Operation to remove adenoids methods. Removal of adenoids in children under local anesthesia

08.03.2020 -

Removal of adenoids is one of the methods for treating pathological growth of the nasopharyngeal tonsil. It is prescribed if the child is diagnosed with complications caused by adenoids (nasal breathing disorder, hearing loss, chronic inflammation of the nasopharynx), and drug therapy does not bring positive results.

Removal of adenoids, which is carried out in a child, regardless of his age group, is a radical method of treating nasopharyngeal disease, called adenotomy.

Therapeutic manipulations of this type are a full-fledged surgical operation, which is aimed at excising an excessively enlarged lymphoid tissue. It is from it that the nasopharyngeal tonsil consists, which has undergone hyperplasia and disrupted the normal air circulation in the upper respiratory tract.

The table below shows the types of surgical intervention, as well as the specifics of its implementation:

Removal of adenoids in a child occurs at stages 3 and 4 of adenoiditis

Type of adenotomy	Characteristic surgical treatment
Complete	It provides for a complete resection of the pharyngeal tonsil, which has undergone pathological influence and has greatly increased in size. The decision on the complete excision of the adenoids is made by the otolaryngologist based on the results of the examination. Lymphoid tissue is completely excised if it is severely altered by a chronic inflammatory process, is a source of chronic infection and no longer performs its physiological functions.
Partial	Only part of the tonsil is surgically removed. The use of this type of adenotomy is advisable if there are no signs of inflammation of the lymphoid tissue, and its hyperplasia is not significant. Partial removal of the nasopharyngeal tonsil minimizes soft tissue injury, preserves the functionality of the lymphoid tissue and ensures rapid postoperative recovery.
Classic adenotomy	During the removal of the nasopharyngeal tonsils, a special surgical instrument is used - an adenoid knife. The main disadvantages of this type of removal of adenoids are a narrow field of view, as well as profuse bleeding, which opens immediately after cutting off the lymphoid tissue. Due to this, the healing time of the wound increases, which can last from 7 to 10 days.
laser	Modern method of removal of adenoids. Allows you to get rid of diseased nasopharyngeal tonsils with a laser that quickly excised hyperplastic tissue, but there is no large blood loss. Laser removal of adenoids is characterized by high accuracy and minimal trauma to the surrounding tissues, as well as the mucous membrane of the nasopharynx. The recovery period is 2-3 days.
Endoscopic	One of the most common and effective methods of performing adenotomy. In the process of carrying out surgical manipulations, an adenome knife and an endoscope are used. The doctor performing the treatment sees the object surgical intervention and removes exclusively lymphoid tissue that disrupts air circulation in the nasopharyngeal cavity.
Coblation	This type of adenotomy involves the use of a cold plasma apparatus. Medical equipment of this type allows painless excision of the nasopharyngeal tonsils, avoiding bleeding, cauterizing the operated area and ensuring the fastest possible recovery of the body.

The cost of removing adenoids depends on the type of operation performed. Conventional surgery without the use of expensive medical equipment, as well as with the use of an endoscope, is carried out free of charge in public institutions healthcare.

Innovative methods of excision of nasopharyngeal tonsils using cold plasma and laser instruments are carried out in private clinics, and the average cost of medical services of this type is 3000-4000 rubles.

Advantages and disadvantages of removing adenoids in a child

Removal of adenoids in a child is a surgical intervention on the tonsils of the nasopharynx, which involves damage to the soft tissues and mucous membranes located in a circle.

Advantages prompt removal adenoids are: results that can be achieved after surgical procedures:

nasal breathing is restored, which was completely or partially absent before;
deep and good sleep, since before that he could not sleep normally due to a constantly stuffy nose;
prevents malocclusion and development mandible, because with adenoids, breathing is possible only through the mouth, which remains constantly open (there is an incorrect formation of the zygomatic-orbital joints);
the child is less likely to get colds and infectious diseases of the nasopharynx;
reduced risk of developing comorbidities respiratory tract in the form of sinusitis, sinusitis, frontal sinusitis, which are often diagnosed in children with non-removed adenoids;
snoring disappears, which occurs in every 2nd child with hyperplasia of the nasopharyngeal tonsils;
timely removal of adenoids prevents otitis media and hearing loss;
normal speech and diction develops, the child stops talking through the nose.

The advantages in surgical treatment of adenoids are much greater than the potential disadvantages.

The disadvantages of surgery are the following risks:

adenoids consist entirely of lymphoid tissue, participate in the synthesis of special cells - lymphocytes, which are necessary to ensure local immunity (their removal will make the nasopharynx more vulnerable to dangerous bacterial and viral microorganisms);
about 25% of operations to remove the nasopharyngeal tonsils end with a relapse of the disease, which returns again after a long cold, SARS, flu;
a focus of chronic infection may develop in the nasopharynx, which will lead to the frequent and causeless appearance of a runny nose, purulent discharge;
the child will receive psychological stress caused by the type of blood, surgical instruments (the minds of children aged 3-5 are not yet ready for manipulations that will be performed in the depths of their oral cavity, which will lead to the release of blood, pain and restrictions on eating);
there is always a risk of joining a bacterial infection, which can lead to complications, cause the formation of abscesses, cause a prolonged inflammatory process;
damage to receptors, nerve endings and loss of smell (the child simply ceases to distinguish smells).

All the pros and cons of surgical removal of the adenoids are explained to the parents of the child before setting the date of the surgical intervention. Excision of the nasopharyngeal tonsils with a laser or cold plasma instrumentation minimizes all of the above disadvantages and risks.

Indications for removal of adenoids in a child

Removal of adenoids in a child is a radical method of treatment, the need for which is determined solely by an otolaryngologist.

Surgical excision of enlarged tonsils of the nasopharynx is indicated if the child has the following signs pathologies:

there is no nasal breathing, the child makes attempts to inhale, but the lymphoid tissue blocks the lumen of the respiratory canal;
the child is always with his mouth open;
at night, the baby is disturbed by strong snoring, which is heard throughout the room;
the child often suffers from colds and infectious diseases, suffers from chronic rhinitis;
concomitant complications of the adenoid developed in the form of sinusitis, sinusitis, frontal sinusitis;
drug treatment does not bring a positive therapeutic result;
the child's hearing began to decline, speech and diction were disturbed, he began to hoot;
there was a risk of developing dental problems associated with a constantly open mouth, drying of the mucous membrane of the gums, palate, inner surface of the cheeks and tongue, and the formation of malocclusion.

Parents who believe that their child does not need surgery to remove enlarged adenoids have the right to refuse surgical intervention. They are provided with a document form in which they indicate that they have been explained the need surgical treatment child, as well as the consequences of the lack of appropriate therapy.

Contraindications to the removal of adenoids in a child

Removal of adenoids in a child is not a complicated surgical operation that is well tolerated, and also has a minimal number of complications. Despite this, there are a number of limitations to its implementation.

It is contraindicated to remove adenoids in the following cases:

In the process of examining a child and preparing him for surgery, the attending physician may find other grounds that exclude surgical intervention completely, or that require temporary therapy.

What examinations should be done before removing adenoids in a child

Before setting the date for the removal of the nasopharyngeal tonsils, the child must pass the following tests and undergo an instrumental examination of the body:

In addition to the above types of examination, the child takes general analysis blood and urine. Before prescribing a diagnosis, the attending physician palpates the nasopharynx and performs anterior rhinoscopy by examining the surface of the adenoids through the nasal openings.

Preparation for removal of adenoids in a child

Before performing a surgical operation, it is necessary to follow a number of rules that will ensure the normal passage of the process of removing adenoids and minimize the risk of complications.

The following preparatory steps are taken:

Removal of adenoids in a child is not a complicated surgical operation, but it requires the right mental attitude and moral endurance. Especially if the surgery is performed in the traditional surgical way without the use of an endoscope.

This method of surgical treatment of adenoids is still used in district hospitals with poor material and technical base, where there are no endoscopic devices. Parents need to set the child up for the fact that the operation will be quick, and its implementation is extremely necessary for his health.

