Surgery to remove adenoids in a child. Adenoids in children: symptoms, treatment and reasons for removal

Adenoid vegetations, the diagnosis of which is adenoiditis, are associated with the proliferation of the nasopharyngeal tonsils. In adults, the disease is extremely rare, but in children it is common. Starting from the age of 10, the adenoid tissue begins to atrophy and gradually loses its ability to grow. Is it necessary to remove your child’s adenoids, when is the best time to do it, and is it worth deciding on surgery at all? All caring parents are looking for answers to these questions.

The importance of adenoids for the body

Adenoids are part of the immune system; they provide the baby with protection from bacteria and viruses. Until the immune system is fully formed, and this is approximately until the age of 5, the body needs tonsils. By deciding to remove vegetation, the parent will deprive the child of natural protection and allow microbes to periodically undermine the child’s health. Moms and dads of children who had to undergo surgery know that even after it, the baby still sometimes suffers from colds and infectious diseases.

It turns out that before the removal of vegetations, the cause of frequent illnesses lay in the favorable environment created in the nasal cavity. After surgery, the culprit is a weakened immune system, which allows bacteria and viruses to enter the body unhindered. Therefore, parents must approach the decision to remove adenoids or not responsibly.

Adenotomy: indications for tonsil removal

Absolute indications that you need to urgently get rid of tonsils are the following deviations:

1. the child experiences persistent hearing loss;
2. improper development of the jaw area of ​​the face;
3. short-term pauses in breathing during sleep (adenoids 2 – 3 degrees);
4. 24-hour nasal breathing disturbance (at the 3rd stage of adenoiditis).

Is it worth sending children for surgery to remove adenoids if they often suffer from otitis, sinusitis, and sinusitis? These diseases, as well as nasal speech with halitosis, constitute the number of relative indications for excision of vegetations.

But Komarovsky’s opinion

Here are a few contraindications that prohibit cutting out adenoids:

• severe course of diseases of the cardiovascular system;
• abnormalities of the circulatory system with bleeding and clotting disorders;
• the child’s presence in the stage of any acute disease;
• relapse of chronic pathology and weakness of the body as its consequence.

Arguments in favor of adenotomy

Despite the fact that adenoids cease to cause discomfort to a child by adolescence, otolaryngologists put forward a number of compelling arguments for their excision.

1. Inflamed tonsils create an area for the activity of pathogenic microorganisms. They disrupt the outflow of mucous contents from the nose, which naturally rids the organ of foreign “residents”. Once in the nose, any infection becomes more active and provokes the development of diseases. Taking chronic forms, they affect the lower respiratory tract.
2. Constant ear congestion should convince parents that their child needs surgery. Poor hearing creates learning problems and impairs quality of life.
3. Oxygen starvation of the brain is also an argument in favor of excision of adenoid tissue in children. Impaired nasal breathing creates a deficiency of oxygen (the baby does not receive about 20% of this vital substance).
4. Distortion of the facial skeleton leaves a specific imprint on the child’s face.
5. Constantly swollen nasal mucosa forces children to nasal and gasp for air.

Refusal of surgical intervention in favor of conservative measures may delay treatment for years. As a result, the use of medications and general improvement of the body may be ineffective.

Do tonsils grow again?

By excising the adenoids in children, parents give them a good chance of getting rid of the disease. However, in some cases, adenoid tissue growth occurs soon after surgery. It is facilitated by the child’s early age, allergies, and genetic predisposition to adenoiditis. Re-growth of tonsils also happens due to poor quality of surgery, when a piece of inflamed tissue remains in the nasopharynx. Experienced ENT doctors cut out the adenoids “under the spine” - this approach helps to avoid relapses.

If the operation is performed on a child before one year of age, there is a high probability of regrowth of the tonsils. If the condition of the baby allows, the vegetation may not be removed for up to 3 years. As for the seasonality of the operation, it will have to be postponed during a flu epidemic or massive surges of ARVI. At the time of excision of the hypertrophied tonsil, the baby must be completely healthy. It is better to remove vegetation in the summer.

