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Adenotomy is one of the most common surgical interventions in ENT practice, which does not lose its relevance even with the advent of a host of other methods for treating pathology. The operation eliminates the symptoms of adenoiditis, prevents the dangerous consequences of the disease and significantly improves the quality of life of patients.

Often adenotomy is performed in childhood, the predominant age of patients is children from 3 years old and preschool children. It is at this age that adenoiditis is most common, because the child actively contacts the external environment and other people, encounters new infections and develops immunity to them.

The pharyngeal tonsil is part of the Waldeyer-Pirogov lymphoid ring, which is designed to contain infection below the pharynx. The protective function can turn into a serious pathology when the lymphatic tissue begins to grow disproportionately larger than is required for local immunity.

An enlarged tonsil creates a mechanical obstruction in the pharynx, which manifests itself as breathing problems, and also serves as a source of constant reproduction of all kinds of microbes. Initial degrees of adenoiditis are treated conservatively, although symptoms of the disease already exist. The lack of effect of therapy and the progression of pathology leads patients to a surgeon.

Indications for adenoid removal

Enlargement of the pharyngeal tonsil in itself is not a reason for surgery. Specialists will do everything possible to help the patient in conservative ways, because surgery is an injury and a certain risk. However, it happens that it cannot be done without it, then the ENT weighs all the pros and cons, talks with the parents if we are talking about a small patient, and sets a date for the intervention.

Many parents know that the lymphoid pharyngeal ring is the most important barrier to infection, so they are afraid that after the operation the child will lose this protection and will get sick more often. Doctors explain to them that abnormally overgrown lymphoid tissue not only does not fulfill its direct role, but also maintains chronic inflammation, prevents the child from growing and developing properly, creates a risk of dangerous complications, therefore in these cases there is no need to hesitate or hesitate, and the only way to get rid of the child will undergo surgical intervention from suffering.

Indications for adenotomy are:

• Adenoids grade 3;
• Frequent recurrent respiratory infections, difficult to respond to conservative therapy and causing progression of adenoiditis;
• Recurrent otitis media and hearing loss in one or both ears;
• Speech and physical development disorders in a child;
• Difficulty breathing with sleep apnea;
• Changes in bite and formation of a specific “adenoid” face.

degree of adenoiditis

The main reason for intervention is the third degree of adenoiditis, leading to difficulty breathing through the nose, and constantly worsening infections of the upper respiratory tract and ENT organs. In a small child, proper physical development is disrupted, the face acquires characteristic features that will be almost impossible to correct later. In addition to physical suffering, the patient experiences psycho-emotional anxiety, lacks sleep due to the inability to breathe normally, and suffers from intellectual development.

The main symptoms of severe adenoiditis are difficulty in nasal breathing and frequent infections of the ENT organs. The child breathes through the mouth, which is why the skin of the lips becomes dry and cracked, and the face becomes puffy and stretched. The constantly slightly open mouth attracts attention, and at night parents hear with concern how hard it is for the baby to breathe. Episodes of nocturnal breathing stops are possible, when the tonsil completely blocks the airways with its volume.

It is important that adenoid removal surgery be performed before irreversible changes and serious complications occur from a seemingly minor problem limited to the pharynx. Untimely treatment, and especially its absence, can cause disability, so it is unacceptable to ignore the pathology.

The best age for adenotomy in children is 3-7 years. Unreasonably postponing surgery leads to serious consequences:

1. Persistent hearing loss;
2. Chronic otitis media;
3. Changes in the facial skeleton;
4. Dental problems - malocclusion, caries, impaired eruption of permanent teeth;
5. Bronchial asthma;
6. Glomerulopathies.

Adenotomy, although much less common, is also performed on adult patients. The reason may be:

• Nocturnal snoring and sleep disordered breathing;
• Frequent respiratory infections with diagnosed adenoiditis;
• Recurrent sinusitis, otitis.

Contraindications to adenoid removal are also defined. Among them:

1. Age up to two years;
2. Acute infectious pathology (flu, chicken pox, intestinal infections, etc.) until it is completely cured;
3. Congenital malformations of the facial skeleton and anomalies in the structure of blood vessels;
4. Vaccination carried out less than a month ago;
5. Malignant tumors;
6. Severe bleeding disorders.

Preparing for surgery

When the need for surgery is decided, the patient or his parents begin searching for a suitable hospital. There are usually no difficulties in choosing, because surgical removal of tonsils is carried out in all ENT departments of public hospitals. The intervention is not very difficult, but the surgeon must be sufficiently qualified and experienced, especially when working with young children.

Preparation for surgery to remove adenoids includes standard laboratory tests - general and biochemical blood tests, coagulation tests, determination of group and Rh affiliation, urine test, blood tests for HIV, syphilis and hepatitis. Adult patients are prescribed an ECG; children are examined by a pediatrician, who, together with an otolaryngologist, decides on the safety of the operation.

Adenotomy can be performed on an outpatient or inpatient basis, but most often hospitalization is not required. On the eve of the operation, the patient is allowed to have dinner at least 12 hours before the intervention, after which food and drink are completely excluded, because general anesthesia can be used, and the child may vomit during pain relief. In female patients, surgery is not prescribed during menstruation due to the risk of bleeding.

Features of anesthesia

The method of pain relief is one of the most important and responsible stages of treatment; it is determined by the age of the patient. If we are talking about a child under seven years old, then general anesthesia is indicated; for older children and adults, adenotomy is performed under local anesthesia, although in each case the doctor approaches it individually.