The procedure for the removal of adenoids in a child

Excision of the nasopharyngeal tonsils can be performed in several ways. The procedure for removing adenoids depends on what type of surgical intervention was chosen by the attending physician and the baby's parents.

Surgical method

This method of removing overgrown lymphoid tissue involves the following procedure:

The child is transferred to the ward of the surgical department, where he receives further medical treatment aimed at preventing bacterial infection and speedy healing nasopharynx.

laser removal

A modern and practically painless method of surgical therapy, which is carried out as follows:

Immediately after the completion of surgical procedures using this method, the baby can go home. If the treatment procedure went without complications, there is no bleeding, then hospitalization is not required.

Endoscopic

This method of removal of adenoids is used more often than all other methods of surgical intervention.

In order to save the baby from adenoids, the surgeon performs the following steps:

The child receives local or general anesthesia.
The oral cavity is fixed in an open position so that the doctor has unhindered access to the lymphoid tissue.
An endoscopic probe is inserted into the nasal opening, which transmits a video image in real time and allows the doctor to see the adenoids on the computer monitor.
Removal of the nasopharyngeal tonsils is carried out through the mouth with the help of surgical instruments.

Immediately after the completion of medical manipulations, the child is transferred to the ward. general therapy. A good field of view and modern equipment allow for rapid excision of lymphoid tissue with minimal trauma to the nasopharyngeal mucosa.

Adenotomy using the coblation method is carried out exactly according to the same principle as laser removal of the nasopharyngeal tonsils, but only using a cold plasma device.

Recovery after removal of adenoids in a child

If the surgical operation was performed without violations of the treatment protocol, there were no complications and the surrounding tissues and nerve endings were not affected, then a special course of restorative rehabilitation is not required. The child should not eat anything in the first 2 hours after the removal of the adenoids.

After the specified time, you can eat broth, mashed potatoes and other liquid foods. Stale foods, rough, fibrous, salty, pickled, sour, spicy foods are completely excluded from the diet.

In the next 5 days after the operation, it is recommended to rinse the mouth and larynx with a weakly concentrated antiseptic solution. To prepare it, you need to take 1 tsp. food salt without a slide and dissolve it in 0.5 liters of warm water.

With the prepared solution, the child should perform daily rinsing of the mouth and throat. Duration medical procedure- 3-5 min. 2 times a day after brushing your teeth. Children under the age of 5 who do not yet have sufficient oral care skills are given an antiseptic treatment of the throat with a Lugol solution. The procedure is performed 1 time per day for 5 days.

How long will the result last after removal of adenoids in a child

Adenoid hyperplasia is not a recurrent disease. With the complete removal of lymphoid tissue, a long-term therapeutic result is provided, excluding the re-formation of growths. Partial excision of the adenoids, while preserving part of the tonsils, increases the risk of tissue re-growth and blockage of the airway.

In this case, the child may again face the problem of breathing through the nose. The likelihood of recurrence of the disease is unlikely, and the recurrence of adenoids is rare.

The only exceptions are cases of violation of the treatment protocol, mistakes made during the operation, preservation of most of the hyperplastic tissue of the nasopharyngeal tonsils. To avoid recurrence of the disease, it is recommended during the year at least once a month. visit a pediatric otolaryngologist.

Possible complications after removal of adenoids in a child

Complications arising after removal of adenoids in children of all age groups are associated with the characteristics of the postoperative period.

In the first 2-3 days after surgery, the following complications may occur:

In the event that after the removal of the adenoids the child has the above complications, it is necessary to immediately contact the attending otolaryngologist or the surgeon performing the operation.

Adenotomy is not dangerous operation that needs to be completed on time. Strongly enlarged tissue of the nasopharyngeal tonsils is more difficult to remove. Operation on a child early dates adenoid formation, guarantees the restoration of nasal breathing, rapid healing of the nasopharynx and the absence of negative consequences.

Article formatting: Mila Fridan

Video about adenotomy

Review of the child after adenotomy:

To have an idea of how dangerous the disease is, you should consider the structure of the nasopharynx. On the side walls of the channel through which air enters, the mouths of the Eustachian tubes are located, which are connected to the middle ear.

On the back wall cavity contains the nasopharyngeal tonsil. She is a part immune system, its function is the production of leukocytes that take on the attacks of pathogenic microflora. In the case of frequent inflammations provoked by infection, allergies or other factors, the lymphoid tissue begins to increase and gradually blocks the auditory tubes and restricts air access.

At healthy baby adenoids normally close up to a quarter of the lumen of the nasopharyngeal canal. Depending on the neglect of the disease, three degrees of pathological growth are distinguished:

The first - blocked up to 33% of the lumen of the nasopharyngeal canal in the area of the vomer - part of the bony septum of the nose. In this case, the child experiences minor difficulty in breathing through the nose, at night it may worsen due to swelling. Adenotomy - surgery to remove adenoids - is usually out of the question, preferably conservative treatment.
Closed from 33 to 66% of the lumen. This is the II degree of enlargement of the adenoids, in which the child can snore at night, his hearing is impaired. During the day, the baby’s breathing is difficult, due to nasal congestion, his mouth is constantly ajar (the so-called adenoid type of face). The recommendation of an ENT specialist for surgical intervention is possible. If left untreated, adenoids may gradually grow.
Third - there is an almost complete overlap of the nasal canal of the respiratory tract with connective tissue. Breathing through the nose is almost completely absent, immediate medical intervention, since consequences are possible in the form of incorrect formation of the facial part of the skull, hearing impairment. With the third degree of adenoids, the baby experiences constant torment, headaches, fever are possible.

As noted above, adenotomy is performed under local anesthesia and under general anesthesia. Using general anesthesia the child falls asleep for a short period of time, during which doctors perform the procedure for removing the adenoids. After the end of the operation, the patient does not feel pain. This method avoids traumatizing the weak child's psyche.

But much more often adenotomy is performed under local anesthesia, during which the mucous membrane of the nasopharynx is lubricated with painkillers. Often, an anesthetic spray method can be used to lower the pain threshold. For this, a special nozzle is used, which allows the anesthetic to be evenly distributed over the entire surface of the adenoids.

If anesthesia is done with high quality, then with local anesthesia the presence of pain in patients.

A significant disadvantage with local anesthesia is that during the operation, the patient can observe all its stages: he sees surgical instruments and blood. This can lead to a stressful state not only for a child, but also for an adult. To avoid the occurrence of unpleasant situations, a sedative injection can be given to the patient before anesthesia.

In some cases, anesthesia for adenotomy is not performed, since the patient may have contraindications to its use. According to physiologists, adenoids do not contain nerve endings, so anesthesia can be neglected. But still, the person will experience pain during the operation. Therefore, anesthesia for adenotomy is not used extremely rarely.

Indications for removal of adenoids

By itself, an increase in the pharyngeal tonsil is not a reason for surgery. Specialists will do everything possible to help the patient in conservative ways, because the operation is a trauma and a certain risk. However, it happens that one cannot do without it, then the ENT weighs all the pros and cons, talks with parents if it is a small patient, and sets the 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 immediate role, but also maintains chronic inflammation, prevents the child from growing and developing properly, creates a risk of dangerous complications, therefore, in these cases, one should not hesitate or hesitate, and the only way to get rid of child from suffering will be surgery.

Indications for adenotomy are:

Adenoids of the 3rd degree;
Frequent recurrent respiratory infections that do not respond well to conservative therapy and cause progression of adenoiditis;
Recurrent otitis and hearing loss in one or both ears;
Disorders of speech and physical development in a child;
Difficulty breathing with sleep apnea;
Changing the bite and the formation of a specific "adenoid" face.

degree of adenoiditis

The main reason for intervention is the third degree of adenoiditis, which entails difficulty in breathing through the nose, and constantly aggravated infections of the upper respiratory tract and ENT organs. At small child correct physical development is disturbed, the person acquires character traits which would be next to impossible to correct.

