Removal of adenoids: postoperative period. Recommendations for the patient during rehabilitation

After the operation to remove the adenoids, the patient is discharged from the hospital. The time after discharge is as important as the operation itself. The main thing is the further timely compliance with the recommendations for carrying out activities, which are based on monitoring the health of the child and proper prevention of the disease.

Adenoids are the most common disease in children aged 3 to 7 years.

Particular attention should be paid to the diet, daily routine and hardening.

Depending on what the operation was, the recovery period will be different for each child. Small operations (for example, adenotomy) are special in that further adherence to bed rest is not provided. However, one of the adults (mother, grandmother or the person who cares) must constantly monitor. At home, it is important to create such conditions so that the child can observe a strict regimen.

When the child is at home after the hospital, he needs to lay out clean bed linen, ventilate the room and let it warm up a little, if necessary, turn down the bright light. If the doctor prescribed temperature measurement, then this should be done in the morning from 7 to 9, and in the evening - from 18 to 20 hours. All temperatures must be recorded. If the temperature exceeded 38C, then it is worth resorting to an antipyretic.

After several outpatient surgeries, relatives often rush to pick up the child from the hospital. But it must be remembered that in order to prevent swelling, a compress of cold water or an ice pack should be applied to the site of the surgical wound. In the first days of the postoperative period, edema of the upper eyelid may form in the sinuses, so you need to monitor the eyes of the child. in case of swelling, you need to rinse your eyes with a warm solution of albucid (20%). The procedure is done at home and is safe.

What should the patient remember after the operation?

• After the operation, the patient should be observed by a pediatrician.
• Do not overexert yourself physically, stay in sunlight for a long time and swim. You need to follow the daily routine and include daytime sleep (about 2 hours).
• The diet should also be observed: limit the use of spicy, fried and meat dishes.
• It is allowed to eat carrot juice (half a glass in the morning), kefir (1 glass in the morning and evening); cereals: buckwheat, semolina, oatmeal; eggs (1 pc. per day), cottage cheese, vegetable dishes.
• After 7 days after the operation, you can eat steam cutlets, boiled liver, meat soups and fish.
• Fruits can be consumed in unlimited quantities.
• After some time, you can start hardening the body and visiting a sanatorium.

If the operation to remove the adenoids was performed in the clinic, then it is allowed to pick up the child a couple of hours after the procedure in the ENT doctor's office. But this is allowed when there is a medical aid station in the settlement.

In order to prevent bleeding that may occur after surgery, the child must remain in bed during the first day, and in the next few days limit physical activity (physical education, outdoor games, etc.). You can not overheat, take a shared bathroom and stay in the bath. It is necessary to bury the nose with vasoconstrictor drops (1-2% ephedrine solution, 2% protargol solution or 0.05% naphthyzinum solution) twice or thrice a day. In the first couple of days, spicy and hot dishes should be excluded from the diet.

The room where the child is located must be clean, well ventilated, and cleaned with a wet method. If bleeding occurs, immediate hospitalization is required, preferably in the ENT department where the operation was performed.

If after the operation nasal nasality appears, you should seek help from a speech therapist. In case of prolonged difficulty breathing through the nose after adenotomy, the child should be shown to the surgeon who operated on him. Many children after removal of the adenoids breathe through the mouth, while there are no difficulties in breathing through the nose. In this case, there are some special exercises that help strengthen the respiratory muscles and rid the child of the habit of breathing through the mouth. Such gymnastics is performed under the supervision of a doctor or a specialist in physical therapy, or at home after certain recommendations.

Breathing exercises in the postoperative period

First, the exercises are carried out 3-4 times each for 5-6 days. Next, you should increase the load up to 12-15 times.

When performing, the following rules should be taken into account: when the child bends to the side, forward, crouches, then you need to exhale. When the arms are raised in front of you or spread apart to the side, a breath is taken. When raising your hands in front of you, up and down - exhale.

