Can adenoids be removed under general anesthesia? Surgical treatment of adenoids: which method to choose and how to prepare? Surgery to remove adenoids

Today there are a huge number of diseases that affect children. In this article I would like to talk about adenoids and their removal.

About the concept

If it is planned for a child, every mother should know what kind of disease it is, which must be fought through surgical intervention. So, the adenoids themselves are an increase in a person, due to which there is some difficulty in breathing, snoring may appear, colds occur more often than usual, adenoids can also fester. Not all children have a problem, this may be due to various allergic reactions, the constitution of the human body, and frequent diseases of an infectious nature. Adenoids occur mainly at the age of 2-8 years.

Indications

Far from immediately, the doctor will direct the removal of adenoids in a child. First, conservative treatment will be performed: washing the nose with various solutions, sucking out mucus, and a drug solution to the problem can be prescribed. But very often this is not enough, adenotomy occurs - adenoids of 3-4 degrees. Only then is surgical intervention indicated.

Endoscopy

Removal of adenoids in a child is most often performed by endoscopy under You can, of course, have an operation under, however, modern doctors and parents of babies most often try to protect the child from such an injury as monitoring the actions of a doctor. Often in such a situation, ordinary fear prevents children from relaxing and receiving quality treatment. The endoscopic method allows the surgeon to better view the operated field and, as a result, perform the operation with high quality. At the same time, the kids themselves do not feel anything at all, they are not witnesses of surgical actions, which in itself is a huge plus. It should be noted that endoscopy, which is widespread today, allows to significantly improve the quality of the operation and avoid recurrences in the future. Also, this method of solving the problem is less traumatic, which is very important.

Operation

How is the removal of adenoids in a child? The operation itself takes a little time, about 5 minutes. The doctor examines the operated field with the help of an endoscope, prepares, and then excised the tonsils. That's all. There is nothing difficult for a real specialist in this.

If a mom can't decide what is the best way to see off parents who have gone through this, a good source of information. You can talk with mothers who have resorted to various methods of surgical intervention, and draw certain conclusions for yourself. It may also be important to know how expensive it is to remove adenoids in children. The cost of the operation can be completely different. If manipulations are performed in a local clinic, then this is generally done free of charge (officially). If the clinic is paid, you need to check with the administrator or the doctor. As a rule, the cost fluctuates within 20 thousand rubles.

Postoperative period

As such, there is no postoperative period. But mothers should take care of the baby's nutrition for about a week after the operation. He is not recommended to consume hot foods, everything should be slightly warmed up, otherwise the vessels may expand and bleeding may begin. It is also necessary to avoid various injuries of the nose. That's all the precautions.

The diagnosis of "Adenoids" causes panic in some parents. They begin to frantically search for an answer to the question: is it necessary to remove adenoids in children? The concern is related to the operation itself. Fear and fear causes the possibility of complications and the consequences of anesthesia. Parents are horrified at the thought that the operation will be performed under local anesthesia. Many begin to search the Internet for a video of how the removal takes place.

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

No medicines, drops and ointments will help get rid of adenoids. This applies to conspiracies, healing videos and other non-traditional methods. Postponing the operation will only lead to the growth of adenoids in children.

Some fathers and mothers are firmly convinced that, in addition to surgical procedures, there are other ways to treat adenoids. In fact, these formations are anatomical in nature. They are not swelling that can resolve. It is an independent part of the body. This video helps to make sure:

For the formation to disappear, an operation 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 of chronic inflammation of the adenoid tissue. This condition is indeed treated conservatively. The final decision that surgery is necessary is made by the attending physician.

What threatens the presence of adenoids?

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

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

How painful is the operation?

In the past, doctors did not have effective anesthetics at their disposal. Therefore, this procedure was performed without anesthesia. Some parents, based on their own experience (or the stories of 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:

Removal of adenoids is performed using the following methods of anesthesia:

• local anesthesia;
• general anesthesia.

Western doctors perform any ENT surgery under general anesthesia. In many domestic hospitals, similar anesthesia is practiced. It does not injure the psyche of children. The little patient falls asleep, and when he wakes up, the worst is over. The only drawback of surgery under general anesthesia is the likelihood of complications.

The operation is often performed under local anesthesia. How exactly this anesthesia works 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 completely painless. This is noticeable in the video.

The disadvantage of removing adenoids under local anesthesia is that the patient observes the progress of the operation. The sight of blood and surgical instruments can be very stressful.