Surgery under general anesthesia for a small child it has an important advantage: the absence of operational stress, as is the case when the baby sees everything that happens in the operating room without even feeling pain. The anesthesiologist selects drugs for anesthesia individually, but most modern drugs are safe, low-toxic, and anesthesia is similar to normal sleep. Currently, Esmeron, Dormicum, Diprivan, etc. are used in pediatrics.

General anesthesia is preferable in children 3-4 years old, in whom the effect of being present at the operation can cause severe fear and anxiety. With older patients, even those under seven years of age, it is easier to negotiate, explain and reassure, so local anesthesia can also be performed on preschool children.

If planned local anesthesia, then a sedative is first administered, and the nasopharynx is irrigated with a lidocaine solution so that further injection of the anesthetic is not painful. To achieve a good level of pain relief, lidocaine or novocaine is used, which is injected directly into the tonsil area. The advantage of such anesthesia is the absence of a period of “recovery” from anesthesia and the toxic effect of drugs.

In the case of local anesthesia, the patient is conscious, sees and hears everything, so fear and anxiety are not uncommon even in adults. To minimize stress, before adenotomy, the doctor tells the patient in detail about the upcoming operation and tries to calm him down as much as possible, especially if the latter is a child. Psychological support and attention from parents are also of no small importance, which will help to endure the operation as calmly as possible.

Today, in addition to classical adenotomy, other methods have been developed for removing the pharyngeal tonsil using physical factors - laser, coblation, radio wave coagulation. The use of endoscopic technology makes treatment more effective and safe.

Classic adenoid removal surgery

classic adenotomy

Classic adenotomy is performed using a special instrument - Beckmann's adenotomy. The patient, as a rule, sits, and the adenotom is inserted into the oral cavity to the tonsil behind the soft palate, which is raised by the laryngeal mirror. The adenoids must completely enter the adenotomy ring, after which they are excised with one quick movement of the surgeon’s hand and removed through the mouth. The bleeding stops on its own or the vessels coagulate. In case of severe bleeding, the surgical area is treated with hemostatic agents.

The operation is often performed under local anesthesia and takes a few minutes. Children who are sedated and prepared for the procedure by their parents and doctor tolerate it well, which is why many specialists prefer local anesthesia.

After removal of the tonsil, the child is sent to the ward with one of the parents, and if the postoperative period is favorable, he can be sent home on the same day.

The advantage of the method it is considered possible to use it on an outpatient basis and under local anesthesia. A significant disadvantage is that the surgeon acts blindly, if it is not possible to use an endoscope, because of this there is a high probability of leaving lymphoid tissue with subsequent relapse.

Others shortcomings possible pain during manipulation is considered, as well as a higher risk of dangerous complications - entry of removed tissue into the respiratory tract, infectious complications (pneumonia, meningitis), injuries to the lower jaw, pathology of the hearing organs. The psychological trauma that can be inflicted on a child cannot be ignored. It has been established that children may experience an increased level of anxiety and develop neurosis, so most doctors still agree on the advisability of general anesthesia.

Endoscopic adenotomy

Endoscopic removal of adenoids is one of the most modern and promising methods of treating pathology. The use of endoscopic technology allows a thorough examination of the pharyngeal area and safe and radical removal of the pharyngeal tonsil.

The operation is performed under general anesthesia. The endoscope is inserted through one of the nasal passages, the surgeon examines the wall of the pharynx, after which he excises the adenoid tissue with an adenotome, forceps, microdebrider, or laser. Some specialists complement endoscopic control with visual control by introducing a laryngeal speculum through the oral cavity.

Endoscopy makes it possible to most completely remove the overgrown lymphoid tissue, and in case of relapse it is simply irreplaceable. Endoscopic removal of adenoids is especially indicated when the growth occurs not in the lumen of the pharynx, but along its surface. The operation is longer than a classic adenotomy, but also more accurate, because the surgeon acts with precision. The excised tissue is often removed through the nasal passage, free from the endoscope, but it is also possible through the oral cavity.

endoscopic adenotomy

An option for endoscopic adenoid removal is shaver technique, when the tissue is excised with a special device - a shaver (microdebrider). This device is a micro-mill with a rotating head placed in a hollow tube. The cutter blade cuts off the hypertrophied tissue, crushes it, and then the tonsil is sucked out by an aspirator into a special container, which eliminates the risk of it getting into the respiratory tract.

The advantage of shaver technology- low trauma, that is, healthy tissue of the pharynx is not damaged, the risk of bleeding is minimal, no scars remain, while endoscopic control makes it possible to completely excise the tonsil, preventing relapse. The method is considered one of the most modern and effective.

A limitation to removing the tonsil with a microdebrider may be that the nasal passages in a small child are too narrow, through which it is impossible to insert instruments. In addition, not every hospital can afford the necessary expensive equipment, so private clinics often offer this method.

Video: endoscopic adenotomy

The use of physical energy in the treatment of adenoiditis

The most common methods of excision of the pharyngeal tonsil using physical energy are the use of laser, radio waves, and electrocoagulation.

laser treatment

Laser removal of adenoids consists of exposure of tissue to radiation, which causes a local increase in temperature, evaporation of water from cells (vaporization) and destruction of hypertrophic growths. The method is not accompanied by bleeding, this is its advantage, but there are also significant disadvantages:

• Inability to control the depth of exposure, which creates a risk of damage to healthy tissue;
• The operation is long;
• The need for appropriate equipment and highly qualified personnel.

