When adetonomy is needed, its types and features. Removal of adenoids in children under general anesthesia: advantages, disadvantages, consequences Removal of adenoids in children indications for surgery

Growths of lymphadenoid tissue in the nasopharynx quite often represent a persistent anatomical formation, which, if large, prevents the baby from living. Therefore, the operation to remove the adenoids is used as a radical way to get rid of this problem, when other means were powerless.

The need for surgical intervention is determined by the attending physician - an otolaryngologist after a complete comprehensive examination of the child.

Adenoids is a pathologically growing and steadily increasing nasopharyngeal tonsil. Its progressive growth leads to significant difficulty in nasal breathing, persistent hearing loss and other serious disorders.

And yet, there are nuances that parents need to know:

• what is the name of the operation?
• indications and contraindications for adenotomy;
• methods of surgical interventions;
• features of the course of the postoperative period;
• complications and rehabilitation measures after removal of the adenoids.

Currently, a fairly common treatment tactic in pediatric otolaryngology is the removal of adenoid growths (adenotomy) from the moment the pathology in the child is determined - this is the wrong tactic. But the question of whether an operation of the adenoids is necessary, in each case, only the doctor decides.

Usually, with any degree of growth of adenoid vegetations, conservative treatment is resorted to, but if positive result no, clinical manifestations progress or complications arise - adenoids are removed. At the same time, experts recommend performing adenotomy after 5 years, but when absolute indications appear, surgical intervention is performed at any age.

Indications and contraindications for adenotomy

Adenotomy is performed with adenoid growths of 3-4 degrees

Direct indications for the removal of adenoids - the operation is performed:

1. With the complete ineffectiveness of conservative methods of treatment and a progressive increase in adenoid vegetations.
2. With relapses of adenoiditis more than four times a year, their complicated course (sinusitis, otitis media, eustachitis, laryngotracheitis, bronchitis, pneumonia).
3. If serious complications occur:

• attacks of respiratory arrest (apnea) during sleep;
• progressive hearing loss;
• the occurrence of neuropsychiatric disorders (convulsions, neuroses, enuresis);
• maxillofacial changes, speech disorders;
• somatic diseases (rheumatism, arthritis, glomerulonephritis, vasculitis and other pathologies).

But even in the presence of these signs, surgical removal of adenoids is carried out only after complete examination child and in the absence of contraindications.

These include:

• acute respiratory disease or exacerbation of any chronic process - adenotomy is prescribed only 3-4 weeks after the patient has fully recovered;
• serious diseases of the hematopoietic system, if the operation is essential, it is carried out in a specialized hospital;
• pathology of the heart without correction;
• tuberculosis;
• influenza epidemic period.

How is the operation performed - methods of surgical interventions

Parents are most often concerned about the question of how it goes and how long the surgery lasts.

The need for an operation causes fear and excitement, both the very fact of surgical intervention in a child, and everything connected with it:

• choice of adenotomy method;
• anesthesia during surgery;
• possible complications;
• consequences after adenoid surgery;
• features of the recovery period.

Endoscopic method of adenotomy

The main difference between endoscopic techniques is the introduction of an endoscope (video camera) into the nasopharynx, which allows the specialist to clearly see the location of adenoid growths and more carefully remove them. But at the same time, "blind" methods of adenotomy are often used.

Classical adenoidectomy was previously performed under local anesthesia after irrigation of the nasopharynx with lidocaine or even without anesthesia due to the fact that these growths of lymphoid tissue do not have nerve endings. But at the same time, various serious psychological problems often arose in the child.

Therefore, most modern specialized clinics currently remove adenoids in children only under general anesthesia. And now adenoid vegetations are being removed under local anesthesia, but in addition to the child, a sedative drug is administered, most often a tranquilizer.

The duration of the operation averages from 20 to 50 minutes - it depends on many factors, including the method of adenotomy and individual characteristics patient.