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

Adenotomy can be performed without anesthesia (if there are contraindications for 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 increase up to 38?;
• vomiting blood clots;
• nasality;
• nasal congestion;
• disturbed stool, unexpressed abdominal pain.

These consequences of the removal of pathological formations in children disappear on the tenth day. After the removal of adenoid growths, the use of rehabilitation measures is required. You can see the features of their implementation on the video of the program “School of Dr. Komarovsky”.

For a month, any physical activity is excluded. The child should not be exposed to direct sunlight. It is forbidden to stay in a stuffy and hot room for a long time.

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

In order for the surgical wound to heal faster, it is necessary to bury the nose. For five days, vasoconstrictor drops are used, then they switch to drying and astringent agents. Good effect provides breathing exercises.

Can relapses occur?

Another thought that worries parents a lot: the appearance of adenoids after surgery. In medical practice, such unpleasant phenomena are noted quite often. The main reasons leading to the re-growth of adenoids include the following factors:

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

Currently, removal of adenoid growths can be performed by endoscopy. Features of the procedure using a technologically advanced medical novelty can be viewed on the video:

The advantage of this technique is the guaranteed removal of adenoid tissues, which practically eliminates recurrences.

Which method is best for your child, the doctor will determine. 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.

From time to time, all babies suffer from colds. However, some children get sick too often. Constant illnesses force parents to look for the cause of such a problem. Often, frequent colds are associated with uncontrolled growth of the lymphoid tissue of the nasopharyngeal tonsil - adenoids. In this case, lymphocytes become the cause of chronic inflammation. That is why most doctors advise Reviews confirm that this is the main method to improve the well-being of the baby.

Physiological features

Enlargement of adenoids in children occurs at the age of seven. It is during this period that there is an increase in their activity in connection with the formation of the immune system. With a significant increase, surgery may be recommended. Removal of adenoids in children is considered with the following symptoms:

• Baby almost at night. With an increase in adenoids of 2-3 degrees, such symptoms are observed during the day.
• At night, the child sniffs heavily, snores. Even breath holdings can be observed - obstructive sleep apnea.
• The speech of the baby ceases to be legible. The voice becomes nasal.
• Hearing is reduced. Constantly recur sinusitis, otitis media.
• The child is seriously and often sick with viral, colds. Often, the baby is diagnosed with pneumonia, bronchitis, sinusitis, tonsillitis.

Diagnosis of adenoids

Visually, with the child's mouth open, it is impossible to see the problem. Diagnose the growth of adenoids allow special methods. The doctor examines them with a mirror, performs a study with his fingers and endoscopy of the nasopharynx. After the diagnosis, the doctor decides whether it is necessary to remove the adenoids in the child. Reviews show that such an operation has a beneficial effect on the further well-being of the baby.

Let's consider in more detail the diagnostic methods:

1. Finger examination. Today, this study is practically not used. Since this is an uninformative and painful examination.
2. X-ray. Such a study shows the size of the adenoids. However, little information is provided about the inflammatory process. In addition, an x-ray is not a completely harmless examination for a child's body.
3. Endoscopy. The most painless and safe study that provides a complete picture of the growth of adenoids. A prerequisite in this case is a completely healthy child. If the baby has recently been ill, the clinical picture of the inflammatory process will be false.

When is adenoid removal necessary?

Most parents are afraid to have surgery. Removal of adenoids, reviews testify to this, is constantly delayed. Many are trying to find an alternative in conservative treatment. Today, many methods of such healing have been developed. But, unfortunately, not all of them are effective. In addition, for complex cases, the only solution is the surgical removal of adenoids in a child. Feedback from parents confirms that after such an intervention, many health problems can be avoided.

When is surgery required? The decision on the need for surgical intervention is made with the following symptoms and diseases:

• If the baby is seriously disturbed breathing through the nose. Apnea syndrome occurs, in which the delay is from 10 seconds. This condition is very dangerous for the baby, as it can lead to permanent hypoxia.
• In the case of the transformation of the tonsil into a malignant one.
• In the middle ear, mucus accumulates, which leads to hearing loss.
• If the growth of adenoids provokes maxillofacial anomalies.
• In case of unsuccessful treatment of adenoids by conservative methods throughout the year.

Contraindications for surgery

There are cases when surgery can harm the body. Removal of adenoids in children is not performed under such circumstances:

• blood diseases;
• the presence of an infectious disease, influenza (surgical intervention is allowed only 2 months after recovery);
• babies diagnosed with bronchial asthma, serious allergic diseases (treatment is carried out exclusively by a conservative method);
• in cardiovascular diseases.

