Removal of adenoids in children

Adenotomy is one of the most frequent surgeries in ENT surgery. Removal of adenoids in children is carried out with their inflammation. Let's consider features of the given procedure.

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

Nasopharyngeal tonsils are an immune organ in the nasopharynx, performing protective functions. Adenoid vegetations (sprouting) diagnose in children 3-15 years. The disease is associated with the age-related features of the development of the immune system. During this period tonsils actively grow and often become inflamed.

Features of adenoid removal:

• After surgery, the protective properties of the immune system in children are reduced. But in 2-3 months the immunity is gradually restored.
• The enlarged tonsils indicate that the patient often suffers from infectious and viral diseases that provoke an increase in lymphoid tissue.
• The risk of recurrence depends on the quality of the operation, that is, the secondary proliferation of tissues. If the procedure is carried out almost blindly, then in 50% of cases the particles of lymphoid tissue again grow. But modern endoscopic operations reduce this to a minimum, so relapses occur in 7% of patients.
• In adults, this pathology arises from prolonged exposure to unfavorable environmental factors. Adenotomy and medication are also administered for treatment.

Normally pharyngeal tonsils represent several folds of lymphoid tissue that protrude above the surface of the mucosa of the posterior pharyngeal wall that enters the pharyngeal lymphatic ring. Glands contain lymphocytes - immunocompetent cells that take part in the formation of immunity.

[1]

Indications for the procedure

Difficult nasal breathing, hearing impairment, sleep problems, night snoring, deformity 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, medication, that is, conservative therapy, is performed. The operation is necessary for the rapid proliferation of adenoid tissue and the 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 give the desired results.
• High risk of malignant degeneration of the tonsils.

Let's consider more detailed indications for the removal of adenoids in children:

1. Difficult nasal breathing - due to the fact that the patient breathes through the mouth, there is a drying out of the mucous membranes, frequent ARVI and their complications. There is restless sleep and disturbances in the psychoemotional state.
2. The apnea syndrome is a delay in breathing in a dream. Hypoxia negatively affects the work of the brain and the growing body.
3. Otitis - frequent infections lead to chronic and exudative inflammation of the middle ear. Enlarged adenoids cover the auditory tube, causing pathology in the middle ear. Children get otitis media more often 4 times a year. Against this background, there is a persistent decrease in hearing.
4. Disorders of the facial skeleton - enlarged adenoids provoke abnormal deformations in the maxillofacial bones. In medicine, there is a term for the "adenoid face" mentioned above.
5. Malignant changes - hypertrophied tonsils can cause the oncological process.

Removal of tonsils is carried out after a complex of diagnostic measures. An otolaryngologist and a surgeon are engaged in treatment. If necessary, if there are clear indications and serious reasons, the operation is performed even in infancy. In this case, frequent ARVI are not an indication for surgery, as well as preserved nasal breathing.

[2], [3], [4], [5]

Preparation

Like any operation, the removal of adenoids in children requires careful preparation. Treatment is best done in early autumn, when the immunity of a small patient is in good condition, and the body is full of vitamins. In the cold season, the operation is not performed, as there is a risk of developing ARVI and other diseases. In hot weather, the risk of purulent and infectious complications in postoperative time is increased, because during this period the bacteria multiply actively.

Preparation for adenotomy:

• Examination at the dentist and dental treatment.
• Kupirovanie inflammatory processes in the body.
• Complex of laboratory studies.
• Instrumental diagnostics.
• Differential survey.

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

The process of recovery takes a couple of months. Proper preparation minimizes the risk of complications, while parents should remember the risk of their occurrence. In the first time after the operation, the immunity is reduced. Also, temporarily blocked nasal congestion, the separation of mucus with bloody veins. After 2 weeks the patient's condition is normalized.

Analyzes before removal of adenoids in children

Before the adenotomy, the patient is assigned a set of laboratory examinations. Analyzes before removal of adenoids in children consist of:

• Blood test (general, biochemical).
• Analysis of urine.
• Coagulogram - a study of blood coagulation indicators.
• Analysis for hepatitis B and C viruses.
• Blood test for HIV and syphilis.
• Electrocardiogram.

The results of the analyzes are interpreted by a therapist or an otolaryngologist. If necessary, additional studies are scheduled.

[6], [7], [8], [9], [10]

Technique of the removal of adenoids in children

To date, 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 any discomfort during the procedure.