The course of the operation may differ in the method of excision of the nasopharyngeal tonsil:

• the doctor uses an ordinary circular scalpel - a Beckman knife;
• pathologically altered tissues are cut with a shaver instrument (microdebrider);
• removal of adenoids is performed by a laser;
• for excision of adenoids, a special apparatus is used with a “loop” that heats up to high temperatures(electrocoagulation);
• cold plasma adenotomy;
• removal of growths with a radio knife;
• a combination of several methods - the area after removal with a scalpel or microdebrider (large adenoids) after surgery is often supplemented with laser or radio wave treatment, which reduces the risk of recurrence.

The price of surgery depends on the qualifications of the specialist, the volume of adenotomy and the equipment that is used.

Removal of adenoids with a laser

Currently, innovative methods of adenotomy are increasingly being used, which are considered to be less traumatic and with a minimal risk of bacterial complications.

Therefore, parents are often interested in the question of how laser surgery is performed on adenoids. Is it safe and painless?

The technology of surgical intervention using a laser is carried out in the form of two types of manipulations:

• coagulation- in this case, the focused beam removes the growths of lymphoid tissue;
• vaporization- the tissue of the nasopharyngeal tonsils is evaporated in layers.

In addition, the laser cut is processed after the operation, which was carried out in a different way. And yet, only a highly qualified specialist will be able to determine the depth of laser destruction, which is provided the latest technologies laser systems to provide the ability to set the desired beam diameter and full control depth of exposure for complete removal of growths.

Recovery period after surgery

Surgery for adenoids postoperative period are of great importance.

Adenotomy takes place in 2 stages:

• direct surgical intervention;
• procedures to normalize nasal breathing and restore hearing.

On the first day (immediately after surgery), with any technique, the child may experience:

• vomiting blood clots, dark stools;
• abdominal pain and/or diarrhea;
• an increase in temperature to high numbers in the first 48 hours after surgery;
• nasal speech and increased nasal congestion due to significant swelling of the nasopharynx after adenotomy.

As an antipyretic, acetylsalicylic acid is categorically not recommended - this greatly increases the risk of bleeding.

Most often, complications after adenotomy are postoperative bleeding associated with blood clotting problems or the presence of an area of ​​lymphoid tissue in the nasopharynx.

In addition, there may be:

• nasopharyngeal injuries;
• otitis due to infection in the middle ear area;
• prolonged subfebrile condition;
• re-growth of adenoid vegetations.

To avoid most complications, the following rules must be observed:

• bed or semi-bed rest for 2 days;
• completely limit physical activity for a month;
• follow a special diet for 10 - 14 days (exclude hot and rough foods from the diet, limit marinades, spicy, fatty and fried foods in the diet);
• exclude the possibility of prolonged exposure to the sun, taking a hot bath, visiting a bath;
• it is necessary to ensure that the child is not in a stuffy and hot room;
• avoid contact with SARS - for 2 weeks less to be in crowded places, not to visit children's groups (the child is at home).

To improve the healing of the surgical wound, the child is prescribed nose drops containing silver, vasoconstrictor drops. In this case, the instructions of the attending physician must be followed in full. For the prevention of relapse, nasal is often prescribed for a month 1 time at night.

After the operation, the observation is carried out by the district pediatrician and the pediatric otolaryngologist. Drinking and eating should be fortified, the child's diet should be balanced. To improve healing, warm carrot juice, a decoction of nettle, yarrow, string, and plantain juice are added to the menu.

To strengthen immune system course receptions of plant adaptogens (echinacea, ginseng, magnolia vine), outdoor walks, and, if necessary, mild immunomodulators are prescribed.

Breathing training is carried out in the morning (before breakfast) and in the evening (after dinner) for 20 minutes. This contributes to the gradual restoration of breathing through the nose and the rapid recovery of the child's body. The video will help you learn more about the features of this surgical intervention and show the operation on the adenoids.