Adenoid Removal Methods

In modern medicine, there are several ways to perform an operation.

traditional method

Surgery is performed using the usual instruments of the surgeon. This removal option has significant drawbacks. Unfortunately, with this method, it is not always possible to completely excise the overgrown tissue. And this is fraught with relapse. In this case, the adenoids grow again, and the child needs another operation. In addition, healing with traditional excision is rather slow. After all, the wound bleeding surface is large.

Laser removal

This is a more efficient method. This operation is bloodless and painless. The laser beam affects only the area of ​​​​inflammation, while quickly eliminating infectious edema. Laser removal can be carried out at any stage of complexity. For small adenoids, a carbon dioxide apparatus is used. In this case, they are not removed, but are smoothed out with a laser. For excision of large tonsils, the coagulation method is used. This operation is performed without anesthesia, because the laser has an analgesic property.

Endoscopic removal of adenoids

This is the most modern method. If with the traditional method the excision of adenoids was carried out almost “blindly”, then with this method the endoscope is inserted into the oral cavity or half of the nose. This allows you to perfectly see the entire surface of the operation. Of course, this method guarantees the complete removal of the adenoids. And protects the little patient from their re-growth.

Anesthesia methods

This question almost always worries parents. Doctors say that pain relief during adenotomy (no surgery is required. It does not have nerve endings. In this regard, the patient does not experience pain. The problem lies precisely in the psychological factor. The child is small enough, so he is afraid of the operation.

Western clinics have long carried out the removal of adenoids under anesthesia. Today, our hospitals have followed the example of foreign colleagues. At the same time, we must not forget that any anesthesia is a serious risk factor. Especially when it comes to children's fragile body.

Sometimes operations are performed using local anesthesia. Painkillers are sprayed onto the mucous membranes. But the psychological factor can play a role. The baby sees blood and is able to be very frightened.

Today, most parents insist on it for their children who need to have their adenoids removed. Reviews indicate that babies in this case tolerate the operation more favorably. Without a shudder, they remember the ward, the doctors. Children who underwent adenotomy without "plunging into sleep" and watched the progress of the operation, in most cases received psychological trauma.

Consequences of the operation

Most often, the results are favorable. After the operation (removal of the adenoids), the ability to naturally breathe through the nose returns to the babies. Children become less susceptible to viral and colds. In young patients, immunity is significantly strengthened. The auditory function is perfectly restored, the quality of speech is improved.

However, in some cases, the results are disappointing - repeated growths of tissues are observed.

The reasons for such negative consequences may lie in the following factors:

• Incomplete removal of adenoids. Even a small piece can grow to a significant size.
• Age. According to statistics, patients who underwent surgery up to three years often experience a relapse of the disease.
• Allergy. Such a factor can reduce immunity. As a result, already completely excised tissues may reappear.

Blood coagulation tests, etc.) to reduce the risk of complications during and after surgery.

Should adenoids be removed?

Absolute indications for removal of adenoids are:

• Respiratory failure leading to oxygen starvation of the body.
• Frequent and severe infectious diseases of the upper respiratory tract.
• Hearing impairment (permanent or intermittent).
• Progressive enlargement of the adenoids.
• Lack of effect from medication and other therapeutic measures.
• Adenoids in adults (if this disease first appeared in an adult, most likely it will progress, and the probability of self-healing is extremely small).

• With blood diseases associated with an increased risk of bleeding during surgery. In this case, you should first correct the impaired coagulation system (by transfusion of blood products, plasma or other methods), and then re-consider the possibility of performing the operation.
• In the presence of acute infections of the nasopharynx, oral cavity or respiratory tract. In this case, the operation is possible not earlier than 1-1.5 months after the disappearance of clinical and laboratory signs of infection.
• If a tumor is suspected in the nasopharyngeal region (in this case, additional diagnostic measures should be taken).
• In weakened, emaciated children.

• surgical (classical) operation;
• endoscopic surgery;
• laser removal of adenoids;
• removal of adenoids with liquid nitrogen;
• coblation of the adenoids.

Surgery to remove adenoids

After the bleeding has stopped, the child must be in the hospital for at least 2 to 4 hours. If at this time there were no serious complications, he can go home.

If the child is very anxious, the operation can be performed under general anesthesia. In this case, the child must be hospitalized and stay in the hospital for at least 2 to 3 days after the operation. Also, hospitalization is indicated for the removal of large adenoids, with a risk of bleeding or other complications in the postoperative period.

