Removal of adenoids in children under the general. Removal of adenoids (adenotomy operation): indications, methods, conduct, postoperative period

The need for surgical removal of adenoids often causes fear and anxiety in parents of babies. Of particular concern is not only the operation itself and its complications, but also the conduct of anesthesia, as well as its possible negative consequences and negative impact on the health of the child.
A lot depends on the composition of anesthesia, including the success of the operation.

When is surgery needed?

Surgical intervention for adenoids (adenotomy) is recommended to be performed as soon as possible.

Immediately after the detection of pathology due to the ineffectiveness of any ointments, medications or drops.

Untimely operation leads to even greater growth of adenoids.

Important! The mistake with the need to perform the intervention of a surgeon is associated with the adoption by parents of pathological formations for a disease such as adenoiditis ().

It is an inflammation of the adenoid tissue of a chronic nature, which is amenable to conservative methods of treatment.

The decision on the need for surgery should be made by the attending otolaryngologist.

The threat of non-removed adenoids

The growth of formations in children can be supplemented by an increase in the tonsils.

In the absence of the necessary operation for adenoids in children, the following problems are possible:

• difficulty and impaired breathing through the nose, which is observed with;
• as a result, predominantly oral breathing, there is an underdevelopment of the upper jaw;
• the face acquires an irregular elongated shape;
• there is unevenness of the teeth;
• sleep is disturbed and night snoring is noted;
• pathology leads to oxygen starvation;
• the risk of developing otitis media increases (it is written about the treatment of tubo-otitis);
• hearing loss is possible.

Pathology with a long-term effect on the baby's body causes fatigue, frequent headaches and a decrease in educational information, which leads to problems with the baby's well-being and poor performance in a preschool or school.

Benefits of general anesthesia

Many years ago, doctors did not have drugs for pain relief in their arsenal, and when removing adenoids, small patients had to endure pain.

Today, there are two types of anesthesia - local and general, each of which has its own characteristics of use, advantages and disadvantages.

The positive aspects of performing surgical intervention for adenoids using general anesthesia include:

1. getting rid of the baby from pain during the operation, which means reducing the risk of psychological problems after medical interventions. The child falls asleep under the influence of anesthesia and does not observe the manipulations of a specialist, does not see medical instruments and blood, but wakes up when the operation is already completed.
2. the method of anesthesia is safe and has a low risk of complications during surgery.
3. there is a possibility of reduction of terms of surgical intervention. Typically, manipulations last no more than half an hour, removal of adenoids is considered one of the shortest surgical operations.

The advantage of this type of anesthesia is the greatest convenience for both the small patient and the doctor, who during the surgical operation will not be distracted by the reaction of the baby, since under general anesthesia the child will be immobilized for the duration of all medical procedures.

Disadvantages of General Anesthesia

The negative point of the operation under general anesthesia is the risk of complications. But there are negative effects are very rare, up to 1% of cases from all operations to remove adenoids.

The complication of the operation itself can manifest itself in the form after the intervention. The risk of tooth damage, aspiration and infection is virtually nil.

During surgery under general anesthesia, there may be problems maintaining a stable body temperature, which can cause hyperthermia, a problem associated with overheating or hypothermia of the baby's body.

To prevent this complication, the doctor during all manipulations pays special attention to the child's body temperature.

Important! Scientists say that anesthesia has a negative effect on the child's nervous system and the state of brain cells.

After general anesthesia, children may lag behind in development for some time.

When anesthesia is used, hearing and sleep disturbance may occur, immediately after waking up or some time after the operation.

When the baby wakes up after general anesthesia, headaches, hallucinations, problems with hearing and speech can be observed.

Preparing for the operation

To prepare for surgery using general anesthesia, the child is prescribed the following tests:

• general analysis of urine and blood;
• blood coagulation study.

The doctor studies the family history, the child's vaccination schedule, past diseases and prescribes medical therapy for the small patient, aimed at preparing the child for anesthesia.

The specialist must pay attention to the presence of allergies in the child.

To reduce the negative impact on the baby's body, 30 minutes before anesthesia, the doctor injects Promidol or Atropine.

Before the operation, the child is given an enema to cleanse and empty the bladder. On the day of surgery, children are forbidden to eat, and 3-4 hours before anesthesia, you can not drink.