In modern clinics, when performing endoscopic adenotomy, the doctor has the opportunity to completely remove the lymphoid tissue under the control of special devices. The implementation of all recommendations in the postoperative period + in a timely and correct manner is the key to a complete cure for this serious disease without consequences for the health of the baby.

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

Indications for removal

In medicine, adenoids are divided into 3 main degrees:

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

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

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

• the child is not breathing well or cannot breathe through the nose at all;
• hearing impairment;
• unstable sleep, he often wakes up;
• night snoring, which is not typical for children 3-7 years old;
• children often suffer from otitis media, sinusitis, SARS;
• occasionally in children over 5 years of age, facial deformity is observed.

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

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

Contraindications

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

Even if your surgeon insists on an immediate operation, and you know there are contraindications, you should not rush, says Dr. Komarovsky. You always have the option to speak up against it and consult with another doctor.

Video "Methods and methods of removal"

Removal methods

According to Dr. Evgeny Komarovsky, a good and experienced surgeon will immediately tell you exactly what methods exist and how adenoids are removed in children. Parents will be able to choose the most optimal and safe way for the child, weighing all the pros and cons.

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

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

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

Special preparation for the procedure is not needed. This operation is performed under general anesthesia. If the adenoids are very large, then Evgeny Komarovsky advises using the laser only for processing the cut, and the main procedure was endoscopic intervention.

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

The surgeon carefully cuts off the adenoids using special instruments. This eliminates relapses almost completely. Immediately after the cut, the wound is pressed for several minutes, which prevents bleeding and speeds up the healing process. You need to agree to such an operation if the adenoids are deep in the nose. Special indications for such a procedure are not needed.

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

If you are against surgery, then Dr. Komarovsky advises taking a course of cryotherapy. Cryotherapy is an effect on the adenoids by irrigating them with liquid nitrogen vapor. This procedure is absolutely safe and painless. During cryotherapy, a tube of a cryo-atomizer is inserted into the baby's nose. During the process itself, steam comes out of the mouth, like smoke from a dragon. For which the children nicknamed cryotherapy "Dragon".

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

Anesthesia methods

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

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

It is best when local anesthesia is supplemented with the introduction of sedatives intravenously, after which it is conscious, but sleeping or dozing. It is better to weigh the pros and cons of local anesthesia before the operation, and choose best option for your child.

What could be the consequences

After removal of the adenoids, complications in the form of otitis media, bleeding, severe pain, purulent-septic complications. The most terrible consequence may be a recurrence of adenoids. It happens in 85% of cases. Recurrence most often occurs in cases where the operation is performed on young children under the age of 3 years. Relapses occur in children with a tendency to allergic reactions.

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

Due to swallowing a large number blood during the procedure, hematemesis may begin. If vomiting does not stop within an hour, the baby should be shown to the doctor. Purulent otitis occurs due to an infection introduced during surgery. An increase in body temperature for two days after removal is not excluded.

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

Video "Adenoids. Indications for removal »

To understand in what situations it is necessary to resort to the removal of adenoids, we recommend watching the following video clip. Dr. Komarovsky popularly explains all the advantages and disadvantages of the operation.

Removal of adenoids by modern methods at the Ear, Nose and Throat Clinic. Our surgeons have performed thousands of successful surgeries.

What is adenoid removal?

Surgery to remove adenoid vegetations is called adenotomy. Adenoid is a pathologically enlarged nasopharyngeal tonsil. Normally, this organ protects against infections, but frequent infectious diseases lead to recurring inflammation of the lymphoid tissue, due to which its excessive growth is noted - adenoids are formed. Most often, children from 3 to 14 years old get sick, adults encounter adenoids very rarely.