The main symptoms of severe adenoiditis are difficult nasal breathing and frequent infections of the upper respiratory tract. The child breathes through the mouth, which causes the skin of the lips to become dry and cracked, and the face becomes puffy and stretched. The constantly ajar mouth is noteworthy, and at night the parents hear with concern how hard it is for the baby to breathe. Episodes of nocturnal respiratory arrests are possible, when the amygdala completely blocks the airways with its volume.

It is important that surgery to remove the adenoids is carried out before irreversible changes and serious complications appear, it seems to be a small problem limited to the pharynx. Untimely treatment and, moreover, its absence can cause disability, so ignoring the pathology is unacceptable.

best age for adenotomy in children - 3-7 years. Unreasonable postponing of the operation leads to serious consequences:

Persistent hearing disorder;
Chronic otitis;
Change in the facial skeleton;
Dental problems - malocclusion, caries, impaired eruption of permanent teeth;
Bronchial asthma;
Glomerulopathies.

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

Night snoring and breathing disorder during sleep;
Frequent respiratory infections with diagnosed adenoiditis;
Recurrent sinusitis, otitis.

Contraindications to the removal of adenoids are also defined. Among them:

Age up to two years;
Acute infectious pathology (influenza, chicken pox, intestinal infections, etc.) until it is completely cured;
birth defects facial skeleton and anomalies in the structure of blood vessels;
Less than a month old vaccination;
Malignant tumors;
Severe bleeding disorders.

In accordance with the recommendations of the famous Ukrainian pediatrician Komarovsky, adenoids should be surgically removed only when conservative therapy is ineffective and there are vital indications for surgery, i.e. serious health complications caused by adenoids. In all other cases, the doctor recommends conservative treatment.

Pediatric otolaryngologists explain their skepticism about adenotomy as a method of choice as follows:

The operation does not guarantee recovery, especially surgery performed by the classical (blind) method. The reason is the remnants of the lymphoid tissue, which is able to grow again, leading to a relapse. The solution is image-guided adenotomy using endoscopic techniques, but not all clinics have the necessary equipment for this.
There is a risk of developing quite serious consequences, for example, overgrowth of scar tissue in the Eustachian tubes or paralysis of the soft palate.
Removing the tonsils weakens the body's defenses. The pharyngeal ring, of which the pharyngeal tonsil is a part, prevents the infection from entering the body with breathing. Removing tonsils in children puts them at further risk of frequent respiratory problems.

However, sometimes the risk associated with adenotomy is much less than the risk of continued presence of the adenoids, in which case surgery is necessary.

Indications for adenotomy:

complete absence nasal breathing, the child breathes only through the mouth;
frequent inflammation of the middle ear (otitis media), hearing loss;
frequent tonsillitis (infection from the nasopharyngeal tonsil extends to the palatine);
relapses paratonsillar abscess.

At what age can adenoids be removed? In the presence of absolute indications, adenotomy can be performed in patients of any age. If circumstances allow it to wait, it is better not to operate on children under three years of age, as they have a higher risk of recurrence.

The decision on whether to remove adenoids from a child surgically is made by the attending ENT doctor together with the child's parents, explaining to them in detail what the essence of the operation is, why such treatment would be optimal, and what to do if undesirable consequences.

In some cases, the operation to remove adenoids in children is postponed for a certain period:

for 1 month - with acute respiratory infections and tonsillitis;
for 2 months - after recovery from influenza and after vaccination;
for 3 months - after chickenpox;
for 4 months - after scarlet fever and rubella;
for six months - after suffering measles, mumps, whooping cough.

The answer to the question why it is impossible to remove adenoids after an infection is obvious: there is a decrease in immunity, complications are possible. Before the operation, it is found out whether the child has recently been in contact with infectious patients, if given fact is detected, adenotomy is postponed for a period long in the incubation period of the disease.

Contraindications to adenotomy are:

chronic infectious diseases or acute respiratory infections, acute respiratory viral infections;
some diseases of the circulatory and cardiovascular systems;
pathological development of the palate;
age up to 2 years;
untreated dental caries;
some diseases internal organs;
thymomegaly.

With the above conditions, a non-surgical method of treatment is chosen.

Under no circumstances should children with severe operable stages of adenoids be operated on if they are at the peak of respiratory exacerbation (seasonal influenza epidemics, acute respiratory viral infections, acute respiratory infections, herpes intoxication).

What else can be contraindications? In addition to the decisive refusal and the final opinion of specialists in pediatric visceral medicine - about chronic diseases of the psychoneurological ICD code, cardiologists, endocrinologists?

Yes, such indications exist. For example, high temperature unknown etiology, without obvious symptoms of a cold, this is an unconditional obstacle to adenotomy. First, you should identify the root cause of such a painful symptom. Sometimes, this is how a sluggish reduction of microflora, infectious etiopathology manifests itself. Main danger, which, in a latent form of pathogenesis, strains such as:

streptococcus, Pseudomonas aeruginosa (causative agents of a sluggish, inactive type of sinusitis);
encephalitis and arachnoiditis (from the defeat of harmful microorganisms - ticks);
consequences of atypical influenza.

Perhaps the child has been taking potent antibiotics of the same group for a long time, without concomitant use (or insignificant in volume) of antistatic agents (Laktovit-forte, Nystatin, Baktisubtil).

Most often, this is an erroneous action on the part of parents. The desire to cure their children from disease-causing adenoid foci, from emerging diseases as soon as possible. As a result, adenoid vegetation acquires the property of a “super mutation”, hid and hid in deep visceral areas of the body.

In the postoperative period, such a mine in the form of a veiled pathogenic strain may well provoke major troubles - suppuration of wound locations in the operated nasopharyngeal organs, up to sepsis. But, not in comparison, the worst thing is to influence the awakening of the child from general anesthesia, bringing psychomotor dynamics back to normal (return of consciousness, adequate perception of reality).

Epilogue: A happy time will come for your child and for you, his loving parents, if by joint efforts, love and care you have overcome the fear of surgery - removal of adenoids in children under general anesthesia!

Possible consequences of the operation

The danger of the disease is that the parents of a baby suffering from a constantly stuffy nose do not attach much importance to this and notice changes when the consequences become apparent.

Typical facial expressions with an adenoid face: displacement of the chin, constantly ajar mouth - leads to irreversible consequences. The structure of the jaws is gradually deformed, which is not always possible to correct even surgically.

Overgrown adenoids greatly complicate the life of the child, psychosomatic diseases may appear: nervous tic, enuresis, convulsive conditions. The baby becomes lethargic or excitable. Due to the nasality and hearing loss, verbal communication worsens; during a conversation, he often asks to repeat what he was told.

Hypertrophied nasopharyngeal tonsils often become inflamed under the influence of negative factors, which is the cause of adenoiditis, a disease characterized by high temperature, chronic runny nose and headache.

Adenoids interfere with the outflow of mucus, which deprives the body of a protective function. Inflammatory processes can provoke otitis, pharyngitis, tracheitis.

In most cases, the operation goes without complications. Negative effects of surgery include:

Occurrence of otitis. Swelling of the damaged tissue can block the ear canals and cause temporary hearing problems.
Snoring, difficult breathing. The baby can sniff, grunt and cough. This phenomenon is associated with swelling of the nasopharynx after removal of the adenoids. Such symptoms usually disappear on their own after seven to ten days, if there is no improvement, you need to consult with the lore.
Decreased immunity. Perhaps, as after any surgical intervention, including against the background of stress.
Wound infection. To avoid a secondary infection, it is advisable to limit contact with other people and follow the doctor's instructions.

Preparing for the operation

Adenotomy is a surgical intervention that contains a certain risk. The necessary preparation will help to avoid the risk of bleeding, complications, infection. To do this, a number of laboratory tests are carried out before the operation: for sensitivity to an anesthetic drug, blood tests - general and biochemical. They also determine if the baby is sick with hepatitis, AIDS, determine his blood type and Rh factor.