Adenoids are inflamed tonsils that significantly increase in size and make it difficult for a person to breathe. At the age of 3 to 6 years, they actively grow, and doctors advise removal of adenoids in children precisely in this age interval. Now let's talk in more detail about how adenoids are removed in children and when is the best time to do it.

Indications for removal

In medicine, adenoids are divided into 3 main degrees:

• in the first degree, the adenoids are slightly enlarged, as a result of which the child has difficulty breathing at night. He may snore while sleeping. Parents rarely pay attention to first-degree adenoids;
• adenoids of the second degree of inflammation can be diagnosed when a child consistently snores at night and even during the day cannot breathe normally through the nose;
• third degree adenoids are the most dangerous. According to Dr. Evgeniy Komarovsky, they cover the nasopharynx by 90% or completely. When the adenoids reach the third degree, the child can only breathe through his mouth, snores heavily during sleep, and also begins to speak nasally. Adenoids of the second and third degrees, at night, can cause severe suffocation.

Unfortunately, parents do not attach much importance to first-degree adenoids, which often leads to a deterioration in the general condition, as Dr. Evgeniy Komarovsky says. In the second and third degrees, frequent colds are observed, when the nasopharynx is blocked, mucus with harmful bacteria enters the larynx, thereby provoking inflammatory processes in the respiratory tract. Adenoids in the nose inhibit the development of speech in children; they have a nasal sound and slur their words.

The child gets tired quickly, weakens, and wants to sleep all the time. Even first-degree adenoids can cause hearing impairment in children. Therefore, when you notice at least one of these symptoms, you need to show your child to an ENT doctor. Dr. Komarovsky advises removing adenoids in children only if there are significant indications, which depend on the degree of enlargement. Here are the main indications for surgery in children aged 3 to 6 years:

• the child breathes poorly or cannot breathe through his nose at all;
• hearing impairment;
• unstable sleep, he often wakes up;
• night snoring, which is not typical for children 3-7 years old;
• children often suffer from otitis media, sinusitis, and ARVI;
• Rarely, children over 5 years old experience facial deformation.

Indications for the operation are prescribed by the ENT doctor and then by the surgeon. Only after this do parents give their permission. Surgeons often advise parents to remove adenoids at the age of 5-7 years, regardless of their degree. Evgeny Komarovsky, in turn, says that it is better not to rush into the operation. Radical ways to eliminate adenoids are a last resort.

When conservative treatment methods have failed and the child’s condition worsens, only then is it necessary to prescribe an operation, the result of which does not have any dependence on how old the child is.

Contraindications

Before the operation is scheduled, pediatrician Evgeniy Komarovsky says that you need to carefully read all the contraindications. Surgical intervention is not possible if the child is under 3 years of age, if an anomaly in the development of the soft palate or hard palate is diagnosed, if he has any blood diseases, as well as acute infectious diseases. Also, the operation is not performed in the first month after the introduction of vaccinations or during an epidemic of acute respiratory diseases.

Even if your surgeon insists on immediate surgery, and you know about the presence of contraindications, there is no need to rush, says Dr. Komarovsky. You always have the option to oppose this and consult with another doctor.

Video “Methods and techniques of removal”

Removal methods

According to Dr. Evgeniy Komarovsky, a good and experienced surgeon will immediately tell you exactly what methods exist and how adenoid removal in children proceeds. Parents will be able to choose the most optimal and safest method for the child, weighing all the pros and cons.

In medicine, there are the following removal methods. Cutting off the adenoids in the classic way. This operation is performed under local anesthesia. The adenoids in the nose are lubricated with a local anesthetic (Lidocoine); if they are located in the throat, then local anesthesia is used in the form of a spray. The surgeon cuts off the growths using a special ring-shaped scalpel.

Evgeny Komarovsky is categorically against this type of operation. Since the child will be conscious, he is in a stressful state, resists and cries. Such interference in 99% of cases causes him psychological and physical trauma. When growths are cut off “blindly,” the surgeon risks leaving a piece of tissue that can grow again. The main argument against such an operation is the high pain of the procedure and a large amount of blood, the sight of which children are very afraid of.