Features and complications

After the onset of general anesthesia, the child's mouth is slightly opened using a special medical instrument. Then the doctor examines the location of the adenoids and removes them using one of the known methods:

• cauterization of formations with the help of diathermy;
• scraping with a curette.

The operation is considered completed when the bleeding from the vessels stops.

For normal air intake during the manipulations of the surgeon through the respiratory tract, an endotracheal tube or a laryngeal mask is used.

In the first case, more reliable protection of the respiratory tract is noted, but the unpleasant consequences of pain relief after waking up with such anesthesia are harder and longer than when using a mask.

The implementation of anesthesia involves the use of inhalation and non-inhalation agents.

Propofol or modern inhalation anesthetics, such as Sevoflurane, Isoflurane, and others, are used to quickly and most painlessly exit the child from anesthesia during surgery.

A child's body perceives general anesthesia differently than an adult. In children's practice, only proven medical products are used, which are safe and have passed multiple clinical trials.

Modern drugs used for general anesthesia are quickly excreted from the child's body and practically do not cause adverse reactions and negative consequences after use.

Children usually recover within two hours, depending on the dose of the anesthetic. After waking up, the anesthesiologist should observe the baby for several hours.

For a sufficiently "small" anesthesia with a shorter period of action.

Waking up after such anesthesia is faster and easier than with high doses of anesthesia, when the risk of an overdose of anesthetics is increased with the possibility of developing hypoxia and negative complications from the cardiovascular and nervous systems.

After 2-4 hours after surgery with general anesthesia, children are allowed to get up and walk, as well as eat.

Contraindications

Any type of anesthesia can cause complications, so it is important to find out if there are any contraindications for the child to undergo anesthesia.

If the baby has chronic diseases, the doctor finds out the stage of the disease. During exacerbation, it is forbidden to perform any surgical interventions using general anesthesia. The operation will have to be postponed until the disease enters the stage of remission.

Other contraindications for surgical intervention under general anesthesia:

• acute infectious diseases;
• severe hypotrophy;
• pronounced rickets;
• respiratory diseases in the acute stage;
• pyoderma;
• hyperemia of unknown origin;
• the period from the moment of vaccination is less than 6 months.

An important condition for a successful operation with general anesthesia is the choice of a clinic with competent, highly qualified experienced specialists who will select the correct dosage of anesthesia in order to reduce the negative impact on the baby's body and eliminate undesirable consequences.

Another condition for a successful operation to remove adenoids under anesthesia is the positive attitude of the smallest patient, the responsibility for which lies mainly with the parents.

General anesthesia when removing adenoids is advisable to use to prevent the occurrence of stress and psychological trauma in a child. A competent specialist will reduce the risk of consequences and complications after anesthesia to zero.

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 of the cavity is the nasopharyngeal tonsil. It is part of the 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.

In a 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, conservative treatment is desirable.
• 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 is required, 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. When 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 is completely excluded.

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 considered to be 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. In a small child, the correct physical development is disturbed, the face acquires characteristic features that will be almost impossible to correct later.

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 be performed before irreversible changes and serious complications appear, it seems, a small problem limited to the pharynx. Untimely treatment and, moreover, its absence can cause disability, so ignoring the pathology is unacceptable.

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

1. Persistent hearing disorder;
2. Chronic otitis;
3. Change 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 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:

1. Age up to two years;
2. Acute infectious pathology (influenza, 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. Less than a month old vaccination;
5. malignant tumors;
6. 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:

1. 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.
2. 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.
3. 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 further presence of the adenoids, in which case surgery is necessary.

Indications for adenotomy:

• complete absence of 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 occur.

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 turns out whether the child has recently been in contact with infectious patients, if this fact is revealed, the 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 of the 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, a high temperature of unknown etiology, without obvious symptoms of a cold, 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. The main danger, which, in a latent form of pathogenesis, is 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 a 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 blocked 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, and 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 fever, 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. The 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, before the operation, a number of laboratory tests are carried out: 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 child is examined by a pediatrician 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 a complete examination of the child. The doctor collects anamnesis, including family history, paying attention to previous and existing diseases, allergies to drugs, etc. Laboratory blood and urine tests are performed 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 drugs are safe, low-toxic, and anesthesia is similar to ordinary 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. To achieve a good level of anesthesia, 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 "exit" 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 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

classic adenotomy

Classical adenotomy is performed using a special instrument - Beckman's adenotomy. The patient, as a rule, sits, and the adenoid is inserted into the oral cavity to the tonsil behind the soft palate, which is raised by the 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. The psychological trauma that can be inflicted on a child cannot be ignored.