Endoscopic removal of adenoids

The main advantage of such an operation is higher accuracy (compared to the use of an adenotome). The risk of incomplete removal of adenoid growths, which often cause a relapse (repeated exacerbation) of the disease, is reduced. The disadvantages include the relative high cost of the method.

Removal of adenoids with a laser

The advantages of the method include:

• High accuracy. With a laser scalpel, even the smallest areas of adenoid growths can be removed.
• Minimal blood loss. The blood vessels in the area of ​​the "cut" are instantly clogged.
• Disinfection. If bacteria are present in the incision area, they will be destroyed.
• Painlessness. Laser exposure instantly destroys the nerve endings in the area of ​​influence, so pain is minimal (however, the use of local anesthesia is also a prerequisite).
• Fast recovery. The child can return to daily activities within a day after the operation, and the complete healing of damaged tissues occurs within 2-4 weeks.

Removal of adenoids with liquid nitrogen (cryotherapy)

Before the start of the procedure, the child sits on a chair and throws back his head, after which the doctor, under visual control, inserts a special tube through his mouth, through which a stream of liquid nitrogen is supplied for 2-3 seconds, directed exclusively to adenoid vegetations. This is repeated 2-3 times with an interval of 1-2 minutes. After performing the procedure, the doctor once again visually assesses the condition of the nasopharyngeal mucosa using mirrors. If there are no complications, the child can go home. Complete healing occurs within 2 to 4 weeks.

Coblation of adenoids

The procedure is performed under local or general anesthesia. Under the control of an endoscope (a thin flexible tube with a video camera at the end), an electrode is inserted through the nasal cavity. After visualization of the adenoids, a saline solution is supplied through a special tube and they are removed.

The advantages of the coblation method include:

• High accuracy. Damage to healthy tissue is minimal.
• Bloodlessness. With the correct procedure, bleeding is practically absent.
• High efficiency. Performing the procedure under the control of the endoscope allows you to remove both large and small adenoid growths.
• Painlessness. With coblation, the nerve endings in the affected area are destroyed, so pain in the postoperative period is minimal.

What to do after removal of adenoids?

The duration and severity of the postoperative period is determined by:

• The type of operation. The recovery period is longer with surgical removal of the adenoids, while after other operations, wound healing is much faster.
• The general condition of the patient. In weakened, long-term ill children, the restoration of damaged tissues and the normalization of the general condition of the body are slower.

• The patient's age. In a child, tissue recovery processes proceed several times faster than in an adult, so the period of healing of a postoperative wound in children will also be shorter.
• The degree of the disease. After removal of the first degree adenoids, the patient can return to normal life the very next day, while after the removal of large adenoid growths, the recovery period may take weeks or even months.

• After classical or endoscopic surgery, the patient is shown bed rest for 24 hours. In the next 2-3 days, depending on the general condition, outdoor walks are allowed, and a return to full-fledged physical activity (including attending a kindergarten or school) is possible no earlier than in a week. After removal of the adenoids by other methods, the patient is advised to avoid severe physical activity for 1 to 3 days after the operation.
• Observe the rules of personal hygiene. This is an extremely important stage in the recovery period, as it helps to prevent the development of infectious complications. In addition to brushing your teeth 2 times a day (in the morning and at bedtime), it is recommended to rinse your mouth and gargle with disinfectant saline solutions (1 teaspoon per glass of warm boiled water) after each meal. These rules should be observed within 2 weeks after classical or endoscopic surgery and within 5-7 days after removal of the adenoids by another method.
• Regularly perform the toilet of the nasal passages. Starting from 2-3 days after the operation, you can rinse your nose with saline solutions or sea water. In this case, you should not blow your nose too intensely, as this can damage the delicate tissue in the wound area and cause bleeding.
• Avoid sudden temperature changes. Within 1 - 2 weeks after surgery, it is recommended to avoid prolonged exposure to frost, as this can lead to hypothermia of the nasopharyngeal mucosa and the development of infection. You should also refrain from visiting the bathhouse, swimming pool, solarium, as the ingress of hot steam or water with bleach (chlorine is added to the water in all pools) can lead to irritation of the mucous membrane and the development of inflammation. In addition, visiting such places is associated with an increased risk of infection in the area of ​​the postoperative wound.

Do I need to follow a diet after adenoid removal?

The duration of the diet depends on the type of operation. With the classical and endoscopic adenoid removal methods, the diet should be observed for 1-2 weeks, while with other methods - for 3-5 days. On the first day after any operation, it is recommended to take only liquid food (broths, jelly) in a warm form. Other foods can be added on the following days.