In the ENT surgery, these methods are used to remove adenoids in children:

1. The classical method - during the operation there is no possibility of visual observation of the procedure. In the oral cavity is introduced adenotom - this is a ring-shaped knife. To visualize the procedure, a guttural mirror is used. The main drawback of the operation is the intensive bleeding and the inability to completely remove the 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 nasopharyngeal cavity. The image obtained during the operation significantly improves the accuracy of the procedure and its results.
   • Laser removal is a high-precision and low-traumatic method. The sterility of the laser minimizes the risk of postoperative complications. The recovery and healing period is much faster.
   • Endoscopic treatment - with a videoendoscope, the doctor removes hypertrophied tissues with high accuracy. This method gives good results.
   • Radiowave adenotomy - inflamed tissues are removed using a special device. The technique delivers a minimum of painful sensations and allows to minimize the risk of complications development.
   • Cold-plasma treatment is a combination of cryotherapy and plasma techniques. The excision of tissues is carried out with the help of low temperatures. The advantages of the method include his bloodlessness and painlessness. The main disadvantage of this therapy is that scars that cause problems in the pharynx can remain.

Surgical intervention is recommended in early autumn, when the protective properties of the immune system are at a high level. In order to recover quickly and without complications, you should adhere to a special diet and restorative respiratory gymnastics.

How is the adenoid removal in children?

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

Basic operational methods and features of their implementation:

1. Classical operation - the removal of tonsils occurs through the mouth cavity using a special scalpel. The procedure is performed under local anesthesia. Its main drawback is the lack of visualization of the operating field. That is, removal is blind and there is a high risk of recurrence.
2. Laser removal - a laser beam is used to excise the tissues. It coagulates the inflamed tissues or gradually evaporates them layer by layer. Plus this procedure in the absence of bleeding. The minuses include its duration, which is more than 20 minutes.
3. Microbirder - using a shaver (apparatus with a rotating scalpel), the doctor excludes adenoids. During the procedure, the adjacent mucous membranes are not affected. If there is bleeding, the wound is treated with a laser or radio waves.
4. Electrocoagulation - the amygdala is removed by throwing on them a special loop of the electrode. This method is absolutely bloodless, as the vessels are sealed during removal.
5. Cold plasma an adenotomy - on a fabric I influence by means of a plasma beam. This method is most often used in the abnormal location of the tonsils. The doctor can adjust the depth of penetration of the beam.

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

Removal of adenoids of 2nd degree in children

A significant increase in tonsil tissue with the closure of 2/3 of the nasal cavity is the second stage of adenoids. The pathological process is manifested by violations of nasal breathing. The child is difficult to breathe day and night, which leads to sleep disorders. Because of an inferior night rest, the baby becomes listless and irritable. The oxygen deficit provokes severe headaches and developmental lag.

Inflamed glands can cause symptoms, which at first glance are not associated with the nasopharynx:

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

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

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

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

The main goal of the operation is the opening of the nasal passages with the preservation of the lymphoid tissue of the nasal tonsils in order to maintain the normal state of immunity. The operation is performed with partial or complete removal of deformed tissues. Treatment is most often under general anesthesia using endoscopic methods. Surgery is contraindicated outside the phase of exacerbation of inflammation. In other cases, preventive measures are carried out, suppressing the growth of adenoid tissue.

Removal of adenoids of 3rd degree in children

If the enlarged adenoid tissue completely blocks the nasal passage and the patient breathes only through the mouth, then this indicates the 3 degree of adenoiditis, which is the most dangerous. Most of this disease affects children of childhood. Adenoid growths are the source of infection, which quickly spreads to the nasal sinuses, pharynx and bronchi. The pathological process is accompanied by allergization and contamination by bacteria.

Removal of adenoids of the third degree in children is carried out in the absence of positive results of drug therapy and with the growth of 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 such complications:

• Violations of the physiological characteristics of the middle ear.
• Chronic infectious processes in the body.
• Frequent colds.
• Inflammation of the respiratory tract.
• Deformations of the bones of the face.
• Decreased efficiency.

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

Endoscopic removal of adenoids in children

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

Advantages of endoscopy:

• During the operation, the patient is in a drug-induced sleep, so there is no discomfort.
• Removal of tissues is carried out using video endoscopic equipment, so the whole 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 in tonsils, which spread along the walls of the mucosa, and do not grow in the lumen of the respiratory tract. Such a structure of tissues does not interfere with the respiratory process, but it significantly disturbs the ventilation of the auditory tube. On this background, frequent otitis occur, and in the neglected case, 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 introduced into the nasal cavity.
2. On the lower nasal passage the doctor introduces an endoscope and examines the operating field.
3. Removal of hypertrophied pharyngeal tissue is carried out with the help of various endoscopic instruments: an elektronozh, a resection loop or forceps. The choice of the instrument depends on the structure of the pharyngeal tonsils.

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 face such painful symptoms: nausea and vomiting, headaches and dizziness, nosebleeds. In most cases, the baby is sent home 2-3 days after resection.