Laser removal of adenoids. Laser removal is recommended for young children under the age of 6 years. Instead of a scalpel, a laser is used to cut the adenoids. There are two types of manipulations - coagulation, which is used for large growths, and valorization, when small inflammations are cut off in layers. The advantages of this operation are rapid wound healing, absence of relapses, and a painless postoperative period.

No special preparation is needed for the procedure. This operation is performed under general anesthesia. If the adenoids are very large, then Evgeniy Komarovsky advises using a laser only to process the cut, and the main procedure was endoscopic intervention.

Another method of removal is endoscopic intervention. This procedure is performed not under local, but under general anesthesia. Endoscopic removal is one of the safest and most reliable methods.

The surgeon carefully cuts off the adenoids using special instruments. This eliminates relapses almost completely. Immediately after the cut, the wound is pressed for several minutes, which prevents bleeding and speeds up the healing process. You must agree to such an operation if the adenoids are deep in the nose. There are no special indications for this procedure.

Today, cold plasma removal is gaining popularity. The procedure is performed using a coblator (cold plasma) under general anesthesia. The main advantages are minimal operation time, healthy tissue is not damaged, absence of pain and complete bloodlessness of the procedure.
Preparing for surgery is an important process. You need to donate blood for a general and clinical analysis, and undergo an endoscopic examination of the nasopharynx. Before the operation you cannot eat anything, even exclude water. The moral preparation of children plays an important role.

If you are against surgical intervention, then Dr. Komarovsky advises taking a course of cryotherapy. Cryotherapy is an effect on the adenoids by irrigating them with liquid nitrogen vapor. This procedure is absolutely safe and painless. During cryotherapy, a Crysta nebulizer tube is inserted into the child's nose. During the process itself, steam comes out of the mouth, like the smoke of a dragon. That’s why children nicknamed cryotherapy “Little Dragon.”

The process itself takes no more than 15 minutes. Cryotherapy has a beneficial effect on damaged lymphoid tissues, which are quickly restored. The course is designed for 4-5 procedures with a break of one to three months. The effect of this procedure is quite long-lasting and immediately noticeable.

Pain relief methods

In our progressive age, there are different methods of pain relief. One of the most common methods is when the operation is performed under general anesthesia. It is worth noting the positive aspects of such pain relief. The child falls asleep for a while and wakes up when the parents are nearby and everything is over. During general anesthesia, stress is completely eliminated. Many doctors are against such anesthesia, as some complications may follow.

Removal can also be performed under local anesthesia. The nasopharynx is lubricated with painkillers. In this case, pain may be present. The main disadvantage of this anesthesia is that the child is conscious and sees doctors, surgical instruments, and blood. All this leads to severe stress and often affects the psyche, no matter how old the child is - 3 or 12.

It is best when local anesthesia is supplemented with intravenous sedatives, after which the patient is conscious, but asleep or dozing. It is better to weigh the pros and cons of local anesthesia before surgery and choose the best option for your child.

What could be the consequences?

After removal of the adenoids, complications such as otitis media, bleeding, severe pain, and purulent-septic complications cannot be excluded. The worst consequence may be relapse of adenoids. It occurs in 85% of cases. Relapse most often occurs in cases where the operation is performed on young children under 3 years of age. Relapses occur in children with a tendency to allergic reactions.

To avoid such consequences, the operation should be performed by an experienced surgeon. The adenoid tissue must be cut off completely, since even a small remnant can reappear as a growth. There are other complications after surgery.

Due to ingestion of large amounts of blood during the procedure, bloody vomiting may occur. If the vomiting does not stop within an hour, the baby should be shown to a doctor. Purulent otitis media occurs due to an infection acquired during surgery. It is possible that body temperature may increase within two days after removal.

Injuries to the nasopharynx are possible due to low qualifications of specialists or due to breakdown or malfunction of instruments and equipment. When you have already decided to have it removed, you need the doctor to be able to tell you in detail about the possible consequences and complications.

Video “Adenoids. Indications for removal"

To understand in what situations you should resort to adenoid removal, we recommend watching the following video. Dr. Komarovsky popularly explains all the advantages and disadvantages of the operation.