Initial exercises

1. The position of the legs is shoulder-width apart, the head is tilted back, hands on the belt. Take a slow breath in through the mouth, while lowering the lower jaw, then exhale through the nose (raise the lower jaw). Repeat the exercise 5-6 times.
2. The position of the legs together. Rise on your toes, raise your hands up - inhale, lower your hands - exhale. Do the exercise up to 12-15 times.

Exercises for the shoulder girdle and neck muscles

1. The head and torso are held straight, the shoulders are slightly laid back and lowered, the position of the legs is shoulder width apart. Hands along the body, tilt the head to the chest. Spread your arms to the side, and tilt your head back. Repeat the exercise 10-15 times.
2. Put your head on the right shoulder, then move it to the left. Breathe in through your nose and out through your mouth. Repeat 12 times.
3. Clasp your hands behind your back, slowly tilt your head back and gradually open your mouth, inhaling, and exhaling through your nose. Perform the exercise 10-15 times.
4. Perform circular movements of the head alternately in both directions 12-15 times.

Breathing training

1. For complete breathing. Take the starting position as in the previous group of exercises. Take a long breath through the nose, while sticking out the stomach, and then expanding the chest. Exhaling through the nose, do the opposite: reduce the chest, and then draw in the stomach. The number of repetitions is 10-15 times.
2. For chest breathing. Exhale, followed by a long nasal inhalation. In this case, the chest will increase, and the stomach will be drawn in. With a nasal exhalation, everything will happen in the opposite order. Repeat up to 15 times.
3. For abdominal breathing. Exhale, and after it - a long nasal breath. At this time, you need to stick out your stomach. As you exhale, the front of the abdominal wall will retract. Carry out the exercise up to 15 times.

Nose breathing exercises

1. Take a standing position, legs slightly apart, hands at the seams. Slowly raise your hands with your palms to the top inward, while inhaling, then lower your hands already through the sides, exhaling. Breathing is done only through the nose. During the exercise, you need to bend in the lower back and chest. Exercise to do 10-15 times.
2. Put your feet together, place your hands along the body, and do quick deep squats. At the same time, hands should be stretched forward with palms to the bottom and exhale, and while straightening, inhale. Repeat the exercise 5-6 times.
3. Spread to the sides of the legs. Slowly take turns inhaling and exhaling through one nostril, and press the other with your finger. The mouth is closed during execution. Do 5-6 times.
4. Take a standing position, feet together. Pinch your nose with your fingers. Count loudly to 10 in your voice, then take a deep breath and exhale completely through your nose, while closing your mouth. Do the exercise 5-6 times.
5. Run in place on your toes, raising your knees high. Breathing may be voluntary. "Run" for a few minutes.

Carrying out all the above exercises for one and a half to two months helps to improve nasal breathing and the rapid recovery of the child's body.

Adenotomy, like any surgical intervention, can cause serious consequences. After adenoids in children, the following problems most often occur:

• Reduced immunity - this consequence is temporary. With a full recovery period, the immune system returns to normal within 1-3 months.
• Snoring and runny nose - these symptoms are considered normal for 1-2 weeks after surgery. As soon as the swelling goes down, the snoring will go away. If the symptoms persist for a long period of time, you should consult an otolaryngologist.
• Secondary infections - their development is possible if a wound remains in the nasopharynx after surgery. A weakened immune system also leads to infection.

In addition to the above consequences, more serious problems are possible: aspiration of the respiratory tract, trauma to the palate, intense bleeding after surgery or during it.

Temperature after removal of adenoids in children

Any surgical intervention is stressful for the body. Therefore, the temperature after removal of adenoids in children is a normal reaction. As a rule, there is a slight hyperthermia from 37 to 38 ° C. The temperature rises in the late afternoon, but it is not recommended to bring it down with drugs that include aspirin. Such medicines affect the structure of the blood, diluting it. Even one tablet can cause severe bleeding.