Radio wave treatment carried out using the Surgitron apparatus. The pharyngeal tonsil is removed with a nozzle that generates radio waves, while the vessels are coagulated. The undoubted advantage of the method is the low probability of bleeding and low blood loss during surgery.

Plasma coagulators and coblation systems also used by some clinics. These methods can significantly reduce the pain that occurs in the postoperative period, and are also practically bloodless, therefore they are indicated for patients with blood clotting disorders.

Coblation is the effect of “cold” plasma when tissues are destroyed or coagulated without burns. Advantages - high accuracy and efficiency, safety, short recovery period. Among the disadvantages are the high cost of equipment and training of surgeons, recurrence of adenoiditis, and the likelihood of scarring in the tissues of the pharynx.

As you can see, there are many ways to get rid of the pharyngeal tonsil, and choosing a specific one is not an easy task. Each patient requires an individual approach, taking into account age, anatomical features of the structure of the pharynx and nose, psycho-emotional background, and concomitant pathology.

Postoperative period

As a rule, the postoperative period is easy; complications can be considered rare if the surgical technique is chosen correctly. On the first day, a rise in temperature is possible, which is reduced by conventional antipyretic drugs - paracetamol, ibufen.

Some children complain of sore throat and difficulty breathing through the nose, which are caused by swelling of the mucous membranes and trauma during the operation. These symptoms do not require specific treatment (except nasal drops) and disappear within the first few days.

The patient does not eat for the first 2 hours, and for the next 7-10 days he adheres to a diet, since nutrition plays a significant role in the restoration of nasopharyngeal tissue. For several days after the operation, soft, pureed food, purees, and porridges are recommended. The child can be given special baby food for babies, which will not cause injury to the pharyngeal mucosa. By the end of the first week, the menu expands; you can add pasta, omelet, meat and fish soufflé. It is important that the food is not hard, too hot or cold, or composed of large pieces.

In the postoperative period, carbonated drinks, concentrated juice or compote, crackers, hard cookies, spices, salty and spicy foods are strictly not recommended, as they increase local blood circulation with the risk of bleeding and can injure the mucous membrane of the pharynx.

1. bathhouse, sauna, hot bath are excluded for the entire recovery period (up to a month);
2. playing sports - no earlier than a month later, while normal activity remains at the usual level;
3. It is advisable to protect the person undergoing surgery from contact with potential carriers of a respiratory infection; the child is not taken to kindergarten or school for about 2 weeks.

Drug therapy in the postoperative period is not needed, only nasal drops are indicated, which constrict blood vessels and have a local disinfecting effect (protargol, xylin), but always under the supervision of a doctor.

Many parents are faced with the fact that after treatment, the child continues to breathe through the mouth, out of habit, because nothing interferes with nasal breathing. This problem is dealt with through special breathing exercises.

Complications include bleeding, purulent processes in the pharynx, acute inflammation in the ear, and relapse of adenoiditis. Sufficient pain relief, endoscopic control, and antibiotic protection make it possible to minimize the risk of complications with any of the surgical options.

In most cases, adenotomy is performed in an outpatient clinic, mainly in the morning. The operation itself lasts no longer than 10 minutes, after which the little patient must remain under medical supervision for about 5 hours, then, if there are no complications, he is sent home. Less often, a child needs to be hospitalized in a hospital if side effects from anesthesia or bleeding occur.

When does conservative treatment fail?

Many parents postpone surgery, trying to find an alternative in . Today, there are many methods of drug treatment, but, as practice shows, they rarely bring positive results. Complex cases require surgery. It is after adenotomy that many health problems can be avoided.

The decision on surgical treatment is made for the following symptoms and pathologies:

• the child has seriously impaired nasal breathing - he practically does not breathe through his nose;
• the child sniffs heavily during sleep, and attacks of apnea are observed - holding the breath for up to 10 seconds, which causes the development of constant hypoxia during sleep;
• slurred and nasal speech;
• hearing loss occurs due to the accumulation of mucus and inflammation in the middle ear - exudative;
• the child gets sick a lot and relapses of otitis media, bronchitis, and pneumonia often occur;
• overgrown adenoids cause the development of maxillofacial anomalies.

Medicines and folk recipes are not able to get rid of adenoids; the overgrown tissue of the tonsils will not go anywhere; on the contrary, in the absence of surgical treatment, it will grow even more. Therefore, adenoid surgery in children is a necessity.

Contraindications for surgery

Sometimes adenotomy can cause damage to the body.

The operation is not performed in the following cases:

• blood diseases;
• allergies in the acute stage;
• bronchial asthma;
• acute infectious diseases - ARVI, influenza, intestinal infection, etc.;
• heart and vascular diseases;
• age up to 2 years;
• congenital pathologies of the structure of the facial part of the skull (for example, cleft lip);
• the first month after vaccination;
• oncological diseases.

Features of the operation

All excited mothers and fathers whose children are scheduled for adenotomy are interested in the question of how adenoid surgery in children proceeds. Surgery is performed using anesthesia - local or general.

In the first case, the mucous membrane of the operated area is treated with an anesthetic, and a sedative is injected intramuscularly. In the second case, general anesthesia is used: the child is immersed in a medicated sleep, during which he does not feel pain and does not see what is happening.

How adenoid surgery in children proceeds depends on the equipment of the clinic and the characteristics of the pathology of the small patient.