Every doctor knows how adenoids are removed in children. The situation with parental awareness, unfortunately, is far from the proper level. Only the attending physician can determine the baby’s condition and indications/contraindications for surgical intervention and drug treatment.

Parents are engaged in independent treatment and very often lead to a more serious condition of the child. To avoid such misunderstandings and further problems, consult a doctor at the first signs of adenoiditis. The sooner you do this, the lower the risk of the operation.

Indications for adenoid removal

Removal of adenoids in a child should be prescribed by a doctor after several examinations, a certain series of tests, and attempts at drug treatment (depending on the stage of the disease).

The procedure is carried out in the following cases:

• Serious hearing impairment (when the tonsil grows to such a size that it prevents the baby from breathing/hearing/talking normally).
• The patient was exposed to infectious diseases more than 6 times a year.
• Other treatment methods (conservative treatment, inhalations) did not produce positive results.
• The patient was exposed to otitis more than 2 times a year.
• Difficulty breathing through the nose, snoring.
• The patient is subject to frequent inflammation of the larynx.

Only the attending physician can prescribe treatment. Adenoids should be removed only in the most extreme cases. Removing an adenoid is not difficult. We should not forget that the removal of any part of the body is a huge physiological and psychological stress. First of all, parents should be prepared for this. They are obliged to provide the child with proper care before and after surgery.

Removal methods

The method of surgery depends on the type of anesthesia. If general anesthesia is used for the procedure, the operation is performed using endoscopic equipment. How the process works:

• Increased body temperature. The maximum increase is 38 degrees. Under no circumstances use antipyretics that contain acetylsalicylic acid (it can cause bleeding). The fever will subside within 3 to 4 days.
• Vomit. The vomit will consist of blood clots that entered the gastrointestinal tract during surgery.
• Stomach ache. The reason is blood entering the gastrointestinal tract. It goes away within 2-3 days after surgery.
• Nasality, itching in the nose. It will go away on its own within 10 days.

The diagnosis of “Adenoids” causes panic in some parents. They begin to frantically search for an answer to the question: is it really necessary to remove adenoids in children? The concern is related to the operation itself. Fear and apprehension are caused by the possibility of complications and consequences of anesthesia. Parents are horrified by the thought that the operation will be performed under local anesthesia. Many people start looking on the Internet for videos of how the removal takes place.

You should know that removal of the adenoids is the only way to treat this disease. Adenotomy should be performed immediately as soon as such a pathology is discovered.

No medicine, drops or ointments will help get rid of adenoids. This applies to conspiracies, healing videos and other unconventional methods. Delaying surgery will only lead to the growth of adenoids in children.

Some fathers and mothers firmly believe that in addition to surgery, there are other ways to treat adenoids. In fact, these formations are of an anatomical nature. They are not swelling that can resolve. This is an independent part of the body. This video helps you verify this:

To make the formation disappear, surgery is necessary.

The misconception that there are more gentle methods is due to the fact that adenoids are confused with adenoiditis.

This is the name for chronic inflammation of adenoid tissue. This condition can indeed be treated with conservative methods. The final decision about whether surgery is necessary is made by the attending physician.

What are the dangers of the presence of adenoids?

In children, the growth of adenoids may be accompanied by enlargement of the tonsils. In this case, surgery also saves. If adenoids are not removed in children, nasal breathing becomes difficult. The child has to breathe through his mouth. This leads to underdevelopment of the upper jaw. Teeth begin to grow unevenly. The face takes on an elongated shape.

The harmful effects of adenoids are not limited to these troubles. Their presence in the nasal cavity leads to oxygen starvation. Children complain of headaches, get tired quickly and do not perceive the curriculum well. Such children are often diagnosed with otitis media and hearing loss.

How painful is the surgery?

In the past, doctors did not have effective anesthesia at their disposal. Therefore, this procedure was performed without pain relief. Some parents, based on their own experience (or stories from friends), believe that even now they do not use anesthesia. It's not like that at all. To make sure that the patient does not feel pain, just watch the video taken during surgery:

Adenoid removal is performed using the following anesthesia methods:

• local anesthesia;
• general anesthesia.