Before the operation, the pediatrician examines the child and talks with the parents. To exclude the possibility of developing infectious diseases, a course of antibiotics is sometimes prescribed.

Eating less than 12 hours before adenotomy is excluded, otherwise the baby may vomit. Mucous secretions are removed using the "Cuckoo" method.

When the question of the need for surgery is decided, the patient or his parents begin to search for a suitable hospital. Difficulties in choosing usually do not arise, because the surgical removal of the 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 an operation to remove adenoids includes standard laboratory tests - general and biochemical for blood, clotting, determination of group and Rh affiliation, urinalysis, blood for HIV, syphilis and hepatitis. Adult patients are prescribed an ECG, children are examined by a pediatrician who, together with an otorhinolaryngologist, 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 anesthesia can be general, and the child may vomit during anesthesia. In female patients, surgery is not scheduled during menstruation due to the risk of bleeding.

After the decision on surgical intervention is made, preoperative preparation is carried out, which, first of all, includes full examination child. The doctor collects anamnesis, including family history, paying attention to previous and existing diseases, allergies to medications etc. Conduct laboratory blood and urine tests to get an idea of the state of health, and, if necessary, other studies.

If the child, in addition to adenoids, has other pathologies, medication correction may be required.

Features of anesthesia

An operation under general anesthesia for a small child has an important advantage: the absence of operational stress, as in the case when the baby sees everything that happens in the operating room without even feeling pain. The anesthesiologist chooses drugs for anesthesia individually, but most modern means safe, low toxicity, and anesthesia is similar to normal sleep. Currently, pediatrics use esmeron, dormicum, diprivan, etc.

General anesthesia is preferred in children 3-4 years of age, in whom the effect of being present at the operation can cause great fear and anxiety. With older patients, even those who have not even reached the age of seven, it is easier to negotiate, explain and reassure, so local anesthesia can also be performed for preschool children.

If local anesthesia is planned, then a sedative is first introduced, and the nasopharynx is irrigated with a solution of lidocaine so that further injection of the anesthetic is not painful. For achievement good level anesthesia use lidocaine or novocaine, which is injected directly into the tonsil area. The advantage of such anesthesia is the absence of a period of "exit" from anesthesia and toxic action medicines.

In the case of local anesthesia, the patient is conscious, sees and hears everything, so fear and worries are not uncommon even in adults. To minimize stress, the doctor before adenotomy 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.

Classic adenoid removal surgery

classical adenotomy

Classical adenotomy is performed using a special instrument - Beckman's adenotomy. The patient is usually seated and the adenotome is inserted into oral cavity to the tonsil behind the soft palate, which is raised by a laryngeal mirror. The adenoids must fully enter the adenoid ring, after which they are excised with one quick movement of the surgeon's hand and removed through the mouth. Bleeding stops by itself or the vessels coagulate. In case of severe bleeding, the area of operation is treated with hemostatics.

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

Other disadvantages are possible pain during manipulation, as well as a higher risk of dangerous complications - the ingress of removed tissues into the respiratory tract, infectious complications (pneumonia, meningitis), injuries of the lower jaw, pathology of the hearing organs. cannot be ignored and psychological trauma that can be given to a child.

Anesthesia

Parents may doubt the need for surgery due to the risk and possible suffering of the child. Those who had adenoids removed without anesthesia in childhood are especially worried. Now excision of adenoids is performed under general anesthesia for patients under 7 years old or local older children, since it is easier for them to explain the situation.

During local anesthesia, an anesthetic drug, lidocaine or novocaine, is first applied by spraying or smearing, and then injected directly into the tonsil. The child sees and realizes everything that happens, and the sight of tools and his own blood can cause psychological trauma. Therefore, general anesthesia is preferable. If the baby is overly excited and frightened, a sedative is additionally introduced.

The drug for pain relief is selected individually by the anesthesiologist; for small patients, low-toxic and relatively safe medicines are used: Diprivan, Esmeron, Dormicum.

The advantages of general anesthesia include a low risk of psychological and physical trauma, the ability to calmly remove adenoids and carefully examine the throat after surgery. Modern specialists use endotracheal anesthesia, in which anesthetic substances enter both the blood and the respiratory system.

Endoscopic adenotomy

It is quite easy to care for a baby who has undergone surgery. The home recovery regimen after removal of adenoids in a child consists in correcting nutrition, limiting physical activity, and observing hygiene rules. Here general recommendations:

Change your diet. For a child who has undergone an operation to remove adenoids, hot food and drink are prohibited: you need to spare the damaged area. Do not give food that can injure the throat: crackers, chips, hot spices, vinegar dressings, feed dishes containing garlic, onions, and so on. The duration of the diet is about two weeks.
Due to the risk of bleeding, it is advisable to avoid overloading and long stay in the sun, in the bath hot water, bath. The throat and neck should not warm up. Half bed rest is recommended.
Limit contacts to avoid the risk of getting sick.
Fulfill breathing exercises- to study the technique, you can watch a video with your child. It is also important to teach the baby to breathe through the nose all the time.
Follow all the advice of your doctor.

There is no need to lie at home all the time, you can walk in places where there is no mass congestion of people.

Endoscopic removal of adenoids is one of the most modern and promising methods of treating pathology. The use of endoscopic technique allows you to carefully examine the pharyngeal area, safely and radically remove the pharyngeal tonsil.

The operation is performed under general anesthesia. The endoscope is inserted through one of the nasal passages, the surgeon examines the pharyngeal wall, after which the adenoid tissue is excised with an adenoid, forceps, microdebrider, and a laser. Some specialists supplement endoscopic control with visual control by introducing a laryngeal mirror through the oral cavity.

Endoscopy makes it possible to most completely remove the overgrown lymphoid tissue, and in case of recurrence, 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 the classic adenotomy, but also more accurate, because the surgeon is aiming. The excised tissue is removed more often through the nasal passage, free from the endoscope, but it is also possible through the oral cavity.

A variant of endoscopic removal of adenoids is a 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 hypertrophied tissues, grinds them, and then the tonsil is sucked off by an aspirator into a special container, which eliminates the risk of it getting into the respiratory tract.

The advantage of the shaver technique is low invasiveness, that is, healthy tissue of the pharynx is not damaged, the risk of bleeding is minimal, there is no scarring, while endoscopic control makes it possible to completely excise the tonsil, preventing recurrence. The method is considered one of the most modern and effective.

The restriction to the removal of the tonsil with a microdebrider may be too narrow nasal passages in a small child, through which it is impossible to introduce instruments. In addition, not every hospital can afford the necessary expensive equipment, so private clinics often offer this method.

Does it hurt to remove

Whether the baby will suffer or not depends on the method of the operation and the type of anesthesia. In modern clinics, the following methods of adenoid removal are used: classical (Beckman knife), coblation method, laser, shaver adenotomy.

The last three methods are considered the safest and least traumatic, the risk of infection and bleeding is practically eliminated, since the vessels are cauterized during the operation. All types of surgery pass quickly. How long the operation lasts depends on the method, as a rule, no more than ten minutes.

With local anesthesia, the child will feel pain and discomfort; during general anesthesia, discomfort is excluded, since the baby will sleep. But during full anesthesia, there is a possibility of developing sudden complications associated with the introduction of an anesthetic drug. Therefore, parents will have to choose between short-term discomfort, pain of the child and the risk of developing anaphylactic shock. You have to take risks anyway.

There is an opinion that it is not necessary to remove the adenoids, since as the child grows older, the pharyngeal tonsil may decrease in size. According to Dr. Komarovsky, postponing treatment until adolescence unacceptable, as there is a high risk of getting chronic illness and complications. Overgrown adenoids can be removed according to indications and in adulthood.

The use of physical energy in the treatment of adenoiditis

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

laser treatment

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

The impossibility of controlling the depth of exposure, which is why there is a risk of damage to healthy tissues;
The operation is long;
The need for appropriate equipment and highly qualified personnel.

Radio wave treatment is carried out with 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 the operation.