Methods for removing adenoids in children:

• Classic adenotomy - the most common way. The operation to remove adenoids in childhood is carried out using an adenotop - a steel loop with a sharp edge. The procedure lasts several minutes, the technique is simple, but it has a significant disadvantage - the adenoids are removed by touch, there is no visual observation, and there is a possibility of partially damaging nearby tissues and organs.
• Aspiration adenotomy . In this case, the adenoids are removed not with a loop, but with a hollow tube, at the end of which there is a vacuum suction. The disadvantage is the same - the doctor cannot see the progress of the operation, so there is a risk of causing harm to another organ.
• Endoscopic adenotomy . In this case, the operation to remove the adenoids is carried out using an endoscope - a device that allows you to visually monitor the actions of the operating surgeon.
• . Laser removal of adenoids has several advantages - minimal blood loss and reduced risk of injury during the operation.
• Electrocoagulation . The adenoids are removed with a loop that has been exposed to heat.

How painful is the surgery?

Adenotomy is performed using local or general anesthesia. For example, in the West, any operation on the ENT organs is performed under general anesthesia. Our hospitals also practice this type of pain relief because it does not cause mental trauma to children. Removing adenoids in children under general anesthesia has a significant disadvantage - the risk of complications after surgery.

In other cases, adenotomy is performed using local anesthesia. The mucous membranes are treated with an anesthetic, and the procedure is almost painless. But local anesthesia has another disadvantage - the child is conscious and observes the entire surgical process.

The manipulation of medical personnel, the sight of blood and surgical instruments causes stress in many children. To minimize its consequences, the child may be prescribed a sedative.

Sometimes adenotomy is performed without the use of any anesthesia if the child has contraindications to local and general anesthesia. From a physiological point of view, there is nothing critical in this, since there are no nerve endings in the adenoid tissue, and there should not be severe pain. But it’s still better to protect the child from stress as much as possible and numb the operating area with a local anesthetic.

Is surgery dangerous?

Adenotomy in children can have the following consequences:

• Complications after adenoid removal in children . Sometimes the operation is complicated or ends with intense bleeding, aspiration of the respiratory organs, injuries to the palate and complications of general anesthesia.
• Temporary decrease in immune defense . Most children, after an adenotomy, forget what frequent colds are; they actually begin to get sick less often. But sometimes the situation becomes reversed - the child begins to get sick more often against the background of reduced immunity. This is a temporary phenomenon; after a few months, the immune system returns to normal.
• Attachment of a secondary infection . Immediately after adenotomy, a postoperative wound surface remains in the nasopharynx, which can become susceptible to secondary infection, especially if the strength of the immune system is reduced. That is why, after surgery to remove adenoids in children, it is necessary to maintain a home regime and temporarily limit the child’s contact with peers.

Recovery period

Immediately after surgery to remove adenoids, the child is offered ice cream. A chilled treat helps constrict blood vessels.

Pain and discomfort during swallowing will annoy the child for several more days. To reduce pain, the doctor prescribes anesthetics and painkillers during the rehabilitation period.

After surgery to remove adenoids, children may vomit blood. This usually happens because the child swallowed blood during surgery. The same situation can happen with stool.

On the first day after surgery, body temperature may rise to 38°C. The use of antipyretic drugs with acetylsalicylic acid in this case is not recommended, as this substance can cause bleeding.

During the recovery period, the doctor may prescribe astringent nasal medications.

During the week, it is forbidden to be in open sunlight, visit the sauna or take a hot bath. For a month after surgery to remove adenoids in children, it is not recommended to swim in a pool or open water.

The child must stay at home for 2-3 weeks and is exempt from attending kindergarten or school. You cannot engage in physical activity for a month.

The doctor may prescribe a gentle diet that excludes foods that irritate the mucous membranes: these are hot, hard, salty and spicy foods. In this case, the food should be fortified and high in calories.

The postoperative period after removal of the adenoids in children will be accompanied by nasal congestion and nasal sound. Such symptoms disappear on their own after a few days.

A month later, the ENT doctor should examine the child and determine the effectiveness of the adenotomy. As practice shows, in most children, improvements become obvious within a week after surgery to remove the adenoids.

Are there any guarantees that the operation will permanently get rid of adenoids?

Recurrence of adenoids is not uncommon after surgery.

The reasons for the regrowth of adenoids are:

• Incomplete removal of adenoid tissue, resulting from incorrect surgical intervention. If after adenotomy even a small fragment of pathological cells remains, adenoids may well appear again. In this case, a relapse can be excluded by performing an adenotomy in a good clinic from an experienced specialist or by using general anesthesia, during which the child will not be able to prevent the doctor from grabbing the base of the adenoids with the adenotope. It is worth noting that after general anesthesia, the frequency of adenoid relapses is reduced to 30%.
• Early operation. Adenotomy can be performed in children over 3 years of age, of course, if there are no urgent indications for surgery.
• Allergic diseases in a child can also cause relapse of adenoids.
• Individual characteristics of the body determined by genetics.

In conclusion, I would like to say that unfounded fears on the part of parents before undergoing adenotomy for their child are most likely caused by personal unpleasant memories from childhood or horrifying stories from friends about this procedure.

Yes, several decades ago, surgery was carried out without using any method of pain relief, and the operation itself was accompanied by large blood loss. But these days, surgery to remove adenoids in children is performed efficiently and painlessly.