Degrees of enlargement of adenoids

The current classification according to the degree of enlargement of the adenoids (and it determines the indications for medical or surgical treatment):

Methods of conservative treatment of adenoids

The adenoid is an organ of the immune system. Its tissue contains cells that produce antibodies to pathogens. With the success of conservative treatment, this protective barrier is fully preserved. Appointed antibacterial drugs, since adenoiditis (inflammation of the adenoid tissue) occurs primarily due to exposure to pathogenic microflora. To remove bacteria from the nasal mucosa and nasopharynx, courses of nasal lavages are carried out using a vacuum pump. Physiotherapy, such as the KUF tube, laser and magnetic devices, quickly relieve inflammation, improve blood circulation and local immunity. Not only an otolaryngologist is involved in the treatment of the adenoid, but also an allergist-immunologist, he prescribes general strengthening drugs that stimulate the body's defenses in order to reduce the number of acute respiratory infections. But the effectiveness of conservative methods of treatment is about 50% and there is a risk of repeated exacerbations when faced with an infection, which means that the symptoms may resume.

Indications for removal of adenoids

An increase in adenoid vegetations forms a chronic focus of infection, reduces immunity, and disrupts the functioning of the auditory tubes. These changes in the body contribute to the indication for removal of adenoids:

• SARS and ARI. In the nasal cavity there is an obstruction in the form of adenoids, which makes it difficult for the outflow of mucus. Mucus protects us from viruses, but when an obstacle arises, then in the nasal cavity are created favorable conditions for the development of infections and inflammatory processes.
• Hearing loss. The adenoid closes the mouth of the Eustachian tube, preventing the free passage of air into the middle ear. Eardrum loses its mobility, which finds its negative reflection in the auditory sensation.

• Chronic inflammation of the nasopharyngeal tonsil (chronic adenoiditis). Inflamed adenoid vegetations are a good environment for attacking infections. Bacteria and viruses are formed in the nasopharyngeal tonsil, causing chronic adenoiditis, accompanied by a constant runny nose.
• Multiple otitis. The growth of the nasopharyngeal tonsil disrupts the function of the middle ear, and favorable conditions are formed for the spread and development of infections.
• Respiratory tract diseases - pharyngitis, laryngitis, tracheitis, bronchitis. With an increase in lymphoid tissue, chronic inflammation develops. Due to growth, mucus and pus are constantly formed, flowing into the department respiratory system. In case of contact with the mucous membrane, they cause inflammatory processes that lead to infectious diseases of the respiratory tract.
• adenoid cough. This is due to the stimulation of nerve endings located in the nasopharynx and on the back of the pharynx. Most often, doctors associate the patient's cough with colds and flu, while the patient does not have a violation of the bronchial tubes, in which case the cough may be a symptom of adenoids. With the treatment of adenoid, the cough disappears.
• Bronchitis, pneumonia
• Speech disorders
• Lag in physical development
• Neurological disorders - headaches, enuresis, convulsive conditions
• Malocclusion with the formation of "adenoid face"
• Failure of conservative treatment

Removal of adenoids in children

Optimal age for removal of adenoids in children- 3-7 years. Postponing surgery when indications for surgery can have negative consequences and cause diseases such as persistent hearing loss due to disruption of the auditory tube, the formation of a viscous fluid in tympanic cavity(exudative or adhesive otitis), facial deformity, malocclusion, caries, destruction of tooth enamel, violation of teething. The presence of a chronic focus of infection in the body can cause diseases such as bronchial asthma, chronic glomerulonephritis(autoimmune inflammation of the kidneys) and weakens the immune system.

Removal of adenoids in adults

There are cases when adenoids are diagnosed in adults. This is due to the widespread introduction of endoscopic methods for examining the nasal cavity in the diagnosis. Symptoms may not be as pronounced as in childhood Therefore, often complaints of nasal congestion, frequent runny nose, otitis media, mucus flow down the back of the throat in adults can be regarded by doctors as symptoms of other diseases, which leads to treatment failure and aggravation of the situation.