To reduce the temperature after adenotomy, the following drugs are recommended:

• Ibuprofen is the safest antipyretic for children.
• Paracetamol - effectively relieves fever, but has a hepatotoxic effect.
• Metamizole - is used to reduce fever and relieve pain.

If the fever persists for more than three days, you should immediately consult a doctor. In this case, hyperthermia may indicate the development of an infectious disease/complication.

Temperature after surgery may indicate problems not related to the respiratory tract: pathologies of the endocrine system, infectious viral diseases, inflammatory reactions. An unpleasant condition may be due to childhood diseases such as scarlet fever or whooping cough.

Cough after removal of adenoids in a child

The period after adenotomy is dangerous for the development of various clinical symptoms. Cough after removal of the adenoids is associated primarily with the outflow of purulent fluid from the paranasal sinuses after the release of the nasal passage. As a rule, cough attacks go away on their own within 10-14 days.

A prolonged postoperative cough may indicate a relapse, that is, a new growth of the tonsils and swelling of the surrounding tissues. To prevent this condition, you should contact an otolaryngologist for a thorough examination.

Snoring after removal of adenoids in a child

Such a symptom as snoring in a child after adenotomy is normal. It usually lasts for 1-2 weeks. An unpleasant condition is associated with swelling of the nasopharynx and narrowing of the nasal passages due to surgical intervention. But if discomfort is observed within 3-4 weeks, then the baby should be shown to the otolaryngologist.

In some cases, after surgery, children experience secondary snoring, consider its causes:

• Growth of the tonsils (relapse).
• With a long stay in a horizontal position, mucous secretions flow to the back of the larynx, causing snoring.
• Inflammatory processes during the recovery period.
• Allergic reactions.
• Nasal congestion and chronic pathologies of the nasopharynx.
• Anatomical features of the structure of organs: an uneven nasal septum, a suspended tongue of the palate, narrow airways.
• Violation of the hygiene of the nasopharynx.

In addition to the above factors, snoring may be associated with the continued habit of breathing through the mouth. This significantly disrupts the quality of sleep, negatively affects mental abilities and physical activity. In some cases, nighttime snoring causes short-term pauses in breathing. If this condition persists for a long period of time, then there is a risk of oxygen starvation of the brain and impaired functioning of the central nervous system.

• The last meal should consist of soft food that does not irritate the mucous membrane of the larynx.
• Daily breathing exercises normalize nasal breathing and strengthen the walls of the larynx.
• Vasoconstrictor drops reduce mucosal edema, nasal sprays with an antibiotic are also recommended.
• For disinfection of the oral and nasal cavities, washings with hypertonic solutions and herbal infusions are used.

Runny nose after removal of adenoids in a child

The most common signs of adenoids are a prolonged runny nose and constant nasal congestion. With the growth of the nasopharyngeal tonsil, these symptoms are aggravated. If conservative therapy is ineffective, then the patient is prescribed surgical treatment.

Many parents mistakenly believe that a runny nose after removal of adenoids in a child goes away. But this is far from the case, since mucous discharge can persist for 10 days, and this is the norm. It should also be borne in mind that a runny nose is directly related to postoperative swelling of the nasal cavity.

Poor discharge of mucus from the paranasal sinuses may indicate the addition of a secondary infection. In this case, in addition to snot, additional symptoms appear:

• Increased body temperature.
• Bad breath.
• Green thick snot.
• General weakness.

If pathological symptoms persist for 2 or more weeks, then this is a clear sign of a severe bacterial infection, a manifestation of a viral infection, or an exacerbation of a chronic disease that requires treatment.

The appearance of a runny nose after adenotomy may be associated with such pathologies:

• Deformation of the nasal septum.
• Hypertrophic processes in the nasopharynx.
• Immunological reactivity of the organism.
• Bronchopulmonary disorders.

