When is surgery necessary?
Many parents are interested in whether an operation to remove the adenoids is needed or whether drug treatment can be dispensed with. The answer depends on the severity of the pathology and the presence of complications. Typically, adenotomy is performed:
- when inflammation (adenoiditis) becomes chronic. This means that a focus of infection is constantly present in the body, which is fraught with generalization of the process;
- with the rapid growth of lymphoid tissue; with difficulty in nasal breathing, when the child constantly breathes through the mouth, due to which the mucous membrane of the oropharynx dries up and is injured. In addition, children do not sleep well, become irritable, moody and lethargic; when the child temporarily stops breathing during sleep. This condition is called apnea, which results in oxygen starvation of internal organs and their dysfunction;
- with chronic otitis media. The development of inflammation in the middle ear section is due to a decrease in the lumen of the auditory tube due to swelling of the mucous membrane and partial overlap with lymphoid growths. The child has poor hearing and complains of frequent pain in the ear;
- when the facial skeleton changes, when the mouth is constantly open, and the facial expression becomes dejected ("adenoid face").
Removal of adenoids in adults is a very rare operation, since after 10 years the lymphoid tissue undergoes a reverse development, therefore, in adults, the problem of adenoids is not relevant. Intervention is carried out only with the development of a malignant process in the amygdala.
Preparatory stage
Before the adenoids are removed, a complete examination of the child is performed. At the time of preparation for the operation, parents should observe the child's behavior, since the intervention should not be carried out with a cold. If an adenotomy is planned for a schoolchild, it is advisable to perform it during the holidays, so that there is time to restore the body's strength.
Parents should take care of the release of the child from school and clubs in advance. It is also recommended to visit a dentist. Of course, not a very pleasant visit, but the treatment of carious teeth is imperative to eliminate the infection of the oral cavity.
Particular attention should be paid to the psycho-emotional state of the child. In the preoperative period, you need to calm the child, but not talk about the intricacies of the procedure and the strength of the pain. It is better to promise ice cream after surgery, which will significantly improve the mood of the little patient.
It is necessary to remove adenoids after a complete examination, identifying contraindications and determining the risk of surgery. Consultation with an anesthesiologist is required for the choice of anesthesia, the need for additional sedation and the implementation of the doctor's recommendations. They relate to food and fluid intake.
Dinner should be no later than 19:00 on the eve of the adenotomy.
Failure to comply with the recommendations of the anesthesiologist can lead to cancellation and postponement of the intervention to another day, which will be additional stress for the child. In addition, it will be very difficult to go to the hospital again without the child's tantrum.
In addition, the surgeon tells how the amygdala will be removed and what are the features of the postoperative period.
Anesthesia
Parents, no less than children, are interested in whether it is painful to remove tonsils. To calm them all down a little, we will tell you what types of pain relief can be used for children:
- local anesthesia is selected taking into account the age, concomitant diseases and psycho-emotional state of the child. This pain relief is often preferable for older children. To ensure that there is no pain, an anesthetic is sprayed onto the nasopharyngeal and pharyngeal mucosa. In this case, the patient does not feel pain, but children may be afraid of blood, therefore, sedatives are additionally administered intramuscularly. Against their background, the little patient does not react so violently to manipulation, which has a positive effect not only on the child's condition, but also on the course of the intervention. The advantages include the absence of side reactions and lower cost. If parents talk about the child's moodiness, fearfulness and vulnerability, you should not choose local anesthesia;
Local anesthesia is not performed if you are allergic to local anesthetics (lidocaine, novocaine).
- removal of adenoids under general anesthesia is performed quite often. Peaceful sleep of the child not only positively affects his psycho-emotional state, but enables surgeons to perform removal more accurately. Of course, when choosing general anesthesia, parents should take into account the risk, which should be questioned by the anesthesiologist for their peace of mind;
- today, removal of adenoids without anesthesia is not performed. Previously, such operations took place in ENT practice, which was explained by the absence of nerve endings in the amygdala and the painlessness of the manipulation. It was not entirely humane, therefore, in our time, anesthesia is used in any case, protecting the nerves of parents and children.
How the action of anesthesia goes, and what are its features, the anesthesiologist must tell. The operation is carried out only after the voluntary consent of the parents. If necessary, the anesthesiologist can refer the patient for additional examination and consultation of specialists (cardiologist, nephrologist).