After removing adenoids from the diet, it is recommended to exclude:

• Cold drinks and meals- cold compote, jelly, cold appetizers, ice cream.
• Excessively hot drinks and food- tea, coffee, hot chocolate.
• Poorly processed food- Freshly picked fruits or vegetables can contain a large number of microbes or toxins.
• Rough, tough food- the risk of mechanical trauma to the mucosa in the wound area increases, which can lead to bleeding.
• Sweets- sweets, marmalade, marshmallows (their use contributes to the development of bacterial flora in the oral cavity).

Consequences and complications of adenoids

• inflammation of the adenoids;
• development of infection of neighboring organs;
• complications arising after removal of the adenoids.

Inflammation of the adenoids (adenoiditis)

The disease begins acutely and is characterized by:

• An increase in body temperature. At first, mild subfebrile condition (37 - 37.5 degrees) may be noted, but by the end of the first day the temperature usually rises to 38 degrees and above.
• Symptoms of general intoxication. Dizziness, headaches, muscle and bone pain may appear. There is increased sweating and chills (trembling and a feeling of coldness in the hands and feet against the background of increased body temperature).
• Mucous discharge from the nose. If mucous secretions were observed before (which is typical for most children with 2-3 degrees of adenoids), with adenoiditis their number increases. When a bacterial infection is attached, purulent discharge of a gray-yellow color may appear, sometimes with streaks of blood (which indicates damage to the blood vessels of the mucous membrane).
• Nasal congestion. If nasal breathing was disturbed earlier, with adenoiditis, it can completely disappear. This is due to a pronounced swelling of the mucous membrane of the adenoids, which can completely block the lumen of the respiratory tract.
• Hearing impairment. It is also caused by swelling of the mucous membrane, which can block the lumen of the auditory tube on one or both sides.

The principles of treatment of adenoiditis are:

• Bed rest until the fever disappears.
• Antibacterial treatment- ceftriaxone, doxycycline, cefuroxime.
• Antihistamine (antiallergic) drugs- cetirizine, suprastin (eliminate the severity of mucosal edema).
• Vasoconstrictor drops- xylometazoline (constricts blood vessels, eliminates tissue swelling and normalizes nasal breathing).
• vitamin therapy- vitamins C, E, vitamins of group B (necessary for the normal functioning of the immune and other body systems).
• Warm drink- up to 2 - 3 liters of fluid per day (this contributes to the mechanical removal of infection from the nasopharyngeal mucosa, as well as the release of bacterial toxins from the body that could enter the bloodstream).

The development of infection in adenoids

Adenoids can become complicated:

• Rhinitis. In this case, the infection (usually viral) enters the mucous membrane of the nasal passages, which leads to inflammation and swelling. Clinically, this is manifested by nasal congestion, runny nose and severe symptoms of intoxication (the temperature can rise to 39 - 40 degrees). Treatment is symptomatic - vasoconstrictor, anti-inflammatory, antihistamines are used. Antibiotics may be given to treat or prevent a bacterial infection.
• sinusitis. This term refers to inflammation of the paranasal sinuses - maxillary (with sinusitis) or frontal (with frontal sinusitis), which occurs in almost any rhinitis. Under normal conditions, these sinuses communicate with the nasal cavity through small openings. In sinusitis, the inflamed mucosa swells and blocks these messages, and as a result, inflammatory fluid (exudate) can accumulate in the sinuses, bacterial infection can develop, and pus can accumulate. Treatment is usually the same as for rhinitis. In case of accumulation of pus in the sinus, it is punctured (pierced with a special needle), the purulent masses are removed and washed with antibacterial solutions.
• Purulent pharyngitis. It develops during the reproduction of pyogenic microorganisms (staphylococci, pneumococci) on the mucous membrane of the pharynx. In addition to the main manifestations of the infectious-inflammatory process (redness and swelling of the mucosa, fever and other symptoms of general intoxication), a purulent grayish-yellow coating forms on the surface of the posterior pharyngeal wall, severe sore throats appear (especially when swallowing food). Treatment of this disease should be carried out with broad-spectrum antibacterial drugs (penicillins, cefuroxime, ceftriaxone). It is also recommended to gargle with saline solution (1-2 teaspoons of salt per glass of warm boiled water) 4-6 times a day and after each meal to prevent further infection.
• Tonsillitis (tonsillitis). Tonsillitis is an infectious inflammation of the palatine tonsils (tonsils). They become red, swollen and sore. With purulent tonsillitis, a purulent plaque of white or yellowish color may appear on the surface of the mucous membrane of the tonsils, symptoms of general intoxication join. Treatment should be with antibacterial drugs that are applied systemically (orally, intramuscularly or intravenously) and locally (gargling with saline solutions, washing the tonsils, and so on). In severe and often recurrent (re-aggravated) tonsillitis, surgical removal of the palatine tonsils is indicated.
• Eustachitis. This term is called inflammation of the mucous membrane of the auditory tube. The reason for this may be the penetration of infection from the surface of the adenoids, which grow so much that they block the pharyngeal openings of the respiratory tubes. Due to a violation of the drainage function of the pipes (that is, due to the impossibility of outflow of the resulting inflammatory fluid and purulent masses), exudate and pus accumulate in them, leading to pronounced inflammatory changes. In addition to the general symptoms of intoxication, patients complain of congestion and pain in the ear, hearing loss. In the absence of urgent treatment (the use of antibacterial drugs that are injected directly into the auditory tube), the purulent process can spread and destroy neighboring tissues (bones, muscles), as well as move into the tympanic cavity and cause inflammation of the middle ear (otitis media).
• Otitis media. In this case, the infection develops in the middle ear cavity, where the auditory ossicles are located. This can be manifested by severe pain and symptoms of general intoxication, and with the accumulation of pus, hearing impairment may occur (purulent masses and inflammatory fluid fill the tympanic cavity, as a result of which the normal movement of the auditory ossicles becomes impossible). Treatment consists in the appointment of antibacterial and anti-inflammatory drugs. With the progression of the purulent process, surgical treatment may be necessary - opening the focus of accumulation of pus, removing purulent masses and restoring the integrity of damaged structures (if possible).