In order for the mucous discharge from the nasal cavity in the postoperative period not to persist for a long time, it is necessary to follow medical recommendations. First of all, it is forbidden to abuse tablets with antiseptic and antibacterial substances that can thin the nasopharyngeal mucosa and cause infection resistance. It is also not recommended to carry out steam inhalations with alkaline agents or use concentrated saline solutions for washing the nose and throat.

Sore throat after removal of adenoids in children

Removal of hypertrophied adenoid tissue of the pharyngeal tonsils can cause a number of painful symptoms in the postoperative period. Many parents are faced with such a problem when the baby has a sore throat after adenotomy.

Discomfort can be associated with such factors:

• Throat injury during surgery.
• Infectious and inflammatory process.
• Relapse of chronic diseases of the oropharynx.
• Complications after anesthesia.

Sore throats can radiate to the ears and temples, and stiffness when moving the lower jaw is also often observed. As a rule, such a problem goes away within 1-2 weeks. To alleviate the painful condition, the doctor prescribes medicinal aerosols, inhalations and oral medications. If the pathological condition progresses or persists for a long period of time, then it is worth contacting an otolaryngologist.

Headache after removal of adenoids

Another possible complication that occurs after removal of adenoids in children is headaches and dizziness. The painful condition is temporary and most often occurs in such cases:

• An adverse reaction of the anesthesia used.
• Decrease in arterial and intracranial pressure during surgery.
• Dehydration of the body.

Discomfort appears on the first day after surgery and may persist for 2-3 days. Also, when waking up after anesthesia, slight dizziness is possible. Headaches are aching, bursting in nature and are aggravated by loud sounds, sharp turns of the head.

For treatment, plentiful drinking and good rest are shown. With excruciating pain, the doctor prescribes safe painkillers.

Vomiting after removal of adenoids in children

One of the side effects of adenotomy is vomiting. After removal of the adenoids, it acts as a reaction to the anesthesia used and most often proceeds with the following symptom complex:

• Attacks of nausea.
• Stomach ache.
• Deterioration of general well-being.

Sometimes there are blood impurities in the vomit, which disappear 20 minutes after the operation with normal blood clotting in the patient.

In addition to vomiting attacks, children may have a fever. Hyperthermia with abdominal pain should not last more than 24 hours. If symptoms persist for a longer time, an urgent consultation with an otolaryngologist and pediatrician is indicated.

After the removal of the adenoids, the child's voice changed

Many doctors note that after the removal of adenoids in children, the voice may change. Such changes are temporary and persist during the first days after the operation. In some babies, the voice becomes nasal, hoarse and may resemble a cartoon.

As nasal breathing is restored (about 10 days), the voice also normalizes. It becomes clear and resonant. If pathological symptoms persist for more than 2 weeks, then the baby should be shown to the doctor.

The child has a nasal voice after removal of the adenoids

The postoperative period in the surgical treatment of hypertrophied tissues of the pharyngeal tonsils is very often accompanied by voice changes. This symptom is caused by swelling of the nasopharynx and palate, is temporary. But if, after removal of the adenoids, the nasal voice persists for a long period of time, then this may indicate the development of a serious complication.

According to medical statistics, in 5 out of 1000 patients, voice changes are a pathology such as palatopharyngeal insufficiency. It is manifested by a deaf nasal voice, slurred pronunciation of words, especially consonant sounds.

A similar complication develops due to the fact that the soft palate does not completely close the nasal passages. When talking, air enters the nasal cavity, the sound resonates and becomes nasal. For treatment, respiratory gymnastics and a complex of physiotherapy are used. In severe cases, soft palate surgery is possible.

Nervous tic in a child after removal of adenoids

As a rule, a nervous tic in a child after adenotomy is associated with such factors:

• Psycho-emotional trauma.
• Complications of general anesthesia.
• Severe postoperative pain.
• Traumatization of nerve tissue during surgery.

Complications may occur due to the removal of adenoids under local anesthesia. In this case, the nervous tic is associated with the fright of the little patient, who observed all the surgical manipulations.