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 are 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 desirable to avoid overload and prolonged exposure to the sun, in a bath with hot water, a bath. The throat and neck should not warm up. Half bed rest is recommended.
• Limit contacts to avoid the risk of getting sick.
• Perform 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, it is unacceptable to postpone treatment until adolescence, as there is a high risk of getting a chronic disease 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);
• a failure in the heart rhythm: "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 easier for the child to tolerate, however, in some situations (for example, lability of the nervous system), adenoids can be removed 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 the 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 a high risk of 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 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 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.

1. bath, sauna, hot bath are excluded for the entire recovery period (up to a month);
2. playing sports - not earlier than in a month, while the usual activity remains at the usual level;
3. 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 physician.

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.

Among the complications, one can indicate 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.

Colds and an ever-sniffing nose are peculiar 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 it has grown much, 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 adenoids in children surgically.

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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 from children, how the operation goes, whether it is painful. All these worries are groundless - as a rule, there are no negative consequences 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 more about 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, it is performed on an outpatient basis, but it has one important drawback. It consists in the 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.

With endoscopic equipment

This method is considered to be very effective. Excision of the overgrown tissue in the traditional way, using conventional means, including a mirror for visual control, is not the only way to carry out the procedure.

An endoscope inserted through the nose or mouth gives the doctor the opportunity to clearly see the site of the operation, which contributes to the complete removal of overgrown tissues. As a result, re-growth is extremely rare.

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

Overview of Operation Feedback

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

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

Most adults note a significant improvement in the well-being of the child, the rapid normalization of his condition. After the excision of the tonsils, the children stop snoring in their sleep, the voice becomes more sonorous, and the speech becomes intelligible. Most importantly, children begin to get sick much less often. And even the hearing of children suffering from deafness is restored completely.

In one typical review, a mom detailed her five-year-old daughter's adenoid surgery when the doctor's prescription for conservative treatment failed. The doctor diagnosed the girl with third-degree adenoiditis, her eardrums were deformed, and her hearing deteriorated. The operation was performed under general anesthesia and took about an hour. As a result, nasal breathing was completely restored, hearing improved, the girl became healthy and cheerful.

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

According to parents, the adenotomy procedure is painless, since modern methods of anesthesia are used. Removal of adenoids takes a little time, and complications practically do not occur.

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 a good result. But with a strong growth of tissues, an operation to excise tissues 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 an operation.

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

There are the following indications for the removal of adenoids in children:

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

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

It is not difficult to identify severe adenoiditis, in which the intervention of a surgeon is highly desirable. The question of whether adenoids should be removed 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. So, in many cases, it is simply impossible to doubt 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 adenotomize their own child, protecting him from pain. However, it should be understood that in those distant times, adenotomy was performed without any anesthesia, which caused those very unpleasant sensations. But what about now? Does it hurt to remove adenoids today, or are there painless ways?

In modern clinics, during surgery to remove adenoids, local or general anesthesia is used. The general one is preferable for the child, since the small 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, it is worth asking the doctor how the adenoids are removed, 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 afraid of something - the sight of incomprehensible 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 without anesthesia for the child is not performed, because it is very painful.

Existing methods and methods

There are different ways to remove adenoids in children:

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

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

At what age do they do it?

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;
• with recurrent otitis media and sinusitis;
• with respiratory distress 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, then serious troubles may appear:

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

Knowing at what age to remove adenoids most effectively, you can perform the operation on time and with the highest efficiency. At the same time, the age of a child under three years old is included in the list of contraindications. In general, the question of when it is better to remove adenoids is decided individually on the basis of a detailed examination. Perhaps the operation should be postponed, giving preference to conservative methods of treatment.

Possible consequences

Timely performed adenotomy will completely get rid of serious problems. However, there is a removal of adenoids in children and the consequences are quite unpleasant. Sometimes growths occur again (with 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 the tonsils, the child's body loses its protective barrier to infections, which they, in essence, are. On the other hand, the very overgrown tissue not only does not perform this barrier function, but also greatly worsens the general condition of the patient, 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 fails.

In addition to surgery, there is also a conservative method of treatment, and, if possible, doctors try to avoid surgery. Moreover, it is conservative treatment that is considered a priority. Therefore, parents should first try to use conservative methods of therapy for the growth of pharyngeal tonsils, and only if they do not work, agree to adenotomy.