Plasma coagulators and coblative systems are 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 exposure to "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, the recurrence of adenoiditis, the likelihood of cicatricial changes 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 needs an individual approach that takes into account age, anatomical features of the structure of the pharynx and nose, psycho-emotional background, comorbidities.

Adenoid Removal Methods

To reassure parents, professional assurances from leading surgeons and anesthesiologists: “General anesthesia for children in adenotomy operations is carried out exclusively with safe, recommended medicinal anesthetics - Sevoflurane, Propofil or Isoflurane. Through the inhalation option, in the form of applying a laryngeal mask to the child's face.

The time of the operation and the stay of children in anesthesia does not exceed 15-20 minutes. Children easily come out of anesthesia. They are under the direct control of the operating surgeon for the first 2 hours.

As a rule, after examination and certification by the doctor of normal homestasis, (the condition of the child) - the operated patient can be allowed to go home. In complicated operations, children are under strict supervision: first in the intensive care unit, then transferred to the intensive care unit.”

General anesthesia, for the operating ENT surgeon, has a higher priority option:

Firstly, and the main advantage, is the immobilization factor of the patient, which allows you to calmly carry out the planned operation plan, thoroughly and efficiently. Due to this condition, as a rule, the operating specialist does not leave the remains of a disease-causing lymphoid gland. After all, the residual pathogenic epidermis can quickly recur.
Secondly, and no less important point is the psycho-emotional status. As for an operated child (does not feel pain, does not feel fear, does not break out of the hands of assistants, nurses). The same goes for the doctor himself. Because, during the operation, the factor of accidental injury to blood vessels, the nasopharyngeal epidermis by the surgeon is reduced. This can happen due to the fact that the child suddenly and risky "twitches", screams in fright and cries in hysterics.
Thirdly, the calm conduct of operational actions in concentrated silence does not distract the entire medical team. The operating otolaryngologist, together with the anesthesiologist, the therapist, will always be able to respond in time to unforeseen situations from which no one is immune. Although, before the operation, children undergo a complete examination - laboratory, by a cardiologist, endocrinologist, pediatrician-therapist. What can happen?
profuse bleeding that occurs due to a sudden rupture of an extremely thin wall of a vessel (arterial, venous);
failure occurred in heart rate: "flickering syndrome", excessive pulsation of the right or left ventricle, spasm of the heart muscle;
a sharp drop in blood (cranial) pressure.
Fourth, the risk of aspiration disappears. This is a frequent "scourge" of standard surgical operations, which are carried out by a mechanical method - cutting adenoids and tonsils with an adenoid, a curette. "Aspiratory" is a term denoting the reflux of blood, gastric, nasal secretions into the bronchial trachea. The created aspiration requires instant resuscitation - vacuum suction, cleaning of the respiratory canals, injections of muscle relaxants into the trachea so that bronchospastic (sharp spasm, bronchial constriction) does not occur, or even worse - lethal asphyxia (suffocation).
There is a full-fledged opportunity to thoroughly plug the operated field, drain the wound planes, which is not always possible with local local anesthesia.

Indeed, from the standpoint of calm work, well-coordinated actions of the surgical team, general sedation (anesthesia, introduction into the unconscious, not felt state of a small patient) is a blessing. This is a guarantee that the children themselves will not create an undesirable force majeure, an extreme situation.

IMPORTANT INFORMATION! With modern progressive technology of anesthesia, selection of innovative and safe muscle relaxants, neuro neutralizers, removal of adenoids in children under general anesthesia becomes the most guaranteed choice of the type of operation (adenotomy) in children!

When and how adenoids are removed in children depends on the recommendations of the practitioner, the chosen clinic, the availability of the necessary equipment and the degree of pathology.

Adenoids in children are excised under local anesthesia, as this exposes the body to a lesser drug load and is more easily tolerated by the child, however, in some situations (for example, lability nervous system) removal of adenoids can be carried out in children under general anesthesia.

Adenotomy consists in the surgical excision of pathologically enlarged adenoid tissue with a scalpel, as well as electrocoagulation methods (coblation, or cold plasma) and laser surgery.

In the classical operation, an annular knife is used to remove adenoids - an adenoid. After removal of the adenoid tissue, profuse bleeding develops, which usually stops quickly. If this does not happen, it is necessary to examine the nasopharynx, where fragments of tissues are found, after the removal of which the blood stops.

A high-tech method is coblation - cutting a pathologically enlarged nasopharyngeal tonsil with the help of electromagnetic radiation operating in the radio frequency range. This makes it possible to create a cloud of so-called cold plasma, which, being precisely directed, cuts tissues with coagulation in the area of the cut.

Such cold-plasma removal of adenoids in children has the most positive reviews from doctors - there is no bleeding, severe postoperative edema, pain, deep tissues are not damaged. Currently, this method has practically replaced electrocoagulation, which is more painful and associated with high risk complications.

Laser removal of the hypertrophied nasopharyngeal tonsil provides effective and rapid removal of adenoids. The effectiveness of laser removal of adenoids in children is comparable to that of coblation, the method has practically no side effects. Laser treatment of adenoids can be carried out in two versions - a single operation and gradual, over several procedures, irradiation of adenoids with a lower power laser, as a result of which they gradually involute. Such a gradual removal requires minimal anesthesia - it is enough to treat the mucous membrane of the nasopharynx with lubrication with an anesthetic spray.

The advantages of coblation and laser removal methods are minimal trauma to healthy tissues, little or no bleeding, the ability to treat hard-to-reach places, minimal pain both during surgery and during the rehabilitation period, and quick recovery.

In some cases, they resort to combined treatment - for example, they excise the body of the tonsil surgically, followed by treatment of the residual lymphoid tissue with a laser.

Those who wish can see the video of removal of adenoids in children.

Postoperative period: what to look for

As a rule, the postoperative period proceeds easily, complications can be considered a rarity with a correctly chosen operating technique. On the first day, a rise in temperature is possible, which is brought down by the usual antipyretic drugs - paracetamol, ibufen.

Some children complain of sore throats 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 for nose 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 follows a diet, since nutrition plays a significant role in the restoration of nasopharyngeal tissues. A few days after the operation, soft, mashed food, mashed potatoes, cereals are recommended. The child can be given special baby food for babies, which will not cause injury to the pharyngeal mucosa.

bath, sauna, hot tub excluded for the entire recovery period (up to a month);
playing sports - not earlier than in a month, while the usual activity remains at the usual level;
it is advisable to protect the operated person 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 drops in the nose are shown, constricting blood vessels and having a local disinfecting effect (protargol, xylin), but always under the supervision of a doctor.

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

Complications include bleeding, purulent processes in the pharynx, acute inflammation in the ear, recurrence of adenoiditis. Sufficient anesthesia, endoscopic control, antibiotic protection can minimize the risk of complications in any of the options for the operation.

Adenoids are called pathologically enlarged tonsils in children (most often observed between the ages of three and seven years). This disease naturally occurs after past illnesses upper respiratory tract (measles, scarlet fever, influenza) and can lead to hearing loss, slower intellectual development, anemia, and even to a change in appearance (face shape). The diagnosis requires careful and timely treatment by an otolaryngologist who conducts the diagnosis. Based on the data obtained, he makes a verdict: adenoids can be cured or they need to be removed. Parents often ask themselves the question: how does this operation go? When exactly should adenoids be removed?

Is it necessary to remove adenoids?

There are cases when surgery is not necessary at all. The disease has three stages of development. Grade 1, as a rule, does not interfere with a person’s usual life: the child breathes freely, problems appear only during sleep due to the influx of venous blood. The situation is quite fixable with the help of medicines.

Another thing - 2 and 3 stages. Children begin to breathe through their mouths all the time and snore in their sleep, as the adenoids close the choanae (rear openings of the nose) (we recommend reading:). It harms the entire body as a whole. It is necessary to consult with specialists: an otolaryngologist, a dentist, an allergist, an immunologist, so that the treatment is as effective as possible. It is important to do everything on time, because the disease negatively affects both the general health and the appearance of the child.