In order to recover quickly and with minimal complications, the doctor gives a series of recommendations. First of all, a special diet is prescribed. In the first days after the operation, only soft, crushed food is allowed: mashed potatoes, cereals, soups. A week later the menu can be expanded. In addition to diet, a sparing regimen of physical activity is recommended. Complete recovery occurs within 1-3 months.

[11], [12], [13], [14], [15]

Removal of adenoids in children by shiver

One of the varieties of endoscopic adenotomy is the removal of hypertrophied tissues by the shiver.

Features of the procedure:

• The operation is carried out using a micro-cutter, which is similar to a drill and is located in a hollow tube.
• On the side of the tube there is an opening through which the milling cutter rotates, grasps and cuts the fabric.
• The shaver is connected with a suction that removes the removed tissues and prevents their entry into the respiratory tract, significantly reducing the risk of aspiration.

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

The postoperative period lasts for 1-3 days. In the next 10 days, the patient is shown limited physical activity and diet. Normal nasal breathing appears 2-3 days after the operation. To accelerate recovery, special breathing exercises and a course of physiotherapy are shown.

Laser removal of adenoids in children

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

Advantages of laser treatment:

• Minimal traumatization of the operated site.
• High accuracy of the surgeon's actions.
• Minimal blood loss and complete sterility.
• Short recovery period.

Laser adenotomy can be performed in such ways:

1. Valorization - the upper layers of the adenoid tissue are burned by 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 with adenoids of the 3rd degree, a focused laser beam is used to influence the tissue.

The procedure is carried out at a small fraction of the anesthetic, which significantly reduces the risk of complications from anesthesia, facilitates the withdrawal from anesthesia. Despite all the advantages of laser treatment, some surgeons do not recommend using it. This is because the laser beam does not remove, but burns inflamed tissues, restoring their normal size.

Removal of adenoids in children by radio waves

Another popular method for treating adenoiditis is the radio wave method. The procedure is carried out in a hospital with the help of a special device - Surgitron. Hypertrophic nasopharyngeal tonsils are excised by a nozzle with radio waves.

Advantages of removing adenoids in children by 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.
• Restorative period with minimal complications.

Radiowave treatment is indicated in such cases: decreased hearing acuity, complicated nasal breathing, frequent viral diseases, chronic otitis media, no effect from drug therapy. The operation is recommended for severe pathological processes that affect the upper respiratory tract, as well as deformation of the facial skeleton and incorrect bite due to adenoids.

In order for the treatment to be effective, special training is provided. The patient is examined by a pediatrician and an otolaryngologist, a set of laboratory and instrumental studies is assigned. A couple of days before the operation, dietary meals are recommended.

Immediately before the operation, an anesthetic is administered. As soon as the anesthesia works, the doctor begins treatment. Excision of affected tissues is carried out by means of radio waves. The procedure lasts no more than 20 minutes. After removing the glands, the patient is transferred to a general ward and monitored for his condition.

Contraindications to radio-wave adenotomy:

• The age is less than 3 years.
• Oncological diseases.
• Severe bleeding disorders.
• Deformation of the facial skeleton.
• Recent preventive vaccination (less than 1 month).

After surgery, the patient is prescribed plenty of drink and, if necessary, medicines for symptomatic therapy. Particular attention is paid to nutrition and minimal physical exertion. It is forbidden to take a hot bath and sunbathe under direct sunlight.

Contraindications to the procedure

Difficult nasal breathing, frequent colds, hearing loss and a number of other painful symptoms are signs of inflammation of the glands. Treatment depends on the stage of the pathological process. In the early stages of medical therapy, and with severe degree of hypertrophy - surgical treatment.

Consider the main contraindications to the removal of adenoids in children:

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

In addition to the above contraindications, different methods of surgical treatment also have certain prohibitions on their conduct.

[16], [17], [18], [19]

Complications after the procedure

Surgical treatment of inflamed tissues of pharyngeal tonsils can cause various complications. After removal of adenoids in children, a temporary decrease in the immune system, development of a 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 introductory anesthesia: damage to the mucous membranes of the trachea, larynx, oropharynx, pneumothorax due to the introduction of the tube into one of the main bronchi.
• A sharp decrease in cardiac activity while maintaining anesthesia.
• Hypoxia and hemodynamic disorders.
• Pain shock due to improperly selected dose of pain medication.
• Choking due to premature extraction of the endotracheal tube and insufficient monitoring of the patient's condition.

The choice of the most appropriate method of removal of adenoids and the correct preparation for surgery, reduce the risk of complications.