Sometimes they try to cure adenoiditis with folk remedies or widely advertised drugs. One of them is Tuya 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 beautiful deception, but contact a specialist.

Useful video

Useful tips for parents on removing adenoids, see this video:

findings

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 removing adenoids surgically. They do not give relapses, the health of the baby is restored completely.

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A considerable number of parents have to deal with adenoid growth in a child. Removal of adenoids in children is of concern, since any operation at this age is fraught with complications, but in some cases there is no other way out.

There are 6 tonsils in the oral cavity and nasopharynx, each of which performs a protective function, preventing infectious agents from entering the body. Frequent colds can lead to a decrease in this function and the simultaneous growth of the tonsil. Adenoids are the growth of a single tonsil located in the nasopharynx.

It is not possible to recognize this pathology without the use of special mirrors, but it has specific manifestations, due to which it is difficult not to notice the disease.

Symptoms of the disease

To identify the growth of the pharyngeal tonsil, it is enough to pay attention to the health of the child.

The main symptoms include the following:

1. Voice change. The child begins to nasalize, the voice becomes unhealthy.
2. Nasal congestion. Due to the enlargement of the tonsil, the air flow is slowed down, it becomes difficult for the child to breathe through the nose.
3. Runny nose. One of the complications leading to rhinitis and sinusitis.
4. Hearing loss. Growing, lymphoid tissue can partially overlap the auditory tube, causing signs of otitis media.
5. Sleep disorders. The child sleeps badly and anxiously, in the morning it becomes unusually capricious and irritated. There may be attacks of suffocation and snoring caused by the retraction of the root of the tongue.
6. chronic hypoxia. The child himself may not recognize this symptom, but from the outside, a constant lack of oxygen will be visible, leading to problems with appetite and sometimes to anemia.
7. Face change. If the pathological process proceeds for a long time, there may be a violation in the development of the bone tissue of the face, the bite changes. If treatment is started on time, then these changes are reversible, but in advanced cases, the consequences remain for life.
8. Adenoiditis. If the body is exposed to infection during tissue growth, adenoiditis may develop. The body temperature rises, the lymph nodes increase in size.

Adenoid Removal Methods

The need for surgical intervention depends on the degree of neglect of the disease and individual indicators, which can be assessed by a specialist. If the problem is noticed in time, then it is possible to prescribe conservative treatment by using medications.

Medically

If the adenoids cover only a small part of the vomer and the child's breathing is only slightly obstructed, conservative treatment is often sufficient. On the recommendation of a doctor, immunomodulators are taken, rinsing and gargling with saline solutions. If these measures are not enough, antibiotics (cephalosporins, macrolides) are prescribed.

In parallel with taking medicines, rinsing with sea water, solutions of soda or Furacilin is carried out.

Surgically

If the disease has a second or third degree of severity, they resort to surgical intervention. Method options will be discussed below, the choice depends on the degree of the disease, the chosen clinic and the individual situation.

Folk methods

The best of the traditional ways to deal with adenoids in the early stages of the disease is washing with saline solutions, which are easy to prepare yourself. For 1 glass of warm boiled water, 1 tsp is taken. table salt or 0.5 tsp. sea ​​salt. The solution is thoroughly mixed so that the salt crystals do not damage the mucous membrane of the throat. For washing, you can use an aspirator, pipette or syringe.

Another proven method is to instill freshly squeezed aloe or Kalanchoe juice into the nose. For ease of use, you can moisten cotton turundas in juice and inject them for 10-15 minutes into the nasal passages.

When is surgery indicated?

The need for surgery depends on the degree of the disease, so it is important to identify the pathology in time. Immediately after detecting the growth of adenoids, it is imperative to consult a doctor who can say for sure whether they need to be removed and at what age this or that method can be used. Perhaps the specialist will recommend laser intervention, in which the child will not be hurt, and the likelihood of recurrence of the disease will be low.

If we are talking about the second degree of the disease (adenoids cover 2/3 of the vomer), then the decision on the need for surgical intervention is made depending on the patient's condition. With, since they close the opener almost completely and do not allow the child to breathe normally through the nose. In this case, he constantly breathes through his mouth, which is easy to see by drying and cracking lips.

Important! If growths are found, it is imperative to consult a doctor as soon as possible and find out whether they need to be removed.