Indications for surgery

The presence of inflamed tonsils is not a reason to cut out adenoids in the nose. It is necessary to undergo a thorough examination, and only after that the doctor will decide on the need for surgery.

Indications for removal of adenoids

So, we list the main indications for surgical intervention when adenoids are removed in children:

ARI and SARS. The mucus that protects the body from inflammation and the reproduction of microbes encounters an obstacle in the form of adenoids, which is why nasal cavity becomes a breeding ground for infections.
Pharyngitis, laryngitis, tracheitis - diseases of the respiratory tract. Pus gets into them, affecting the mucous membrane, and as a result, the inflammatory process begins.
Multiple otitis. The tonsil grows in size and interferes with the normal functioning of the middle ear.
adenoid cough. It appears when the nerve endings of the pharynx and nasopharynx are irritated, and if the bronchi are not inflamed, then this is not a sign of a cold, but of the adenoids. After the operation, this cough is eliminated.
Pneumonia, bronchitis.
Formation of a malocclusion.
Poor results from conservative, traditional treatment.
Headaches, snoring, breathing difficulties and, as a result, sleep disturbances.
Hearing loss. Adenoids do not allow air to penetrate to the middle ear, due to which the eardrum loses its mobility.
Speech disorders are another indication for removal.

Sometimes, along with the adenoids, it is also necessary to remove the tonsils. For example, if a child often experiences purulent tonsillitis, suffers from rheumatic disease or has problems chewing food and swallowing: overgrown tonsils interfere with these processes.

Preparing for the operation and taking tests

Before the operation to cut out the adenoids in a child, the baby will be forced to pass a series of tests. Parents should find a medical facility in the city where they can be safely removed. The baby in the hospital will need to pass:

blood clotting test;
Analysis of urine;
feces for the presence of worms;
blood for the presence of hepatitis B and C;
general and biochemical analyzes blood.

The results of the above analyzes are valid for ten days, so calculate in advance the time and date of the operation. Important role plays the type of anesthesia: general anesthesia requires an ECG and an analysis of the level of electrolytes. After 14 years, fluorography and a certificate of the absence of syphilis are added to this list.

After the tests are passed, you need to come to the pediatrician and take a certificate stating that the child had no contact with infectious patients. Please note that it is valid for three days. You should have a policy, SNILS, a birth certificate with you. An adult accompanying person must have a passport, fluorography, a syphilis test and a children's vaccination certificate.

The first few days are spent preparing for the operation, during which doctors give medicines for better blood clotting. Antiseptics are used to treat the throat (as a rule, Miramistin is used).

The day before the operation, the child's diet should be light, without junk food. In the morning, they take blood from him (you can’t eat before that, you can only drink water to avoid dehydration). Certainly, psychological support is also important: explain to the child why the operation is needed and reassure him.

Below is a video discussing the issue of deletion: watch it to save yourself the excitement and, if necessary, explain to the child that everything is not so scary.

The use of anesthesia

How is the operation performed - under anesthesia or without sedation? This has always been a subject of controversy. General anesthesia is a strong stress even for the body of an adult, and even more so for a child. Nevertheless, doctors offer new gentle methods of anesthesia. In the end, general anesthesia will be preferable: it will save the baby from negative memories and give the doctor the opportunity to work without distractions. However local anesthesia also applies.

Advantages and disadvantages of local anesthesia

This type of anesthesia is most often offered to older children, as they have developed endurance and self-control. In addition, the pain threshold of the child, his individual characteristics are taken into account. Doctors enter sedatives in case the baby is afraid of the sight of blood or is simply horrified by the process. Undoubted advantages of local anesthesia:

relatively low price compared to other types of anesthesia;
no side effects after surgery.

The downside is that you can never guess how the child will react to the operation, because he is faced with this for the first time. Having a calm nature, the baby can still panic.

How is the excision of enlarged organs performed? The overgrown tissue is frozen with Lidocaine or Ultracaine. There will be practically no pain, but, as mentioned above, there is a risk that the child will not be able to withstand the test from a psychological point of view.

Benefits and possible risks of general anesthesia

It's hard to believe, but before such operations were performed without anesthesia at all. Now, of course, doctors advise parents to have general (endotracheal) anesthesia. In Europe, it has been used for a very long time for a number of reasons:

this will ease the psychological burden on the little patient;
will provide the doctor the necessary conditions for a proper operation.

Sudden complications and associated risks undoubtedly exist. This issue should be discussed in advance with the anesthetist, who will advise you based on your specific situation and individual circumstances. You need to understand that there is always some risk involved.

Removal Methods

How are adenoids removed in children? The generally accepted method of removal - adenotomy - is not the only option. Today, there is a large selection of removal methods. People are operated on using a microdebrider, a radio wave method, laser adenotomy is used ... Let's consider the methods for removing adenoids in more detail.

Classical removal without the use of anesthetics

With the classic version of tissue excision, the removal takes place quite quickly. Parents often ask how long the procedure takes. The entire removal process takes no more than ten minutes. The child is escorted to the office, he sits down or lies down on a pre-prepared place (sometimes standing).

children younger age a sedative is injected and an anesthetic is sprayed into the nose. Then a curved object is inserted into the oral cavity - an adenoid. The knife is pushed towards soft palate and cut off unnecessary fabric. Bleeding after these manipulations is insignificant. The child is taken to the ward so that he can lie down and move away from the effects of the drugs.

The advantage of the method is the quick action of the doctor and the ability of a small patient to immediately return to an “active” life. Minus - the doctor does not see the oral cavity completely and can do something wrong.

Endoscopic removal

Endoscopic adenoid removal procedure

Endoscopic removal is used if the tissue re-grows after removal. A special camera is inserted into the mouth, which broadcasts the picture on the monitor screen, and the doctor sees the full picture. Surgery in children is usually performed under general anesthesia. Endoscopic removal prevents the possibility of recurrence.

Laser adenotomy

Today, laser adenotomy is a popular and effective method of removal. The method of removing tissue with a laser almost completely eliminates the risk of bleeding, because not a scalpel is used, but a laser beam.

Coagulation (fixed beam) is selected with a large volume of tissues, and vaporization (layer-by-layer removal of adenoids) - with a small volume. Laser surgery does not cause pain, does not require hospitalization, the tissue recovers quickly after the process. The risk of complications is low.

Shaver adenotomy (cutting)

To cut tissue, the doctor inserts a curved scalpel or shaver through the nasal passages. After the operation, turundas are inserted. The advantages of this method: the doctor observes the excised tissue, bleeding is minimal or non-existent, and complications are rare. This is the “classic” version of getting rid of adenoids.

radio wave method

In this case, the operation is performed using the Surgitron apparatus. It has a special attachment (radio wave adenome). The adenoid is cut off in one motion, while the vessels are cauterized so that there is no bleeding. This is a modern, technically advanced method. The recovery period after such an operation is very short.

Complications after surgery and recovery

The most common complication after excision of adenoids is bleeding. As a rule, it is observed within a few hours after the last operation. If blood enters the auditory tube, then there is a risk of otitis media. The possibility of the appearance of consequences depends on the professionalism and attentiveness of the doctor.

In rare cases, the patient's body temperature rises, but it does not last long. Among other things, re-growth of adenoid vegetations may occur, but this can be avoided if you treat the choice of anesthesia and the method of removal responsibly.

The postoperative period in children usually proceeds without discomfort. There may be breathing problems due to swelling, but these can be corrected by using nasal drops.

Contraindications for removal of adenoids

Surgery to remove adenoids is not available to everyone. It is contraindicated in tuberculosis, severe infectious inflammation, decompensated form of diabetes mellitus. It is also forbidden to carry it out to patients with diseases of the cardiovascular system and with such an ailment as low blood clotting. The age of the patient can become a hindrance: up to three years, surgical intervention is undesirable. And finally, the operation is not carried out within the first month after any vaccination.