Western doctors perform any ENT operations under general anesthesia. Many domestic hospitals practice such anesthesia. This does not harm the children's psyche. The little patient falls asleep, and when he comes to, the worst is over. The only drawback of surgery under general anesthesia is the likelihood of complications.

Often the operation is performed under local anesthesia. How exactly this pain relief occurs can be seen in the video above. The mucous membrane is lubricated with an anesthetic. Sometimes it is applied by spraying. The operation under local anesthesia is absolutely painless. This is noticeable in the video.

The disadvantage of adenoid removal under local anesthesia is that the patient watches the operation. The sight of blood and surgical instruments can cause great stress.

To avoid such negative phenomena, if local anesthesia is used, a sedative is administered intramuscularly.

Adenotomy can be performed without anesthesia (if there are contraindications for performing it under general and local anesthesia). This is justified from a physiological point of view. Adenoid tissue does not contain nerve endings.

Still, it is better to exclude the stress that may accompany the removal of adenoids in children under local anesthesia. Therefore, general anesthesia is most often used. To reassure parents, they are advised to watch a video of the operation, which confirms the use of effective anesthesia.

Features of rehabilitation

After the operation the following phenomena are possible:

• temperature rise to 38?;
• vomiting blood clots;
• nasality;
• nasal congestion;
• broken stool, unexpressed abdominal pain.

These consequences of removing pathological formations in children disappear on the tenth day. After the removal of adenoid growths is completed, the use of rehabilitation measures is required. Features of their implementation can be seen in the video of the “Doctor Komarovsky School” program.

Any physical activity is excluded for a month. The child should not be exposed to direct sunlight. Prolonged stay in a stuffy and hot room is prohibited.

In the first days after surgery, you should not bathe in hot water. The diet should be maintained for 8-10 days. Rough, spicy, hard, hot and cold foods are excluded from the diet. The menu should include foods rich in vitamins and calories.

In order for the surgical wound to heal faster, it is necessary to bury the nose. Vasoconstrictor drops are used for five days, then they move on to drying and astringent agents. Breathing exercises provide a good effect.

Can relapses occur?

Another thought that worries parents very much: the appearance of adenoids after surgery. In medical practice, such unpleasant phenomena are observed quite often. The main reasons leading to the regrowth of adenoids include the following factors:

1. Incorrect operation: incomplete removal of adenoid tissue. Even if a millimeter fragment of such cells remains, adenoids may appear again. To avoid such troubles, you should contact an experienced surgeon in a specialized clinic.
2. Previous removal of adenoids. It is better to perform such a procedure no earlier than three years (if there are no indications for urgent surgery).
3. Children with allergies are more susceptible to relapses.
4. Individual characteristics of the body, laid down at the genetic level.

Currently, removal of adenoid growths can be done using endoscopy. Features of the procedure using a technological medical innovation can be seen in the video:

The advantage of this technique is the guaranteed removal of adenoid tissue, which virtually eliminates recurrences.

Your doctor will determine which method is best for your child. Parents can find out from him how the operation will take place and even watch the removal procedure on video. Surgical measures are necessary to preserve the health of the child.

Endoscopic adenotomy is a modern operation that involves removing enlarged palatine tonsils. Adenoiditis is a common ENT disease in children from three to 14 years of age. At older ages, adenoids are less common and this is due to the fact that after adolescence, tonsil tissue can be replaced by connective tissue. Conservative treatment of adenoids is not always effective, and the consequences of impaired functioning of the tonsils can be very serious.

Therefore, an operation is prescribed; how endoscopic removal is performed can be found out in detail from a video on the Internet. Modern minimally invasive surgery is carried out in many clinics and, according to reviews, this operation is several times easier to tolerate compared to standard adenotomy. Video monitoring during endoscopic intervention makes it possible to completely cope with adenoid hypertrophy, and in adults it helps to determine the presence of neoplasms.