Another possible cause of the violation is due to the fact that the movements that the patient made were fixed in the form of a tick. Due to impaired nasal breathing, a runny nose or sore throat, children often swallow saliva, greatly straining the muscles of the neck of the pharynx. After the operation, swallowing is manifested by ticks and persists for a certain time.

If the disorder persists for a long period of time, then you should contact your pediatrician. In especially severe cases, it is necessary to consult a neurologist. Anticonvulsants and psychotropic drugs may be prescribed for treatment.

All materials on the site are prepared by specialists in the field of surgery, anatomy and specialized disciplines.
All recommendations are indicative and are not applicable without consulting the attending physician.

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

Often, adenotomy is performed in childhood, the predominant age of patients is babies from 3 years old and preschoolers. It is at this age that the greatest distribution of adenoiditis occurs, because the child is actively in contact with the external environment and other people, meets with new infections and develops immunity to them.

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

An enlarged amygdala creates a mechanical obstruction in the pharynx, which is manifested by a violation of breathing, and also serves as a source of constant reproduction of all kinds of microbes. The initial degrees of adenoiditis are treated conservatively, although there are already symptoms of the disease. The lack of effect from therapy and the progression of the pathology leads patients to the surgeon.

Indications for removal of adenoids

By itself, an increase in the pharyngeal tonsil is not a reason for surgery. Specialists will do everything possible to help the patient in conservative ways, because the operation is a trauma and a certain risk. However, it happens that one cannot do without it, then the ENT weighs all the pros and cons, talks with parents if it is a small patient, and sets the date for the intervention.

Many parents know that the lymphoid pharyngeal ring is the most important barrier to infection, so they are afraid that after the operation the child will lose this protection and will get sick more often. Doctors explain to them that abnormally overgrown lymphoid tissue not only does not fulfill its immediate role, but also maintains chronic inflammation, prevents the child from growing and developing properly, creates a risk of dangerous complications, therefore, in these cases, one should not hesitate or hesitate, and the only way to get rid of child from suffering will be surgery.

Indications for adenotomy are:

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

degree of adenoiditis

The main reason for intervention is the third degree of adenoiditis, leading to difficulty 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. In addition to physical suffering, the patient experiences psycho-emotional anxiety, lacks sleep due to the impossibility of normal breathing, and intellectual development suffers.

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

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

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.

Preparing for the operation

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 on the background of anesthesia. In female patients, surgery is not scheduled during menstruation due to the risk of bleeding.

Features of anesthesia

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

Surgery 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 reached the age of seven, it is easier to negotiate, explain and reassure, so local anesthesia can also be performed for preschool children.

If planned local anesthesia, 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. On the part of parents, psychological support and attention are also of no small importance, which will help to endure the operation as calmly as possible.

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

Classic adenoid removal surgery

classical 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.

Others shortcomings possible pain during manipulation, as well as a higher risk of dangerous complications are considered - 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. It has been established that the level of anxiety in children may increase, neurosis may develop, so most doctors still agree on the advisability of general anesthesia.

Endoscopic adenotomy

Endoscopic removal of adenoids is one of the most modern and promising methods of treating pathology. The use of endoscopic 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.

endoscopic adenotomy

An option for endoscopic removal of adenoids is shaver Technics, 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.

Advantage of the shaver technique- low trauma, 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 insert instruments. In addition, not every hospital can afford the necessary expensive equipment, so private clinics often offer this method.

Video: endoscopic adenotomy

The use of physical energy in the treatment of adenoiditis

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

laser treatment

Removal of adenoids with a laser It 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 carried out by the apparatus Surgitron. 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 Coblation Systems also used by some clinics. These methods can significantly reduce the pain that occurs in the postoperative period, and are also practically bloodless, therefore they are indicated for patients with blood clotting disorders.

Coblation is 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.

Postoperative period

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 first 2 hours the patient does not eat, and 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. By the end of the first week, the menu expands, you can add pasta, scrambled eggs, meat and fish soufflé. It is important that the food is not hard, too hot or cold, consisting of large pieces.