Useful video about performing an operation to remove adenoids in a child

Adenoids are a proliferation of lymphoid tissues of the pharyngeal tonsil, which can begin for many reasons - hereditary predisposition, frequent colds, unfavorable environment, etc. A condition in which the adenoids become inflamed is called adenoiditis, and most often children are susceptible to this disease.

Removing adenoids in children is one of the most common methods of treating adenoiditis. Surgical intervention is aimed not only at eliminating pathologically changed tissues, but also at preventing a number of complications.

Symptoms

Enlargement of the pharyngeal tonsil cannot be detected during examination - even a significant degree of enlargement of lymphoid tissues can only be detected with the help of special otolaryngological devices. But, nevertheless, the symptoms of adenoiditis are sufficiently characteristic for parents to promptly notice signs of trouble and consult a doctor for a diagnosis.

Adenoids, depending on their size, can manifest themselves with the following symptoms:
frequent or constant disturbance of nasal breathing (difficulty or noisy inhalation and exhalation);
during physical activity (running, active games, etc.), the child breathes through his mouth;
snoring during sleep;
obvious decrease in hearing acuity (the child does not respond to his name pronounced at normal volume; he sits closer to the TV or adds sound, etc.).

Adenoids have a certain feature: even with a slight increase in the pharyngeal tonsil, it can completely block the nasal passages, as a result of which the child completely lacks nasal breathing. With the same probability, grade III adenoids can only slightly reduce the patency of the nasal passages - the extent to which nasal breathing can be impaired depends not only on the size of the adenoids, but also on the individual characteristics of the structure of the nasopharynx.

Complications of adenoids

Lack of treatment for adenoids can significantly affect the child’s development and quality of life in the future. This is easy to understand if you remember: most often this condition develops in children 3-7 years old - during the period of the most intensive formation of facial bones, dentofacial apparatus, immune and other systems.

Constant disruption of nasal breathing and the need to breathe through the mouth leads to hypoxia - a deficiency of oxygen in tissues, including brain tissue, which disrupts the intellectual and psycho-emotional development of the child.

In addition, the bone structures of the face and the ligamentous apparatus of the jaws are formed in the same way - under the influence of active breathing through the mouth, which leads to malocclusion, dental defects, and abnormal tooth growth.
Also on the list of complications of adenoids are frequent respiratory diseases, disorders of the immune system (including allergic reactions), chronic otitis media, sinusitis and other ailments.

Conservative treatment of adenoids

Conservative treatment of adenoiditis, depending on the degree of tissue proliferation, symptoms and general health and age of the child, may include the following measures:
systematic hardening aimed at increasing the body's defenses;
taking immunostimulating and restorative medications (vitamin-mineral complexes, bioactive herbal remedies, etc.);
prescribing a course of anti-inflammatory drugs;
flu vaccination before the onset of the autumn-winter season;
improving the ecology of housing (installing air humidifiers, removing “dust collectors” - carpets, heavy curtains, etc.).

But first of all, it is necessary to eliminate the causes of inflammation and proliferation of the pharyngeal tonsil - if such causes are identified. If factors that provoke the proliferation of tissues of the pharyngeal tonsil and cause their inflammation are excluded, conservative therapy may be sufficient to stop the growth of adenoids.

Laser treatment of adenoids in children

Laser therapy is one of the proven methods of treating adenoids in children, which is used comprehensively, in combination with drug therapy. The laser beam, operating in a special frequency mode, stimulates local immunity (in the nasopharynx area), which eliminates the inflammatory process and reduces the growth rate of lymphoid tissues. This treatment method is prescribed taking into account the individual characteristics of adenoiditis, and in some cases can be carried out with a significant increase in adenoids, up to stage III.

In addition, exposure to a laser beam eliminates the infectious component of inflammation, which helps alleviate the symptoms of the disease and speed up recovery.

Surgical treatment of adenoids in children

Conservative treatment does not always bring a positive effect. This may be due to the anatomical features of the nasopharynx in a child, the presence of a genetic predisposition to adenoiditis, and the inability to eliminate provoking factors. In such cases, surgical treatment of adenoids is recommended, in which pathologically overgrown tissue is removed.

An operation to remove adenoids is always carried out as planned and is not considered an emergency: even in the complete absence of nasal breathing, before surgery there is always time to prepare the child and conduct a full examination.
The age of the child, the degree of proliferation of lymphoid tissues and other factors are not determining for the operation: only if there are indications, surgical intervention is prescribed.

A few days before surgery, the child may be prescribed hemostatic, antibacterial, anti-inflammatory, antihistamine or other drugs if the attending physician sees the need to take them. In addition, before the operation, it is necessary to carry out sanitation of the oral cavity with the treatment of carious teeth and/or removal of teeth affected by caries and not subject to treatment.

Indications for adenoid removal

Circumstances in which surgical removal of the adenoids is indicated include the following:
ineffectiveness or low effectiveness of conservative treatment;
constant violation of nasal breathing (the child breathes mainly through the mouth);
hearing impairment, decreased hearing acuity.

Contraindications to adenoid removal

Surgery to remove adenoids is contraindicated in the following cases:
diseases affecting blood clotting;
systemic infectious diseases in the acute stage;
acute inflammatory process in the nasopharynx;
the age of the child is under 2 years (up to 2 years of age, the operation can be performed for health reasons, for example, in the complete absence of nasal breathing in combination with frequent tonsillitis, laryngotracheitis, which increases the risk of suffocation during sleep or with a high growth rate of adenoids with complications in hearing organs).

Adenoid removal techniques

In modern surgical practice, adenoid removal can be performed using the traditional method, using physical instruments or using a laser.