If parents are concerned about the age at which such an operation can be performed and whether it hurts, then a specialist will help to deal with this. Now such an operation is performed on the smallest children, including using modern laser equipment.

It is important to clarify how adenoids are removed in the chosen clinic, since the classical method of intervention is considered outdated today. With a runny nose, the nasal passages are pre-washed so that the procedure takes place with minimal discomfort for the child.

Preparing for the operation

Before the operation, a complete examination is performed, including a pediatrician's examination, blood and urine tests, a coagulogram and an ECG. On the eve of the operation, you should refuse to eat from 6 pm, you can’t even drink water in the morning.

There are 3 absolute contraindications for surgery:

• anomalies of the vessels of the pharynx;
• oncological disease;
• blood clotting disorders.

The operation is not carried out within one month after vaccination and during acute infectious diseases, regardless of whether the disease occurred in summer or winter. How long the operation lasts depends on the type of anesthesia chosen.

The type of anesthesia depends not only on the individual picture of the disease, but also on the age of the patient. The operation under general anesthesia is performed in children under the age of 7 years. Modern drugs of high safety class are non-toxic and do not cause complications even in childhood.

The type of general anesthesia is endotracheal anesthesia, in which an endotracheal tube is inserted, providing safe and full access to the adenoids. The main disadvantage of this method is that after anesthesia the child comes to his senses longer and feels a little worse.

The operation under local anesthesia is performed in children older than 7 years. An anesthetic solution is sprayed into the nasopharynx, a sedative drug is injected intramuscularly, and a weak concentration anesthetic solution is injected directly into the adenoid tissue. During the operation, the child is conscious, so the procedure is faster.

Methods for surgical removal of adenoids

In total, there are 5 ways to remove adenoids:

1. Classical surgical method. Adenoids are removed with a scalpel using local or general anesthesia. Now such pruning is rarely used, as it is one of the most traumatic and painful.
2. radio wave method. In this case, a special device is used that acts on the adenoids with radio waves and excised inflamed growths with minimal risk of blood loss.
3. Laser therapy. This method is one of the most modern and effective, so it is preferred by many clinics. In this case, the scalpel is replaced by a laser beam, and the operation takes place as gently as possible, without injuring the child's psyche.
4. Endoscopy. Removal of adenoids by endoscopy or adenoidectomy with a shaver is the safest and most reliable. This operation is performed under general anesthesia with minimal blood loss. Often the method is combined with laser therapy and radio wave treatment. This combination allows for the most thorough treatment of the operated area, which practically excludes the possibility of recurrence.
5. cold plasma method. It is considered the most progressive way to deal with adenoids. Their removal is performed by cauterization with cold plasma, the procedure is almost painless, and it takes no more than 10 minutes.

Classic operation

The traditional method of cutting out the adenoids is a short operation in which the adenoids are removed using a special scalpel, which does not take more than 2-5 minutes. Its main disadvantage is that the doctor does not see the treated area, so he may accidentally damage healthy tissues or not completely remove the overgrown adenoids, which will lead to a relapse.

The cold plasma removal method has been used in Russia for a little over 15 years. When performed correctly, it does not cause complications and blood loss, it allows you to remove even adenoids ingrown into the nose area. When choosing this method of intervention, you should carefully consider the professionalism of the doctor, as inept actions can lead to damage to healthy tissues and complications.

Endoscopic adenomectomy

Endoscopic equipment helps to avoid medical errors, which are most likely in the classical excision of adenoids. The endoscope is inserted into the nasal passage and allows you to control the operation.

Using a laser

Perhaps, in a modern clinic, experts will recommend a laser. In this case, local anesthesia can be used. Laser burning of adenoids gives excellent results and minimal complications. In addition, this technique has been used for quite a long time, in contrast to cold plasma burning.

In most cases, the use of a radio wave apparatus not only does not give complications, but also avoids relapse. The operation is completely bloodless, so that the child experiences minimal discomfort after it.

Child care in the postoperative period

Regardless of which method was chosen, special care is required for the child in the first days after the operation. Parents must:

• apply the drops prescribed by the doctor in a timely manner;
• monitor the moderation of physical activity of the child;
• regularly ventilate and humidify the air in the room;
• give the child vitamin and mineral supplements to strengthen immunity;
• prevent possible overheating or hypothermia;
• monitor the implementation of breathing exercises.