Complications after removal of adenoids

After removal of the adenoids, you may experience:

• Bleeding. The cause of bleeding can be damage to a blood vessel in the wound area, as well as a violation of the blood coagulation system. The most dangerous in this regard is the period in the first 24 hours after surgery, when any irritation of the area of ​​​​the postoperative wound (for example, rough food) can lead to bleeding. This condition is extremely dangerous due to the possible ingress of blood into the respiratory tract, therefore, at the first sign of bleeding from a wound, an ambulance should be called immediately.
• Infection of the postoperative wound. Wound infection can occur if personal hygiene is not followed, and also if the patient does not take antibiotics prescribed by the doctor and does not gargle with saline solutions. The first signs of infection will be redness, swelling and soreness of the tissues in the wound area. If left untreated, the infection can quickly penetrate into the blood (since the protective properties of the mucous membrane in this area are reduced) and lead to the development of systemic complications.
• Disease relapse. The main reason for recurrence (reappearance) is considered to be incomplete removal of adenoid growths during surgery. The remaining part of the lymphoid tissue increases again over time and can reach large sizes. It is also worth noting that surgical treatment should always be combined with the identification and elimination of the cause of adenoid formation. If this is not done, the likelihood of a recurrence of the disease is also high.

Prevention of adenoids

• Promptly treat nasopharyngeal infections. One of the reasons for the increase in the nasopharyngeal tonsil is frequent infectious diseases. In the case of inadequate treatment, the clinical manifestations of the infection may disappear, however, a certain part of the pathogenic bacteria will survive and continue to exist on the mucous membrane of the pharynx, stimulating immune responses and enlargement of the tonsils. To prevent this, a full-fledged treatment of each infectious disease should be carried out. One of the main conditions for this is a sufficiently long treatment with antibacterial drugs, which must be continued for 7-10 days and at least 3-5 days after the disappearance of all clinical manifestations of the infection.
• Eat well. It is known that for the growth and development of the child's body, nutrients, many trace elements and vitamins are required. It is possible to ensure their intake with food only through a rational, balanced diet. The child should eat at least 4-5 times a day, while the food should be varied and include at least a few fruits or vegetables daily.
• Observe the regime of work and rest. Good sleep is a prerequisite not only for the growth of the child, but also for the normal operation of all systems of the child's body. It has been scientifically proven that a full eight-hour sleep plays an important role in the regulation of the immune system. Chronic sleep deprivation after a few weeks leads to a decrease in the body's defenses and increases the risk of developing infectious diseases.
• Harden the body. A good effect can be given by strengthening the child's body with the help of water procedures (rubbing with a wet towel, dousing with water, outdoor activities). The principle of hardening is that with frequent exposure to stress factors (for example, when pouring water), adaptive and protective mechanisms are turned on and improved (in particular, the activity of the cardiovascular and respiratory systems improves, metabolic processes at the cell level are accelerated, and so on). Ultimately, this leads to the fact that the body becomes more resistant to hypothermia, colds and infectious diseases. It is important to remember that the hardening effect appears gradually after prolonged and regular exercise. If you interrupt the exercise, this effect disappears over time.