The duration of the operation, including preparation and anesthesia, is about 10-15 minutes. Preference is given to local anesthesia, which is carried out using an injection of an anesthetic or a special aerosol that “freezes” the tissue. In both cases, the sensitivity of the operated area is reduced to zero, but the central nervous system is not involved (as is the case with general anesthesia).

Traditional adenoid removal

With this method, the doctor uses a special knife (an instrument in the form of a loop of sharpened wire on a handle), which is inserted through the mouth to the anatomical border of the nasopharynx. After this, the doctor “presses” the loop into the overgrown tissue, which slips inside the loop. With one forward movement, the surgeon cuts off the adenoids - the operation lasts no longer than 1-2 minutes.

Laser removal of adenoids

Laser adenoid removal is considered the preferred surgical method. This is primarily due to the minimal risk of infection of the operated area and the prevention of bleeding.

The laser beam has a coagulating effect - at the moment of contact of the beam with the mucous membrane of the nasopharynx, simultaneous excision of pathological tissues and “cauterization” of blood vessels is carried out. This reduces the chance of bleeding to almost zero. Another advantage of the laser is the sterility of the beam, which prevents both wound infection during surgery and minimizes the threat of postoperative infections.

Possible complications

The most common complication after adenoid removal is their recurrence. This is due to the fact that none of the surgical methods is able to completely remove pathological tissues, which can regenerate after some time.

Re-growth of adenoids is especially common in children for whom relapse prevention measures have not been taken and harmful factors have not been eliminated (parents smoking in the presence of the child, dusty premises, nutritional deficiencies, etc.).

To avoid postoperative health problems, you must follow the following rules for preparing for surgery and going through the recovery period:
within 3-5 days after surgery, exclude from the child’s diet foods that irritate the mucous membrane: nuts, seeds, crackers, carbonated drinks, etc.
make sure that the child does not become hypothermic;
if the child attends school or kindergarten, it is better to leave him at home for the first few days after removal of the adenoids;
if the operation is scheduled for the “epidemiological” period - from October to March - be sure to carry out the prevention of acute respiratory viral infections according to the plan provided to you by the doctor. Considering the vulnerability of the child in the postoperative period, such a preventive measure can become a reliable means of preventing both infectious complications and re-growth of adenoids after surgery.

Adenotomy - removal of adenoids is considered a simple surgical intervention in ENT practice. Patients are rarely left overnight after surgery; usually after 4-5 hours the patient is sent home. Let's try to figure out when removal of the pharyngeal tonsil is required and how to prepare for this procedure.

Indications

Among other things, you should follow your doctor's recommendations regarding food and fluid intake. Dinner should be no later than 19.00 on the evening before the operation. Before going to bed, you can give your child a few sips of water to drink.

Is it necessary to remove adenoids, expert reviews:

Adenoid removal methods

The removal method is selected after. Using this procedure, the doctor can get a complete picture of the size of the nasopharynx, the degree of proliferation of lymphatic tissue, as well as the condition of the entrance holes of the auditory tubes.

Instrumental

To remove adenoids, a special scalpel is used - Beckmann's adenoid. This is a special curved knife, equipped with a box into which the cut tissues subsequently fall.

The instrument is inserted into the nasopharynx so that all the tissue to be removed fits into the knife ring. The adenoid is cut off, the bleeding that appears as a result of the intervention stops on its own after a few minutes.

The only disadvantage of this procedure is that it is carried out “blindly”. The doctor does not see the cavity of the nasopharynx and cannot control whether pieces of adenoid tissue remain, which can subsequently lead to new growths.

Radio wave

Surgical intervention in this case is carried out using the Surgitron device. It has a special attachment designed to remove adenoids. The cut obtained is almost the same as with the instrumental method, but due to exposure to radio waves, the vessels are cauterized, which minimizes the risk of bleeding. Blood loss is minimal.

Laser removal

Laser surgery has long established itself as an effective procedure.

Under the influence of laser devices, the temperature of the tissue increases, as a result of which liquid evaporates from it.

This adenoid removal method is bloodless.

The disadvantage of this method is the likelihood of heating healthy tissue in the area of ​​​​the laser beam.

Shaver (microdebrider)

A shaver, or otherwise a microdebrider, is a special tool with a rotating blade-shaped tip. It is used to grind the adenoid, parts of which are subsequently removed with an aspirator.

This procedure allows you to quickly and completely cut off the lymphoid tissue without damaging the healthy mucosa. This point is very important, since when a healthy mucous membrane is injured, scars can form, which subsequently prevent normal breathing. The risk of relapse after intervention is minimal.

How to perform adenoid removal surgery, watch our video:

Endoscopic adenotomy

The removal procedure performed using an endoscope is considered no less accurate and effective. After anesthesia has been administered, the device (in the form of a probe) is inserted into the nasal cavity. The doctor examines the adenoids and then proceeds to remove them.

For resection of hypertrophied tissue, various available instruments can be used: resection forceps, loop, electric knife. The procedure time is 15-20 minutes.

How painful is the procedure?

Thanks to the use of modern anesthesia, adenoid removal is completely painless.

Minor bleeding that occurs after surgery stops quickly enough without leading to any serious consequences.

The postoperative period is quite easy to bear. In rare cases, a slight increase in body temperature may occur.

Nasal breathing is restored immediately after the intervention, but gradually the tissues swell, and nasal breathing may appear. Such symptoms disappear after 7-10 days without additional intervention. If the patient has chronic diseases, the recovery period may take a longer time.