Recovery after a classic operation may take longer due to possible blood loss, but after a few days the child can go to kindergarten. If a bloodless operation was chosen and no complications arose in its implementation, then the very next day you can walk in the fresh air.

Special breathing exercises help to speed up the restoration of normal nasal breathing. It is started 10-12 days after the operation.

Diet after surgery

After the operation, it is recommended to avoid salty, fatty, spicy foods, giving preference to dietary products. The best diet in the first days after the operation is puree soups, soft cereals, steamed meatballs, low-fat vegetable and meat soups, baked apples, bananas.

Any hard, dry foods that can injure the pharyngeal mucosa that has not fully healed are contraindicated. It is recommended to refuse sweet carbonated drinks, all types of confectionery and any products with a large number of flavors and dyes.

The first meal is allowed 4-5 hours after the operation. The child should eat well, drink enough water and non-acidic fruit juices. The food should not be too hot, but not cold either. After eating, it is recommended to gargle with a decoction of sage, oak bark or chamomile. This is done to remove food debris and prevent inflammation.

If during the first two days after the procedure the child refuses good nutrition due to sore throat, you can offer him chicken broth, soft cottage cheese, yogurt, fruit puree. The question remains whether it is possible to give a child ice cream after such an operation, which can relieve swelling, doctors from different countries have not come to a consensus.

Contraindications and what is dangerous surgical intervention

There are a number of contraindications to the removal of adenoids:

• age less than 2 years;
• oncological pathologies;
• blood diseases;
• acute course of allergy;
• any acute disease.

After the operation, the following problems are possible:

• increase in body temperature;
• pain in the abdomen;
• bad breath after removal of adenoids;
• dizziness;
• vomiting with blood;
• hematomas.

The most common complication is bleeding, which occurs in about 1% of cases and is not critical. If the appearance of fibrin plaque after removal of the adenoids is normal, then an unpleasant odor may indicate the presence of an inflammatory process, tissue decay or decay. In most cases, this situation does not pose a threat to health, but you should definitely consult a doctor with it.

Prevention of relapse prevention

If during the operation the adenoid tissue was not completely removed (which is possible with the traditional approach and rarely occurs with laser reduction and other modern methods), then there is a risk of recurrence of the disease. Adenoids can grow back after removal, and most often this occurs in children under the age of 3 years.

The main actions of parents aimed at preventing recurrence of the disease are reduced to the correct organization of the child's lifestyle. Thanks to this, it is possible to achieve the normal functioning of the immune system. These are full-fledged physical activity, feeding in accordance with appetite, hardening, limiting contact with household chemicals and dust.

With reduced immunity, general strengthening supplements are prescribed that are safe for the health and development of the child. The implementation of the doctor's recommendations in the postoperative period is mandatory, even if the procedure went without complications.

Adenoids - this problem is often faced by parents of children of preschool and primary school age. Exhausted by constant nasal congestion and frequent colds of the child, sooner or later they face a dilemma: “To remove the adenoids or not?” On the one hand, the overgrown adenoid vegetations give the child a lot of unpleasant symptoms, on the other hand, after the age of ten, the adenoid tissue begins to atrophy. So how to be? Let's figure it out!

Despite the fact that the word "adenoids" is used in the plural, this name hides one single nasopharyngeal tonsil. There are several more tonsils in the human pharynx, which together form a lymphoid ring. This ring performs an important function - it controls that pathogens do not enter the body through the mouth or nose. In the process of a child's growth, the main protective function falls precisely on the nasopharyngeal tonsil, and only from the age of seven to ten does it transfer the reins of government to the tonsils, and itself begins to decrease. Therefore, many parents look forward to this age, in the hope that their son or daughter will simply outgrow this condition.

How do adenoid vegetations work? The nasopharyngeal tonsil is part of the human immune system. As soon as viruses and bacteria enter the surface of the tonsil, its tissue increases in size. After the destruction of the enemy, the tissues of the tonsils return to their original size. This is the perfect picture. In fact, the body in childhood is very often attacked by pathogenic microorganisms, and the pharyngeal tonsil simply does not have time to return to its original size. In this case, hypertrophy (enlargement) of the pharyngeal tonsil is diagnosed, and the child begins to show the following signs of the disease:

• the appearance of nasal congestion;
• the baby practically stops breathing through the nose and breathes through the mouth;
• he starts snoring in his sleep;
• the voice becomes raspy.