It so happened that both of my offspring suffered from adenoiditis. And this was not the worst, since the growth of the nasopharyngeal tonsil causes a bunch of problems: from the most harmless permanent rhinitis to chronic otitis media and a change in facial contours

With the face, fortunately, everything remained in order, but otitis was visited almost every month - ten times in the year preceding the operation.

First, I’ll tell you a little about an older child who underwent surgery under local anesthesia in 2013 in Moscow.

The age at which the execution was carried out was only 2 years and 11 months. And even at such a young age, doctors insisted on local anesthesia, arguing that with a general huge pressure on the heart and brain, and the consequences after general anesthesia will be worse than from local anesthesia.

The list of tests collected for the operation was much smaller than for general anesthesia, but still quite impressive + I, as an accompanying person, also needed to provide information on enterobiasis, intestinal protozoosis and current fluorography.

Since 5 years have passed since then and everything has already changed a thousand times, I see no reason to dwell on this in detail. A detailed list of current analyzes and all the nuances can be found below in the text.

★★★ Adenotomy under local anesthesia★★★

we arrived on the morning of the operation, eating and drinking was strictly forbidden!

Since my daughter was the smallest in the ward, she was the first to be taken for the operation. I was only allowed to walk her to the operating room, and they closed the door in front of my nose. Even though it's been 5 years, I still remember that day. I rushed down the corridor, listened to the sounds coming from the operating room, twisted myself and reproached for allowing me to create with my child

All this did not last long, and after about half an hour the surgeon brought his daughter to the ward in his arms.

She did not sleep, she was conscious, pale and tearful, but since at that moment she still did not really talk and was an obedient child, I lulled her, calmed her down, and she fell asleep.

What happened during the operation:

just before the adenotomy, she was given an intramuscular injection of a sedative, after which she was supposed to sleep. And after waking up, you can't remember anything. Then they popped her in the throat with an anesthetic and removed the adenoids with a hook-shaped adenotomy.

The daughter slept for a long time, about three hours, it was necessary to lie on her side so that the ichor from the nose and mouth could freely drain onto a clean diaper or towel. Of course, she did not breathe through her nose, occasionally snoring. After waking up, she did not remember anything, her mood was good, the temperature did not rise. In the evening, she was already allowed to drink kefir, only not through a straw, but from a cup. Before going to bed, I remember that she played ball with other children, although this was strictly forbidden by the rules, because. Physical exertion must be avoided the risk of bleeding is very high in the first few days after surgery.

Something went wrong with an older boy, who was in the same room with us, and he was brought in right after the operation in hysterics, i.e. he was not sedated or something, and he could not calm down and fall asleep, he cried and howled directly for several hours in a row, and the next morning from a conversation with his father it became clear that nothing had been erased from his memory.

As for us, my daughter and I received instructions and were discharged immediately after breakfast.

However, when I got home, I noticed that My daughter has a nervous tic: the eyelids began to blink intensively at intervals of several minutes. My husband and I sounded the alarm, deciding that all these shocks had affected her in this way, and that it could no longer be cured, but a few days later - at home, walking on fresh air and good nutrition, everything, thank God, returned to normal.

Breathing was noisy for the first few days, but on the very first night at home on her side, she was already breathing through her nose, moments so quietly that I even checked if she was breathing at all, because over the previous year she was so used to a small horse snoring nearby

From the treatment, we were prescribed to spray Nasonex in the nose to prevent the development of a relapse. We did not take any antibiotics!

Our results:

before adenotomy, the child was constantly ill, everything started with an incurable runny nose and ended with conjunctivitis, and always otitis media. When it came to the development of hearing loss, we did not wait and signed up for an operation. By the way, very quickly and without delay. In September, they signed up, and in early November they already had surgery. General anesthesia was only offered to those with neurological or cardiological problems. We did not even consider this option, and, despite the nervous tick, I never regretted my decision. After adenotomy, otitis was only once, six months after the operation, and I was already worried that this was a relapse, but no. Of course my daughter was sick. colds, common childhood illnesses, but rhinitis after 7-10 days easily passed by itself or with little treatment, whereas earlier shock doses of hormones, antibiotics, vasoconstrictors, etc. were used. Bronchitis did not start, i.e. the situation stabilized and I was very pleased that we decided and did it!

★★★Endoscopic adenotomy under general anesthesia★★★

The same fate did not escape my youngest child, whom we operated on at 3 years and 1 month. What to do - bad heredity in this regard: my husband also had adenoids removed in the Morozov hospital about thirty years ago)))

When my son began to have endless rhinitis, which coincided with a visit to the nursery, at first I was not very worried. However, when snoring, and then otitis, joined this, it became clear that the operation could not be avoided. The situation was complicated by the fact that he has an intolerance to many antibiotics, and feeding him with zinnat every 3-4 weeks was so-so, because one day resistance would develop to it, and we would simply “disappear” without proper treatment.

In general, the decision was made under the pressure of our ENT doctor, who treated the elder one as well, and we were issued a referral for hospitalization without delay.

However, a lot has changed in Moscow over the past 5 years - now without proper evidence from a neurologist or cardiologist removal of adenoids under local anesthesia has become almost impossible!!!

Everything has been turned upside down!

Such babies are operated on only under general anesthesia, older children, i.e. 6-7 years old, local anesthesia is possible, but only according to indications (convulsions or allergies or something else out of the ordinary).

Doctors justify this by saying that:

for 5 years, drugs for anesthesia have become better, and there are fewer side effects from them than from the psychological stress that a child experiences while being conscious during an operation.
In addition, it is generally accepted that during adenotomy under general anesthesia, the operation is less traumatic due to endoscopic access, and the risks of recurrence are significantly reduced.
After the surgical field is cauterized, which minimizes the risk of postoperative bleeding

It was even more difficult for me to decide on general anesthesia than on the operation itself. I studied all the children's hospitals in Moscow, but everywhere the situation was approximately the same, so it was decided to operate closer to home in the same place as the eldest daughter - in the Morozov hospital.

The appointment was by e-mail for 3 months (and this is very good, because, according to rumors, the queue for surgery under general anesthesia usually stretches for six months). Perhaps the fact that it was the beginning of summer played into the hands, and in the summer children get sick less often, many try not to have surgery in the hot season, and often parents hope that the sea and the sun will do their job and "melt by themselves." We did not resolve anything, and in the summer my son suffered from a runny nose just as he did in other seasons. Moreover, he managed to fall ill 3 weeks before the operation, however, the ENT assured us that if there is no temperature and no viral nature, then it’s not scary. Just Eustachitis...

However, the disease did not pass without a trace, because. many tests were out of range. And I had to pass a LOT of tests.

From "heavy artillery":

blood donation from a vein (this cannot be avoided, unfortunately)
two x-rays - one confirming the presence of adenoiditis, the second - with a chest x-ray Unfortunately, no one in the hospital is interested in BCG and the Mantoux reaction ...

for older children also a stick, if I'm not mistaken.

From "new" for the maintainer - two measles shots or a blood test for measles antibody tritre (in Moscow, such a pleasure is relatively inexpensive - a few thousand, but it takes almost a week).

In general, to chop off the tonsils of your child under general anesthesia you have to try really hard...

All analyzes have their own expiration dates (indicated in the list in the photo above).

But at the same time it is necessary to lay some more time for unforeseen circumstances!

So, my child was diagnosed with an enlarged heart during an X-ray.

To confirm or refute it, it was necessary to sign up for an ultrasound of the heart and, with the conclusion, get a consultation with a cardiologist. And this is not fast, because. summer is in the yard and everyone is on vacation.

Fortunately, everything turned out to be normal, but it took us a week, not to mention the fact that a few gray hairs were added to my long-suffering head.

Preoperative preparation is carried out 7 days before the operation:
Oral antihistamine (for example: zyrtec, claritin, erius) at an age-specific dosage
Dicynon ½-1 t 3 times a day, Askorutin ½-1 tab 3 times a day orally (depending on the age of the child)
Solution processing antimicrobials nasal cavity (for example: miramistin, polydex with phenylephrine) and throat (for example: miramistin, tantumverde) 3 times a day

I bought everything, but we didn’t use anything, because the child had just been ill, drank a course of zinnat, and I was afraid that the child had taken too much medication.