In order to understand if the child has, you should get a consultation from an ENT doctor, who will make the correct diagnosis already during the examination. During the examination, probing of the adenoids with a finger inserted through the mouth into the posterior-lower part of the nasopharynx is used, as well as posterior rhinoscopy - examination of the nasopharynx with the help of a mirror inserted through the mouth. In addition, instrumental methods of examination can be assigned:

• X-ray of the nasopharynx and paranasal sinuses,
• Endoscopic diagnostics - the introduction of a fiberscope into the nose, followed by a visual examination of the adenoids.

Based on the examination, the degree of enlargement of the adenoids is revealed:

• 1 degree- adenoids block the openings connecting the nasal passages with the pharynx by less than 1/3, the child is worried about night snoring and frequent,

• 2 degree- the choanae are closed by a third or half of the lumen, the child does not breathe well with his nose during sleep and during wakefulness,
• 3 degree- the lumen of the choanae is completely blocked by adenoids, the child experiences significant, if left untreated for a long time, an abnormal bite and an adenoid type of face are formed.

Operations to remove adenoids

The appointment of treatment and the definition of surgical tactics is strictly individual only according to the results of a doctor's examination. In general, we can say that:

Grade 1-2 adenoid growths may well be treated conservatively, while grade 3 adenoids should be removed.

As an addition to drug treatment in the early stages of adenoid vegetations, the method is currently successfully used laser therapy- treatment of adenoids with a laser beam that eliminates swelling and has a bactericidal effect on the surface of the adenoids. Due to this action of the laser, a gradual decrease in the size of the nasopharyngeal tonsil and the restoration of nasal breathing are observed. The course of treatment consists of 10-15 daily procedures, which should be repeated every six months. The advantages of laser therapy include painlessness, safety, good efficiency. No shortcomings of the method were found.

Surgery

The operation of adenotomy in children is possible in several ways:

Indications for adenotomy:

• Adenoid vegetations of the 3rd degree,
• Frequent colds, complicated by purulent, tonsillitis,
• Violations of night sleep, hearing loss, constant headaches, the formation of an adenoid type of face.

Contraindications:

1. Children's age up to two years,
2. Acute infectious diseases - SARS, etc.,
3. Congenital anomalies of the facial skeleton (cleft palate, cleft lip),
4. First month after vaccination
5. Oncological diseases,
6. blood diseases,
7. Allergic diseases in the acute stage.

What kind of anesthesia is used during the operation of adenotomy?

The choice of anesthesia is a contentious issue for the parents of a child scheduled for surgery.

Of course, general anesthesia carries a certain risk, in particular for children with allergies and neurological problems, but in recent years, pediatric anesthesiology has made great strides forward, and now you can safely trust the anesthesiologist who examines the child before surgery. Regarding adenotomy, it can be said that general anesthesia is preferable compared to local anesthesia. This is due to the fact that during a short sleep of a child under general anesthesia, the doctor has better access and an overview of the surgical field, and the little patient himself does not experience negative emotions about the operation, since he simply will not remember it later.

Benefits of general anesthesia:

General anesthesia in children is carried out by endotracheal administration of halothane and nitrous oxide to the patient by an anesthesiologist. In this case, the operation is performed in the supine position. After the end of adenotomy (20-30 minutes), as the patient wakes up, he may be disturbed by lethargy, drowsiness, nausea and vomiting. Such symptoms of recovery from anesthesia performed with halothane are relatively rare.

Recently, doctors have been trying to use local anesthesia less frequently, because, despite the absence of pain, any child will experience fear, cry, scream, and escape from the hands of the staff. This will not only bring a lot of unpleasant emotions to the baby and parents, but can also interfere with the quality removal of adenoids. Anesthesia is performed by lubricating or irrigating the nasopharynx with a spray of lidocaine, dicaine, and other local anesthetics.

Regardless of what kind of anesthesia is used, the child is given intravenous or intramuscular injection of sedatives 20-30 minutes before the start of the operation.

How is the operation carried out?