In the postoperative period, carbonated drinks, concentrated juice or compote, crackers, hard biscuits, spices, salty and spicy dishes are categorically not recommended, which increase local blood circulation with a risk of bleeding and can injure 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 desirable to protect the operated person from contact with potential carriers of a respiratory infection; the child is not taken to kindergarten or school for about 2 weeks.

Drug therapy in the postoperative period is not needed, only drops in the nose are shown, constricting blood vessels and having a local disinfecting effect (protargol, xylin), but always under the supervision of a doctor.

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

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 allow minimizing the risk of complications in any of the surgical options.

One of the most common operations in children is the removal of adenoids. This surgical intervention is not difficult, although it is performed under general anesthesia. But there is a good reason for this - the psychological state of the little patient. Few of the children are not afraid of doctors, and the sight of medical instruments, abundant blood flow, long monotonous body position will cause additional discomfort and even stress. In order to prevent complications during the operation or in the first time after it, it is better to eliminate these negative factors with the help of the correct stages of recovery after removal of the adenoids.

Despite the fact that short-term surgical intervention and subsequent inpatient treatment are not planned,rehabilitation after removal of adenoidsis of paramount importance, especially in the first hours.

And although the patient still spends this time within the walls of the hospital, in the general ward, and you can always contact a specialist, you should still remember important manipulations:

• lay the child on its side;
• prepare a towel for expectorating blood and accumulated mucus;
• periodically apply gauze soaked in cold water to the face.

All of the above measures will avoid the resumption of bleeding and inflammation of the mucosa.

After three hours after the operation, the patient is examined by an otolaryngologist. In the absence of complications, the patient can go home, where the recovery process will continue.

Please note: the next two weeks of rehabilitation after removal of the adenoids, the child must be under the supervision of a doctor. The frequency of visits is determined by the specialist in each case individually.

Highlights of home rehabilitation

Postoperative period after removal of adenoids in childreninvolves the creation of certain conditions and at home:

• carrying out daily wet cleaning to prevent the appearance of dust in a timely manner;
• calm atmosphere without escalating the situation, worries and unrest;
• limiting contact with strangers;
• physical rest, lack of excessive motor activity;
• constant ventilation of the room;
• use of air humidifiers;
• frequent breaks for rest, good sleep;
• daily hygiene procedures, including thorough brushing of the teeth, only without rough vigorous movements that can damage the mucous membrane;
• caring and attentive attitude of relatives and friends;
• periodic (twice a day) monitoring of body temperature;
• strict adherence to the drug therapy prescribed by specialists, including primarily vasoconstrictor drugs.

Usually, operations to remove adenoids are carried out in the cold season, but still we emphasize a few more important restrictive recommendations. What exactly should be excluded?

• being in direct sunlight;
• bathing in running water;
• taking warm baths;
• bathing;
• trips;
• flights.

Important: do not panic if the temperature rises to 37 - 37.5 degrees. This is the body's normal response to surgery. The main thing is not to shoot down with aspirin, it thins the blood and can cause unpleasant consequences. If the thermometer scale is kept above 38 degrees, give preference to paracetamol-based products.

But you should only worry if the fever persists for a long time (at least 3 days). In this case, you should immediately contact an otolaryngologist.

What can you eat after adenoid removal?

Recovery after removal of adenoidsand the healing of the mucosa in children passes very quickly and does not cause discomfort and pain, but only if all provoking factors are avoided.

• fruit and vegetable puree;
• meat broth;
• herbal infusions;
• cereals, mainly from oatmeal and semolina;
• soups;
• steam cutlets.

There is also a list of products that are strictly prohibited:

• canned vegetables;
• sweet pastries (cakes and pastries);
• candies;
• canned fish;
• acidic fruits and vegetables;
• stew;
• carbonated drinks;
• unnatural juices;
• hot spices.