Degrees of growth of adenoids

When does the question arise about the need for surgical intervention? Before radically solving the problem, you need to determine its scope. For this, the diagnosis of the disease in the child is carried out.

The most informative and modern way to examine adenoid vegetations is a video endoscopy.

The ENT doctor examines the nose and throat of the baby using a thin tube with a flashlight at the end and a video camera that displays everything seen by the endoscope on the monitor. Such a study helps to determine the degree of growth of adenoid vegetations and to understand whether conservative treatment can be dispensed with without surgery, or surgery is necessary.

Modern otorhinolaryngology distinguishes three stages of growth of adenoid vegetations. In the first stage, the symptoms practically do not manifest themselves. The child periodically snores at night and only during sleep experiences difficulties with nasal breathing. In this case, vegetations grow on one third of the lumen of the nasopharynx.

Adenoid vegetations in themselves are not dangerous. The complications provoked by them are dangerous.

At the second stage, they cover half of the lumen of the nasopharynx. At the same time, difficulty in breathing through the nose is already observed during the day. During sleep, the baby snores with slight pauses in breathing during sleep. At this time, parents begin to notice that something is wrong with the child: he does not get enough sleep, is irritable, naughty, complains of headaches, nasally, often asks again. Most often, it is at this time that parents turn to an otorhinolaryngologist to diagnose the disease and treat adenoids.

Vegetations of the third degree completely block the nasopharynx: it is simply impossible for air to pass through the nose, and the patient breathes only through the mouth. A constantly open mouth should alert parents in the first place. Facial features take on a characteristic "adenoid" appearance: an emotionless, detached expression, the mouth is slightly open, the face is elongated with the jaw pushed forward. The inability to breathe through the nose not only changes facial features, but also causes brain hypoxia. Schoolchildren begin to lag behind in their studies, quickly get tired. There is hearing loss.

Friends! Timely and proper treatment will ensure you a speedy recovery!

How to understand that an operation is needed?

Overgrown vegetation should be removed strictly if there are certain indications:

• persistent hearing loss - this problem not only creates discomfort when communicating with other people, since the child constantly has to ask again, but also creates a serious danger to life, since the baby may simply not hear the noise of an approaching car;
• the formation of an adenoid type of face, when the structure of the facial skeleton changes due to the lack of nasal breathing;
• the development of chronic diseases - stagnation of mucous masses in the nasopharynx is a constant focus of inflammation in the body, the infection passes to healthy tissues, triggering an inflammatory process in them;
• sleep apnea - a condition in which a person's breathing stops for a while while sleeping, which is a real threat to life;
• frequent inflammation of adenoid vegetations - adenoiditis (more than four times a year);
• fatigue, a constant feeling of fatigue, lack of sleep - being in this state affects not only school performance, but also the psycho-emotional state of the patient.

The operation to remove the vegetation is not urgent: the parents have enough time to weigh the pros and cons, as well as to carry out conservative treatment.

Operation

Surgical removal of adenoids in the nose of a child is called adenotomy. The operation is not a complex intervention and does not require special training. Remove adenoids usually no longer than twenty minutes under endoscopic control. It can be done on an outpatient basis. As anesthesia, local or general anesthesia is used: it all depends on the age of the patient and his psycho-emotional state. Adenoids are literally cut off with a single movement of the hand using a special knife - an adenoid. Immediately after removal, the child begins to breathe through the nose. True, after a while, nasal congestion temporarily returns - it is associated with the appearance of postoperative edema.

Treatment of adenoids without surgery

Treatment without surgery lends itself well to growths of the first and second degree. But in the practice of our ENT clinic, there were many cases when vegetation of the third degree could be reduced to the second. Therefore, before removing the adenoids, it is worth being treated conservatively.

In this case, the treatment regimen may include:

• antibacterial agents;
• nose drops ("Polydex", "Isofra");
• vasoconstrictor drops;
• solutions for washing the nasal cavity ("Aquamaris", "Akvalor");
• physiotherapeutic procedures (infrared laser therapy, ultraviolet irradiation, vibroacoustic effect, photodynamic therapy);
• the use of folk remedies (in agreement with the ENT doctor).

If you are faced with the acute issue of the growth of adenoid vegetations, come to the "ENT Clinic of Dr. Zaitsev": we treat adenoids without surgery: with high quality and at the best prices in Moscow.