Anesthesia

For children under 7 years of age, adenotomy is performed under general anesthesia, so little patients do not feel pain, which is a very important point for a child. Modern drugs are non-toxic, do not cause any complications and are quite easily tolerated.

Adenoids can be removed in older children and adults under local anesthesia. Before surgery, a sedative is administered intramuscularly to the patient, and an anesthetic solution is sprayed into the nasopharynx. It is possible to use Lidocaine or Novocaine. During the operation, the person is conscious and can observe the procedure.

Postoperative period

The main goal of therapy after adenotomy is to create good conditions for the regeneration of the mucosa at the site of the cut. It is necessary to strictly follow all medical recommendations to avoid the development of complications:

• the room where the patient is located must be regularly ventilated;
• It is necessary to exclude from the diet all foods that irritate the mucous membranes (spicy, salty, hot and too sweet foods);
• you need to limit physical activity to avoid bleeding;
• You should also use vasoconstrictors prescribed by your doctor;
• To exclude bacterial complications, antibiotic therapy may be prescribed.

In addition, regular visits to the otolaryngologist are required for two weeks after surgery. Medical monitoring of the healing of the mucous membrane will help to suspect incipient abnormalities in time and prescribe appropriate treatment.

How to maintain your health

In the first 10 days after adenotomy, the patient’s contact with others should be limited. This is necessary to eliminate the possibility of infection. Since the immune system suffers after the intervention, it is possible to use immunomodulatory drugs.

During the postoperative period, you must avoid visiting swimming pools, baths, saunas and other public places. In addition, the patient’s exposure to the hot sun should be limited.

Contraindications

Absolute contraindications for adenoid removal are:

• bleeding disorders;
• abnormalities in the development of nasopharyngeal vessels;
• oncological diseases;
• the child is under two years of age.

Also, adenotomy is not performed during the acute period of infectious diseases. In teenage girls, surgery is planned outside of menstruation.

Dr. Komarovsky talks about the indications for adenotomy:

Forecast

If the operation is performed in a timely manner, the risk of developing any complications is zero. Nasal breathing is completely restored. In rare cases, relapses of the disease in the form of new growths are possible. In such cases, a repeat operation is possible.

Colds and an ever-sniffing nose are unique symbols of childhood. Inflammatory phenomena that often occur in the nasopharynx lead to pathological growth of the tonsils (adenoids), which cause many unpleasant disorders.

The tonsil, even if greatly enlarged, is not visible from the outside, and therefore only a doctor with special equipment can see it. Often the only way to get rid of the problem is to remove the adenoids in children surgically.

In contact with

How is the nasopharyngeal tonsil removed?

Many parents, especially young ones, are understandably afraid to take their child to the surgical department. And all because they do not know how adenoids are removed in children, how the operation is performed, and whether it is painful. All these worries are groundless - as a rule, no negative consequences are observed after a well-performed removal procedure.

Modern medicine considers several methods for removing adenoids in children:

• traditional;
• endoscopic;
• using a laser.

Each of them is quite effective, but also has its inherent disadvantages. Read on to learn how adenoids are removed in children.

Traditional operation

The traditional method is based on the use of conventional surgical instruments. It is simple and does not require expensive equipment, is performed on an outpatient basis, but has one important drawback. It consists of slow healing of the wound surface, which sometimes reaches a large area and bleeds. Rehabilitation in this case requires time and regular treatment with antiseptics.

Using endoscopic equipment

This method is considered very effective. Excision of the overgrown tissue in the traditional way, using conventional means, including a speculum for visual inspection, is not the only way to perform the procedure.

An endoscope inserted through the nose or mouth allows the doctor to clearly see the surgical site, which facilitates complete removal of overgrown tissue. As a result, re-growth is extremely rare.

There is no doubt about the effectiveness of laser surgery. It is completely painless, does not cause bleeding, but relieves the patient of adenoids almost completely, with minimal time. Effective at any stage.

Review of reviews about the operation

Some parents doubt for a long time whether it is necessary to remove the child’s adenoids. However, many reviews about this procedure have been published on the Internet, left by those parents who decided to undergo it. Most of them are positive.

Almost all reviews of adenoid removal in children speak of the effectiveness of surgical methods, especially if the intervention was timely.

Most adults note a significant improvement in the child’s well-being and rapid normalization of his condition. After excision of the tonsils, children stop snoring in their sleep, their voice becomes clearer, and their speech becomes clearer. The most important thing is that children begin to get sick much less often. And even the hearing of children suffering from deafness is completely restored.

In one of the typical reviews, a mother spoke in detail about the operation to remove the adenoids of her five-year-old daughter, when the conservative treatment prescribed by the doctor was unsuccessful. The doctor diagnosed the girl with third-degree adenoiditis, her eardrums were deformed, and her hearing had deteriorated. The operation was performed under general anesthesia and took about an hour. As a result, nasal breathing was completely restored, hearing improved, and the girl became healthy and cheerful.

Parents of young patients also note in their reviews that it is impossible to delay the operation, as this leads to very unpleasant consequences.

As parents say, the adenotomy procedure is painless, since modern anesthesia methods are used. Removing adenoids takes little time, and there are practically no complications.

Is surgery necessary?

Practice shows that surgical intervention is not always necessary. Adenoiditis of the first and second degrees is treated with conservative methods, which often give good results. But with severe tissue growth, tissue excision surgery is necessary.