[20], [21]

Bleeding after removal of adenoids in children

A fairly common complication of surgical treatment of adenoiditis is bleeding. After removal of adenoids, this symptom often occurs in the first day after the operation. For its prevention, it is recommended to pay attention to such contraindications:

• Overheating of the child.
• Stay in a stuffy room.
• Use of hot or spicy dishes.
• Increased physical activity.

Patients are shown bed rest and use of vasoconstrictive drops in the nose. Also, do regular wet cleaning and airing the room to facilitate nasal breathing. If there was a nosebleed, then you should contact the ENT for treatment and prevention of the disorder.

[22], [23]

Care after the procedure

The speed of recovery after an adenotomy is dependent on compliance with medical prescription. Recommendations after the operation are reduced to the following rules:

• Compliance with diet for 1-2 weeks. Patients are recommended vitaminized, high-calorie food. In the first days the dishes should be soft (mashed potatoes, porridge, soup).
• Abundant drink - purified water, herbal teas from natural ingredients, fruit drinks, compotes.
• Use of medications - children are prescribed vasoconstrictive drops to prevent reflex edema of the mucous membrane.
• Exemption from physical exertion for 3-4 weeks and bed rest for 1-2 weeks.

In addition to the above recommendations, after the operation, any contacts with virus carriers should be excluded. Do not overcool or overheat the patient.

What is impossible after removal of adenoids in children?

The postoperative period is the same important stage of treatment as the operation itself. That's why parents should know that it is impossible after removal of adenoids in children and how to speed up the process of recovery.

First of all, it is necessary to understand that every child has its own nuances after the operation. They depend on the complexity of the operation performed and the individual characteristics of the child's organism.

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

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

The child must comply with bed rest and is under the constant supervision of adults.

[24]

Postoperative period

After adenotomy, a number of recommendations are given to the patient, which should be adhered to, so that the recovery can take place without complications. Postoperative period and care consist of such rules:

1. After the small patient was released from the hospital home, it is necessary to create the most comfortable conditions for him. First of all, ensure a good ventilation of the room with the optimum temperature and muted light.
2. In the first hours after adenotomy, a cold compress should be applied to the operated area. This will help reduce the swelling of the nasopharynx. Puffiness may appear on the eyelids, to eliminate it, a 20% solution of albucid is instilled in the eyes.
3. Within 3-5 days after surgery, parents should regularly measure the temperature of their child's body. With hyperthermia, if the temperature is above 38 ° C, the baby should be given an antipyretic.
4. Particular attention should be given to nutrition. The first week after the operation shows only puree and liquid food. Dishes should be cooked steamed or stewed so that they can be swallowed easily. The basis of the diet should be grinded cereals, stewed vegetables, steam cutlets, herbal decoctions and compotes. In order for food not to irritate the throat, it should be at room temperature.
5. It is necessary to limit active movements, physical education and sports. The child needs to provide bed rest: a full rest and sleep.

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

Another mandatory condition that must be observed after removal of adenoids in children is breathing exercises to restore normal breathing. If all medical recommendations are observed, the patient's condition will be normalized by 7-10 days.

Respiratory gymnastics after removal of adenoids in children

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

Respiratory exercises should include such exercises:

• Legs on the width of the shoulders, hands on the belt, and the head is thrown back. Slow breath in the mouth and lowering of the lower jaw, exhalation and lifting of the jaw. Inhale should be done on 4 accounts, and exhalation for 2.
• Starting position: standing, legs together. On inhalation, hands are up, legs are on toe-toes, and hands are lowered in exhalation.
• The starting position, as in the previous exercise. On inhaling, tilt the head to the right shoulder, and on exhalation to the left.
• Hands clasped in the lock behind him, his head thrown back. Slow breathing in your mouth and raising your hands up, exhaling.
• Hands along the body, feet shoulder width apart. Slow inhalation with protrusion of the abdomen, exhalation with contraction of muscles. This exercise well trains abdominal breathing.
• Clamp the nose and loudly count to 10. Open the nose and take a deep breath, and breathe out with your mouth.

Exercise should be performed in a well-ventilated room in the morning and in the evening. The respiratory complex should not take 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.

Hospital after removal of adenoids in the child

Despite the fact that adenotomy is a fairly simple operation in ENT practice, it requires careful preparation by both the doctor and the parents of the small patient. Hospital after removal of adenoids in a child is usually issued for up to two weeks. Its duration depends on the characteristics of the operation performed and the general condition of the patient. If necessary, parents can extend the hospital for the care of the child through a medical commission until the full recovery of the baby.

Reviews

Numerous reviews of parents who have experience after surgical treatment of inflamed tonsils in children, confirm the effectiveness of radical therapy. Some say that children are less likely to get sick and easier to bear colds. Others indicate that the child has completely passed through the nasal voice and restored nasal breathing.

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