Indications for endoscopic tonsil removal

Chronic adenoiditis, detected in children, is the cause of many secondary diseases and deterioration in general health. The overgrown tissue of the tonsils no longer fulfills its function and, in addition, prevents other body systems from working in the desired mode. Enlarged adenoids are the main cause of:

• Mouth breathing. At the same time, the child stops breathing as it should be, that is, through the nose, which means that he develops bronchitis, tracheitis, rhinitis, and pharyngitis much more often.
• Hearing loss.
• Enlarged tonsils also negatively affect the oxygen supply to the brain. As a result, children experience a decrease in attention, and schoolchildren often suffer in academic performance.

How is endoscopic adenotomy performed?

Adenotomy using endoscopic equipment is a visually controlled operation, which makes it possible to remove enlarged tonsils with high precision. High-tech intervention has a number of advantages and each of them is worth considering separately.

• General anesthesia is used for the operation. This is very important in the treatment of children; general anesthesia allows the child to undergo surgery without unnecessary psychological trauma. The previously used local anesthesia during a routine operation caused the baby to twitch, and this affected the quality of the removal of hypertrophied tonsils and had a very negative impact on the psycho-emotional state of the child.
• An endoscopic tube with a microcamera is inserted through the nasal passage. Video control allows the doctor to accurately examine the entire nasopharynx and completely remove the overgrown tonsil. Shaver adenotomy is performed using a special microdebrider (shaver) device; at the end it has a stationary part with a sharp blade inside. The cut-off tissue is crushed by a blade and removed to the outside using suction.

General anesthesia used during endoscopic intervention allows the doctor to perform all actions clearly, and this affects the quality of the entire operation and the postoperative period. Under video control, hypertrophied lymphoid tissue is removed exactly in the right place, and this ensures the absence of relapse in the future. Anesthesia for a child is chosen specifically, that is, the anesthesiologist takes into account age, the presence of contraindications and the expected time of adenotomy.

Stages of endoscopic adenotomy

Endoscopic adenotomy is usually prescribed routinely. The child must be prepared for the operation; this means that certain tests must be collected and a cardiogram of the heart must be done. It is necessary that the child is not sick at the time of the operation; if the temperature rises that day, the doctor may not perform an endoscopy. Anesthesia is chosen by the anesthesiologist after a conversation with the mother and examination of the child. A few days before adenotomy, the baby is prescribed antihistamines and nasal drops, which reduce the likelihood of developing an infection. All this allows you to better tolerate both the anesthesia itself and the postoperative period.

The operation itself takes about one hour. After removal, the child is transferred to a ward, where he must be under the supervision of an adult. Anesthesia is usually well tolerated by the child, this is confirmed by numerous reviews from parents. But some children may scream and worry; it is necessary to ensure that they do not vomit after the operation.

After the operation, the child is usually observed for a day, and the next day he is sent home. The anesthesia currently used does not cause any negative changes. Approximately an hour after removal of the adenoids, the patient can be allowed to drink a little, and in the evening food intake is allowed.

Within two weeks after endoscopic surgery, the child is very vulnerable to colds and therefore needs to be protected; physical activity should be limited for a month.

If a fever appears, the baby should be shown to a doctor - the inflammatory process cannot be delayed during this period. Endoscopic surgery in children is easier to tolerate than in adults. This is due to the fact that tissues heal more slowly in older people. But compared to traditional removal, adenotomy performed using video equipment always causes fewer complications.

In addition to endoscopic intervention, cold plasma adenotomy or the coblation method, based on the use of electrodes, is currently used. Sometimes a laser technique is used to treat adenoids. Only an experienced doctor can decide which modern treatment method is right for your child; you can only evaluate the progress of each operation via video. They will help you choose a method of surgical treatment and reviews; most of them are positive about endoscopic intervention.

“My child’s adenoids have been bothering me for more than three years. The endless search for medicines, carrying out all kinds of procedures, snoring at night and frequent colds tired not only him, but also our entire family. Removing tonsils was proposed a long time ago, but we still couldn’t get the mood until I accidentally read positive reviews about endoscopy. We completely decided on such a removal after a conversation with the operating doctor. The child underwent the operation itself easily, and by the evening he was already running and eating. For two weeks we still had snoring, but now everything is fine. And most importantly, we began to get sick much less often, and our performance at school increased” - Marina, 33 years old.