Indications

Many parents are concerned about when it is necessary to remove adenoids from a child, what signs indicate the time has come for surgery.

An increase in the size of the tonsil does not mean that the procedure is mandatory - specialists will first insist on conservative therapy. Removal of adenoids in a child is performed only if therapy does not produce results, and it is no longer possible to do without surgery.

There are the following indications for adenoid removal in children:

• third degree of disease;
• frequent recurrences, which are difficult to treat and aggravate the situation with an enlarged tonsil;
• frequent;
• noticeable hearing loss;
• observation of speech disorders and developmental delays;
• difficulty breathing;
• malocclusion and changes in the appearance of the baby (the so-called adenoid face).

The main indication for surgery is the third degree of the disease, at which many of the problems listed above arise. In addition to them, the baby experiences constant psycho-emotional discomfort and lacks sleep due to difficulty breathing. The development of intelligence is also greatly delayed.

It is not difficult to identify severe adenoiditis, in which surgical intervention is highly desirable. The answer to the question of whether it is worth removing adenoids for a child will be answered unequivocally by frequent infectious diseases, heavy breathing, inability to breathe through the nose, and even occasional pauses in breathing during sleep.

It is especially important to carry out the operation in a timely manner - even before the development of irreversible changes and serious consequences. Lack of treatment or its delay can lead to disability. This means that in many cases there is simply no doubt about whether it is necessary to remove adenoids from a child.

Does the procedure hurt?

Sometimes adults, from the memories of distant childhood, highlight the operation they underwent, and therefore associate it with unpleasant sensations and pain. As a result, they refuse to subject their own child to adenotomy, protecting him from pain. However, it is worth understanding that in those distant times, adenotomy was carried out without any anesthesia, which caused those very unpleasant sensations. What about now? Is it painful to remove adenoids today, or are there painless ways?

In modern clinics, local or general anesthesia is used during adenoid removal surgery. The general one is preferable for a child, since the little patient falls asleep immediately after the injection and will not feel anything, and when he wakes up, all the doctor’s actions will have already been completed.

Before the operation, you should ask your doctor how the adenoids are removed and what form of anesthesia is used. In addition, general anesthesia has several contraindications, so sometimes the doctor is forced to use local anesthesia. It is no less effective, but a small patient may be frightened by something - the sight of strange sparkling instruments, for example. Therefore, along with local anesthesia, an injection of a sedative is often given, and the operation on the adenoids is successful. The procedure cannot be performed on a child without anesthesia, as it is very painful.

Existing methods and methods

There are different ways to remove adenoids in children:

• classic removal surgery;
• using an endoscope;
• laser cauterization.

The choice of one method or another depends solely on the patient’s condition, the severity of the existing problem and some other factors.

At what age is it done?

Adenoids are a phenomenon characteristic of children. They also occur in adults, but much less frequently, and operations are also performed:

• if adenoiditis is accurately diagnosed and is accompanied by frequent respiratory infections;
• for recurrent otitis and sinusitis;
• with breathing disorder during sleep and severe night snoring.

However, young parents are more concerned about the age at which adenoids are removed from children. The best time is from three to seven years. If you constantly delay the operation, serious troubles may arise:

• persistent and quite severe in some cases hearing impairment;
• chronic otitis;
• dental problems, including the formation of malocclusion;
• changes in the position of the lower jaw.

Knowing at what age it is most effective to remove adenoids, you can perform the operation on time and with the highest efficiency. At the same time, experts consider the age of a child under three years of age to be a contraindication. In general, the question of when is the best time to remove adenoids is decided individually based on a detailed examination. Perhaps the operation should be postponed, giving preference to conservative treatment methods.

Possible consequences

A timely adenotomy will allow you to completely get rid of serious problems. However, the removal of adenoids in children also has quite unpleasant consequences. Sometimes the growths appear again (due to a poorly performed operation), and you have to decide on a second operation.

Many parents think about the dangers of removing adenoids in children, and believe that with the removal of tonsils, the child’s body is deprived of the protective barrier to infections, which they, in essence, are. On the other hand, the highly overgrown tissue itself not only does not perform this barrier function, but also greatly worsens the patient’s general condition and reduces immunity.

In general, the consequences after removal of adenoids in children are positive. Parents who are well acquainted with the problem no longer doubt whether it is possible to remove adenoids in children, preferring adenotomy in cases where conservative treatment does not bring results.

In addition to surgery, there is also a conservative method of treatment, and, if possible, doctors try to avoid surgical intervention. Moreover, conservative treatment is considered a priority. Therefore, parents should first try to use conservative methods of treating the proliferation of pharyngeal tonsils, and only if they do not produce results, agree to adenotomy.

Sometimes they try to cure adenoiditis with folk remedies or widely advertised drugs. One of them is Thuja Edas-801 Oil, which is positioned as the most effective remedy for conservative treatment. In fact, homeopathy, as has been repeatedly proven by scientists and confirmed by practice, cannot cure anything at all, and adenoiditis is no exception. Therefore, do not succumb to the beautiful deception, but contact a specialist.

Useful video

For useful tips for parents on adenoid removal, watch this video:

conclusions

1. Adenoiditis is an extremely unpleasant disease. If left untreated or delayed, it can lead to very serious, sometimes even irreversible, consequences.
2. Timely treatment or surgery will completely relieve the patient of the problem.
3. Today, there are very effective methods for surgically removing adenoids. They do not cause relapses, the baby’s health is completely restored.