Adenotomy can be performed both on an outpatient basis (most often) and in an inpatient setting. The issue of hospitalization in the hospital is decided individually, but, as a rule, the length of stay in the hospital is no more than three to four days. The child cannot be fed in the morning before the operation, as anesthesia can be general. After examining the doctor and measuring the patient's temperature, the patient is escorted to the operating room, where general or local anesthesia is performed on the chair. The further stages of the operation have their own characteristics depending on the methodology.

Endoscopic removal of adenoids is the most modern and gentle operation technique. An endoscope is inserted into the nose under general anesthesia, which allows you to examine the adenoids and outline the scope of actions. Further, depending on the tools that this doctor owns, adenoids are removed using a scalpel, radiofrequency knife or microdebrider. In the latter case, the adenoids are removed through the nose. Due to the fact that this technique requires more expensive equipment and more qualified specialists, not every clinic can offer endoscopic adenotomy. Most often, such services are provided in private medical centers.

Image of endoscopic removal of adenoids

One of the varieties of endoscopic surgery is the method of coblation removal of adenoids - the introduction into the nasopharyngeal cavity of an instrument that has a destructive effect on tissues using cold plasma.

Laser adenotomy can be performed under local anesthesia, however, due to the fact that traditional tissue excision is more reliable, many doctors first remove the adenoids with a scalpel or adenotomy, and then use a laser beam to cauterize the remaining areas of the adenoids.

Manual excision of adenoids using adenotome is carried out as follows - a laryngeal mirror is inserted through the child's mouth, which raises the soft palate and tongue, and allows the doctor to examine the area of ​​​​adenoid vegetations in more detail. After examination, a special loop is thrown onto the tonsil, which has sharp edges, and the adenoids are cut off with this loop. Then electrocoagulation of bleeding vessels is carried out, and if necessary, tamponade with hemostatic solutions.

Adenotomy

Adenotomy in general takes no more than 20 minutes. After the operation, the child's nose is again examined by a doctor, then he is transported from the operating room to the observation room, and after 4-5 hours, if there are no complications and in case of a satisfactory condition, he can go home. One-day stay of the child in the hospital is accompanied by one of the parents.

Video: removal of adenoids in children (endoscopic method)

Postoperative period - what is possible and what is not?

In the postoperative period, a slight increase in temperature up to 38 0 is possible, which is easily stopped with suppositories or paracetamol-based syrup, soreness and a feeling of congestion in the nasopharynx, disappearing after a couple of days. Within two hours after the operation, the child should not be fed, and for 7-10 days, follow a light diet - exclude hot, spicy, salty foods that irritate the oropharynx, drink more fluids. Also, for several days, the child should not be bathed, especially in a hot bath or in a bath, and the number of contacts should be limited to avoid a viral infection.

In the first 7-10 days, a reflex edema of the mucous membrane develops in the nasal cavity, in this connection, vasoconstrictor nasal drops should be used for a course of at least 5 days and silver-based drops (protargol, collargol) for ten days or more (up to a month).

In the first month after the operation, the child should receive fortified high-calorie food, consume more fresh vegetables and fruits, have more rest and gain strength.

Possible Complications

It is worth considering possible complications of adenoiditis in case of refusal of surgery are:

1. Otitis and hearing loss caused by impaired patency of the auditory tubes, covered with overgrown adenoids,
2. Violation of mental activity and a decrease in academic performance due to chronic hypoxia of the brain,
3. Allergic diseases, up to bronchial asthma, caused by frequent colds with the acquisition of an allergic component of the common cold and its complications.

In the same time, complications after surgery rarely occur in children, and the main one is bleeding caused by incomplete cutting of adenoid tissue. The probability of such a complication is extremely low if the operation is performed endoscopically and under general anesthesia, since the patient's motor activity, which interferes with the operation, is minimized in this case.

Also considered a complication of adenotomy is recurrence of adenoid vegetations. This is due to the use of local anesthesia, when the child prevents the doctor from fully capturing the base of the adenoids with a loop and completely removing the tissue. The frequency of re-growth of adenoids during the use of general anesthesia has decreased significantly in recent years - from 20-30% with local anesthesia to 1-2% with general anesthesia.

In conclusion, it should be noted that the unconscious fear of parents who are told about the need to remove adenoids to a child is caused by their own unpleasant memories or stories of acquaintances about operations accompanied by a large amount of blood and performed on children who are conscious. The latest achievements of doctors in the field of otorhinolaryngology make it possible to discard such fears and perform the operation competently, efficiently and without pain.

Video: what are adonoids and the operation technique