Types of operations
When it is planned to remove the adenoids, the operation can be performed in several ways:
- the classic method involves the use of an adenotome (a special ring-shaped knife), which is necessary to remove the adenoids. For the operation, a laryngeal mirror is used, with the help of which the surgeon examines the operating field. The disadvantages of this intervention are bleeding and poor visibility. Because of this, the surgeon can leave a piece of hyperplastic tissue, which will later become the basis for a relapse. To stop bleeding intraoperatively, a laser, powders or radio waves are used. In modern otolaryngology, radio wave adenotomes are used. A knife, passed through the lymphoid tissue to remove it, simultaneously seals the damaged vessels, preventing the development of bleeding;
- the laser is considered a less traumatic and accurate method for performing adenotomy. There are several types of instruments that are selected taking into account the anatomical features and the severity of the disease. An integral advantage is the sterility of the operating field, which is achieved by laser exposure. This makes it possible to avoid infectious complications. Postoperative wound healing is much faster;
- endoscopy is characterized by good visibility of the operating field. A complete view is provided with a video endoscope. The endoscopic method refers to high-precision and effective methods of surgical intervention, which allows you to completely excise the altered lymphoid tissue and prevent its re-growth;
- Coblation refers to innovative developments.The operation is performed with the help of a coblator, which allows you to prevent blood loss, pain, shorten the rehabilitation period as much as possible and reduce the risk of complications. The only drawback is the high cost.
Complications of the operation
As it turns out, cutting out the adenoids is not so difficult, but even such a short-term manipulation can lead to undesirable consequences. Among the complications, it is worth highlighting:
- massive bleeding in the intra- and postoperative periods. To stop bleeding, tamponing and coagulation of the bleeding vessel is used. Bleeding can be suspected by clots and drops of blood flowing from the nose.
The child may spit out blood as it flows down the posterior pharyngeal wall. If blood gets into the larynx, coughing up blood is possible, which can greatly scare the child and parents.
- in the process of intervention, trauma to the palate and complications in the form of an allergic reaction to drugs used for anesthesia are possible;
- temporary decrease in immune defense. Some parents think that after removal of the adenoids, the child will become sick more often, but this is not the case, because the proliferation of lymphoid tissue does not perform a protective function. A decrease in immunity after manipulation occurs due to stress and tissue damage, which provokes inflammation. In addition, the child is weak and poorly nourished in the early days, which also predisposes to infection and the development of a cold. Within a month, immunity is restored. The high risk of secondary infection is the reason why children should not go to school and sports in the coming weeks after adenotomy;
- snoring may be disturbing for up to 10 days after the tonsil is removed. It appears due to swelling of injured tissues and deterioration of the patency of the nasal passages;
- For several weeks, blood crusts may persist in the nasopharynx, and streaks of blood may be observed in mucous secretions.
Postoperative period
To improve your child's mood, you can buy ice cream after returning home. It will not only calm the little patient, but also narrow the blood vessels, preventing the development of bleeding. To reduce pain when swallowing, analgesics may be prescribed in the form of a spray for irrigation of the throat or in tablet form.
If the child has swallowed blood, vomiting with a bloody impurity is possible.
On the first day, sometimes there is an increase in temperature up to 38 degrees.
Drinking plenty of fluids is indicated to reduce fever. Of the antipyretic drugs, the use of drugs based on acetylsalicylic acid is prohibited. It can interfere with blood clotting and increase the risk of bleeding.
In consultation with the doctor, nasal drops with a vasoconstrictor and astringent effect may be used. They allow you to reduce swelling of the mucous membrane and restore nasal breathing. During the first week of rehabilitation, it is forbidden to visit hot places (sauna), hot bath and tanning under the sun.
Particular attention is paid to a nutritious diet. Hard, fried, spicy foods and hot tea are excluded, which irritate the mucous membrane of the oropharynx. Breathing exercises are also useful to normalize nasal breathing. It helps the child to reorganize breathing through the mouth to the nasal one.
In the first 2-3 weeks after the operation, heavy physical activity and stressful situations are contraindicated. It is recommended to spend more time outdoors. Airing the room is carried out when the children are not in the room, since a draft can only aggravate their condition.
Parents need to understand that the course of the rehabilitation period is also important in the treatment of the child. Already a month after the adenotomy, the doctor can assess the success of the operation and give further recommendations.