Preoperative preparation:

A week before the operation, I had to bring all the tests to the hospital for verification, and here my son's illness made itself felt - hemoglobin and platelets dropped to critical lows. And platelets are responsible for blood clotting, and it is impossible to operate with such indicators, because. the risk of bleeding increases exponentially!!!

The doctor's verdict is to retake blood, and come to the hospital with fresh tests, and they are already on the spot to decide whether to take their son for surgery or not.

For several days we convulsively ate beef and drank maltofer, although it is clear that blood counts do not recover so quickly, on the eve of the operation, we re-donated blood in vitro and! O MIRACLE! Platelets grew and became within the normal range!!!

Exhaled and went to be operated

Day of hospitalization

It should be noted that not only the approach to the operation has changed over 5 years, but also the conditions! In the truest sense of the word, I didn’t recognize the Morozov hospital, they built such a building with double wards and a playroom for children that you will feel overwhelmed.

But, as you know, it is not the walls that are important - the doctors are important ... But the doctors remained the same. According to the preliminary appointment, the same doctor who did the daughter's adenotomy was supposed to operate. But right before the operation, everything, fortunately, changed, and a completely different surgeon performed the operation.

By 8 am it was necessary to arrive strictly on an empty stomach, nothing to drink. There shouldn't have been poppy dew in the mouth either!!!

An older girl, 4-5 years old, was lying with us in the ward, but she was the first to be taken for the operation.

We had to sit until almost 12 o'clock. Without food and without water. Although it was the end of August, the heat in Moscow was terrible, so it was a difficult test to convince a three-year-old child that he did not want to drink ...

About 20-30 minutes before the operation, the anesthesiologist came up and forced me to sign a form stating that I was warned about the consequences of general anesthesia and relieve the doctors of all responsibility for possible complications. Anesthesia was mask, drug sevoran.

While the operation was going on, I googled what kind of anesthesia it was - it is widespread, and under it children of the youngest age are treated for teeth. Basically, the reviews were good - everyone easily moved away from him and did not complain about anything.

The operation lasted 30 minutes, the son was brought asleep and in no case was allowed to wake him up. By the way, they operated right in the same clothes in which we arrived - street clothes. It was a bit surprising and annoying. Well, there, the operating room, sterility?! ..

Blood came out of his nose for about an hour and a half, and, of course, he could not breathe through his nose. snored

A catheter was placed in the pen - this is one of the main reasons why they are not discharged on the same day - careful medical control is needed behind the catheter so that inflammation does not start. Surprisingly, he quickly got used to him later and never even tried to get rid of his unwanted neighbor.

The operation was performed endoscopically, according to them, through the nose, the postoperative field was then cauterized to minimize the risk of infection, especially since it was summer outside. They didn’t do this to the eldest, they just treated it with antiseptics, but then it was late autumn.

The child slept for a very long time - almost 5 hours, waking up only once in a bad mood, biting a little, and fell asleep again. I was already worried, because after anesthesia I was categorically not allowed to sleep, they tried to wake me up with the whole ward. While I was looking for a doctor, my son woke up, in a wonderful mood, and immediately tried to rush into battle in the playroom.

But, of course, his strength was still not enough, and he was forced to lie down a little more. At 17 o'clock he was allowed to drink kefir. And at 19 o'clock they were already allowed to have a full dinner with rice and sausage healthy food

Life began to improve

There was no temperature, the ichor ceased to stand out even during daytime sleep. The subcervical lymph nodes were slightly swollen, but this is normal after surgery and persisted for several days. The voice was hoarse, of course.

The memo for parents, which weighs in each ward, and another copy of which was given to us along with the extract, reads:

The next morning, right in the ward, the nurse removed the catheter, and they gave us an extract, letting him go home and not even feeding him.

The doctor did not really comment on anything, I did not pay money to anyone, although I prepared a normal amount for him and the anesthesiologist. But in the hospital there was such a flow of patients, as if on an assembly line, that it was not necessary to expect a human approach. Our doctor was like Carlson

he flew away, but promised to return

Elusive, inaccessible and inaccessible ...

In general, we were glad to be at home. I was very surprised to see in the extract that antibiotics should be taken. Especially since we just drank the course 3 weeks ago. But no matter how I tried to avoid this, our local ENT approved the appointment, saying that in any case, bacteria remain in the postoperative zone, which in such a summer heat can give complications up to the development of sepsis. Therefore, it is necessary to drink antibiotics, and the child was prescribed Sumamed for 3 days.

We obediently drank everything, especially since the son continued to snore, i.e. the nose practically did not breathe, although the lymph nodes were gone, and the temperature did not rise. The smell from the mouth disappeared after 6-7 days.

A week later, he returned to the common table, and went to kindergarten.

4 months after surgery:

From the good - there were no more otitis!

From the bad - the son's nose never "breathed"! A couple of times in the fall, when it was still warm, I managed to stop the runny nose with isophra and polydex. But in general, rhinitis now smoothly flows into laryngotracheitis, to which the child has a tendency because of such lousy drugs. On the one hand, this cannot lead to the development of hearing loss, as it would be with otitis media. On the other hand, you still have to use antibiotics, otherwise rhinitis and the subsequent cough run the risk of turning into pneumonia, which, you know, is also not good enough.

We are tightly "sitting" on Nasonex. And I do not rule out that all these problems he has an allergic nature, and in this case, adenotomy is useless and gives only a temporary effect. Adenoids re-grow almost always in the case of an allergic cause.

This can be checked by taking blood from a vein for IgE, but this again needs to expose the child to stress, and in our children's clinic they do not do such an analysis, i.e. you need to look for paid options.

In general, we are waiting for him to grow up. And we hope that we will not have to go through this again - children grow up, outgrow, immunity is strengthened.

True, my own nephew, who will be 7 years old in April, has had a similar problem for 5 years, and she still regularly suffers from otitis media. And her parents are constantly vigilant, whether the child's face shape, which is typical for children with adenoiditis, is changing. But they do not operate, they are waiting for it to outgrow

I am calm in this regard now. Yes, I regularly sit with my son on sick leave, yes - we use this thing harshly, but I know that I did everything I could to remove the focus of infection from his small and still so fragile body.

I do not regret that I performed the operation on my son, but, as experience shows, children are different, and what helped one by 100% may be useless or even harmful for another. The example of our family is very indicative in this regard. Therefore, I still recommend adenotomy if there are unequivocal medical indications for this, but do not expect a miracle, because. fundamental changes may not happen.

★★★★★ Happy New Year everyone and stay safe!!! ★★★★★★★

˙ ● ๑ Your Euphoria ● ˙

Operation to remove adenoids methods. Removal of adenoids in children under local anesthesia

Advantages and disadvantages of removing adenoids in a child

Indications for removal of adenoids in a child

Contraindications to the removal of adenoids in a child

What examinations should be done before removing adenoids in a child

Preparation for removal of adenoids in a child

The procedure for the removal of adenoids in a child

Surgical method

laser removal

Endoscopic

Recovery after removal of adenoids in a child

How long will the result last after removal of adenoids in a child

Possible complications after removal of adenoids in a child

Video about adenotomy

Indications for removal of adenoids

Possible consequences of the operation

Preparing for the operation

Features of anesthesia

Classic adenoid removal surgery

Anesthesia

Endoscopic adenotomy

Does it hurt to remove

The use of physical energy in the treatment of adenoiditis

Adenoid Removal Methods

Postoperative period: what to look for

Is it necessary to remove adenoids?

Indications for surgery

Preparing for the operation and taking tests

The use of anesthesia

Advantages and disadvantages of local anesthesia

Benefits and possible risks of general anesthesia

Removal Methods

Classical removal without the use of anesthetics

Endoscopic removal

Laser adenotomy

Shaver adenotomy (cutting)

radio wave method

Complications after surgery and recovery

Contraindications for removal of adenoids

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