery process.

First of all, it is necessary to understand that the postoperative period for each child has its own nuances. They depend on the complexity of the operation and the individual characteristics of the child's body.

The main contraindications for the patient for 1-2 weeks after adenotomy:

• Bathing in hot water, being in hot rooms or sunbathing.
• Physical activity, active games.
• Hot, hard, rough and spicy foods.

The child must remain in bed and be under constant adult supervision.

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Postoperative period

After adenotomy, the patient is given a number of recommendations that must be followed to ensure that recovery occurs without complications. The postoperative period and care consist of the following rules:

1. After the little patient has been released from the hospital, it is necessary to create the most comfortable conditions for him. First of all, ensure good ventilation of the room with an optimal temperature and subdued lighting.
2. In the first hours after adenotomy, a cold compress should be applied to the operated area. This will help reduce swelling of the nasopharynx. Swelling may appear on the eyelids; to eliminate it, a 20% solution of albucid is instilled into the eyes.
3. For 3-5 days after the operation, parents should regularly measure their child's body temperature. In case of hyperthermia, if the temperature is above 38 °C, the baby should be given an antipyretic.
4. Particular attention should be paid to nutrition. In the first week after surgery, only pureed and liquid food is recommended. It is better to steam or stew dishes so that they can be easily swallowed. The basis of the diet should be mashed cereals, stewed vegetables, steamed cutlets, herbal decoctions and compotes. To avoid irritating the throat, food should be at room temperature.
5. Active movements, physical education and sports should be limited. The child should be provided with bed rest: adequate rest and sleep.

In addition to the above recommendations, the doctor prescribes vasoconstrictor nasal drops that accelerate the healing of the wound surface and facilitate nasal breathing. Most often, these are the following drugs: Tizin, Glazolin, Nazol, Nazivin, Naftazin and others. The duration of their use should not exceed 5 days.

Another mandatory condition that must be observed after adenoid removal in children is breathing exercises to restore normal breathing. If all medical recommendations are followed, the patient's condition will normalize by the 7th-10th day.

Breathing exercises after adenoid removal in children

All patients after surgical treatment of hypertrophied tissues of the pharyngeal tonsils are prescribed breathing exercises. After removal of adenoids in children, physiotherapy is carried out 10-15 days after returning home. The exercises are aimed at restoring nasal breathing.

Breathing exercises should include the following exercises:

• Feet shoulder-width apart, hands on waist, head tilted back. Slowly inhale through mouth and lower jaw, exhale through nose and raise jaw. Inhale for 4 counts, exhale for 2.
• Starting position: standing, feet together. As you inhale, raise your arms up and put your feet on your toes, as you exhale, lower your arms.
• The starting position is the same as in the previous exercise. As you inhale, tilt your head to the right shoulder, and as you exhale, tilt your head to the left shoulder.
• Hands are clasped behind the back, head is thrown back. Slowly inhale through the mouth and raise the hands up, exhale through the nose.
• Arms along the body, legs shoulder-width apart. Slowly inhale with the stomach sticking out, exhale with the muscles contracting. This exercise trains abdominal breathing well.
• Pinch your nose and count loudly to 10. Open your nose and take a deep breath through it and exhale through your mouth.

Exercises should be performed in a well-ventilated room in the morning and evening. The breathing complex should take no more than 30 minutes. The load should be increased gradually, approximately every 4-6 days. The number of repetitions of each exercise is 4-5 times.

Sick leave after adenoid removal in a child

Despite the fact that adenotomy is a fairly simple operation in ENT practice, it requires careful preparation from both the doctor and the parents of the little patient. Sick leave after adenoid removal in a child is most often issued for up to two weeks. Its duration depends on the specifics of the operation and the general condition of the patient. If necessary, parents can extend sick leave to care for the child through a medical commission until the baby is fully recovered.

Reviews

Numerous reviews from parents who have experience after surgical treatment of inflamed tonsils in children confirm the effectiveness of radical therapy. Some note that children have become less likely to get sick and have an easier time with colds. Others point out that the child's nasal voice has completely disappeared and nasal breathing has been restored.

Removal of adenoids in children is especially necessary if the pathological process has caused complications, and conservative therapy has proven ineffective. In this case, excision of hypertrophied tissues of the pharyngeal tonsils allows you to restore the baby's health.