The following should also be banned:

• hard and coarse food. Chewing such foods requires the use of force, and this can adversely affect the recovery process.
• hot dishes. In order to prevent bleeding, replace them with dishes at room temperature or even cold ones.
• food colorings. They will cause allergies and provoke swelling of the mucosa, and as a result, a complication.

Remember: even if the child will demand the usual way of eating and favorite foods, you should not go on about him, it can cost a lot. And the knowledge ofwhat can i eat after adenoid removal, and eating exactly the allowed foods, on the contrary, will speed up the recovery process.

The removal of the adenoids is caused, first of all, by the fact that the glandular tissue that has increased in volume affects the child's breathing. He develops a special type of breathing, in which swallowing of speech is observed.

The operation relieves this problem, however, not immediately: for some time after the operation, the difficulty of the respiratory process and nasality still remain. The child may also complain of tinnitus. Parents should not have worries about this: as soon as the recovery process is over, these phenomena will not leave a trace.

Do not forget, of course, that children who have been with adenoids for a long time need to be corrected, both in breathing and pronunciation. An excellent solution would be classes with a speech therapist. They include breathing exercises and speech training. These exercises can be done on your own at home. Only subject to certain important recommendations:

• stop charging immediately afterremoval of adenoids, in early postoperative period. At this time, the body is most vulnerable, it needs peace and rest.
• humidify the air in the room where the classes are held. Dryness will not benefit, but will cause a cough and sore throat.
• gradual increase in load and duration of training. It’s worth starting with 3 repetitions and consistently after one day bring up to 12.
• introduce new types of exercises gradually and with caution. Increase the number of repetitions in the same way as described above.
• stop all types of training in case of deterioration of health. Resumption is possible only after healing, and should begin with the most minimal load.
• meticulousness in the performance of each individual exercise. First you need to achieve the goal and correct execution in one form, and only then move on to another.

creating a positive attitude and determining motivation. You can use rhyming or draw on your favorite characters, such a game form will arouse interest and pleasure in doing the workout.

Over time, breathing exercises can be carried out not in a well-ventilated room, but directly in the fresh air. Exercise while walking is the key to a successful recovery.

A set of exercises to remember

1. Stretch your arms to the side, while inhaling through the nose, slowly lift up. Hold your breath, while lowering your hands, exhale the collected air through your mouth. Such an exercise can be carried out both at the initial and at the final stage of training. The strength and speed of exhalation, the time of holding the breath can be different and depend only on individual capabilities.
2. The next exercise regulates chest breathing: while inhaling, draw in the stomach, due to which the chest will expand, while exhaling, the opposite effect is observed. We inhale and exhale through the nose.
3. Abdominal breathing training: expanding the abdomen when inhaling, pulling it up when exhaling. Breathing through the nose.
4. Exercise involving one nostril. Press the wing of the nose against the septum, inhale and exhale through the remaining free nostril. Then carry out the same manipulations on the other side.
5. Oral cavity training: we inhale through the nose, direct the collected air into the mouth, roll it inside, like a ball, until the cheeks swell, then gradually exhale through the lips.
6. Pronunciation of sounds during nasal inhalation and exhalation through the mouth. An important note: vowels and hissing are pronounced smoothly, and consonants are jerky. The clarity of this exercise is high-quality and understandable pronunciation. The number of sounds and their variations may be different.
7. Exercises for the development of speech: pronouncing rhymes, tongue twisters, proverbs and sayings. You can complement them with a real puppet show or just gesticulation. The range of sounds should constantly expand, and the speed of pronunciation should increase. You can use this version of this exercise - pronouncing the rhythm of steps while walking.

These were just a few exercises that can restore breathing, develop speech and stimulate brain activity.

Gymnastics is a remedy that will allow you to avoid colds during the recovery period by activating the immune system.

It becomes clear that the operation to remove the adenoids is not at all terrible, the main thing is to follow the regimen after it, then you can avoid unnecessary complications and maintain your health.