Indications for removal of adenoids in adults:

• snoring, breathing problems during sleep
• frequent colds
• chronic tonsillitis or pharyngitis
• difficulty in nasal breathing
• postnasal drip syndrome (drainage of mucus down the back of the throat)
• recurrent sinusitis or chronic sinusitis
• recurrent purulent or exudative otitis, hearing loss
• bronchial asthma, chronic bronchitis

Methods for diagnosing adenoids

The classic methods for diagnosing hypertrophy of the nasopharyngeal tonsil are a digital examination of the nasopharynx and an examination of the posterior parts of the nasal cavity. But these procedures are difficult and provide little information, especially in the case of children. The most modern diagnostic method is endoscopic examination - a method of examining the mucous membrane of the upper respiratory tract with an endoscope. The advantage of endoscopy is that it is painless and safe, the doctor gets a complete picture of the size of the nasopharynx, the degree of enlargement of the adenoid tissue and the condition of the mouths of the auditory tubes. Together, these data allow you to determine the method of treatment and diagnose the disease at an early stage.

Adenoid Removal Methods

Instrumental method for removing adenoids

For removal of adenoids you need a special scalpel - Beckman's adenotome. The adenotome is inserted into the nasopharynx, set in such a way that all the tissue to be removed enters the adenotome ring. And the adenoid is cut off. Bleeding stops on its own within a few minutes. The advantage of the operation is that it is carried out under local anesthesia and on an outpatient basis. Minus - the removal is performed "in the blind", that is, cutting off the tissue, the doctor is not able to see the nasopharyngeal cavity, which means to check whether particles of adenoid tissue remain, which can lead to re-growth (relapse).

Radio wave method for removing adenoids

The operation is performed using the Surgitron device with a nozzle for removing the adenoid - a radio wave adenoid. A radio wave adenoid cuts off the adenoid in a single block, as in a classical operation, but at the same time the radio wave coagulates (cauterizes) the vessels, so bleeding during such an operation is minimized. The advantage of the technique is to reduce blood loss during surgery and reduce the risk of bleeding in the postoperative period.

Removal of adenoids with a laser

One of the modern achievements in the field of surgery is the use of a laser. Under the influence of laser radiation, the temperature of the tissue rises and the liquid evaporates from it. This method is bloodless. However, it has disadvantages - the operation time increases significantly, heating of healthy tissues in the area of ​​laser exposure can occur.

Removal of adenoids with a shaver (microdebrider)

Microdebrider - a tool with a rotating head and a blade at the end. With its help, the adenoid is crushed, and then aspirated into the suction reservoir, which also allows you to quickly and completely remove adenoid vegetations, while not damaging the healthy nasopharyngeal mucosa, this is important, because otherwise bleeding occurs, and later scars form. The microdebrider operation is performed under anesthesia with endoscopic control. This is the most progressive method of adenotomy, in which the risk of recurrence is minimal.

Our clinic uses a combined method of removal. We use the advantages of each of the above methods, it gives greater efficiency, the operation is much faster, the risk of complications is reduced, and the postoperative period for the child is much easier.

Preparation for surgery to remove the adenoids

Preliminary preparation consists in passing a complete examination of the patient. The survey includes:

• general and biochemical analysis blood
• Analysis of urine
• coagulogram
• blood test for infections (hepatitis B and C, syphilis, HIV)
• pediatrician examination

On the eve of removal after 6 pm, you should refrain from eating, it is recommended to take a light dinner, in the morning you should not even drink water.

Absolute contraindications for removal of adenoids:

• severe disorders in the blood coagulation system
• oncological diseases
• anomalies of the vessels of the pharynx

Adenotomy is not performed during acute infectious diseases and within 1 month after vaccination. AT adolescence in girls, surgery is planned for the period before or after menstruation.

Anesthesia for removal of adenoids

Local anesthesia

In children older than 7 years, adenotomy under local anesthesia is possible. Before the operation, a sedative drug is injected intramuscularly into the child, an anesthetic solution (10% lidocaine solution) is sprayed into the nasopharynx, after which a less concentrated anesthetic solution (2% lidocaine or ultracaine) is injected into the adenoid tissue to enhance the effect of anesthesia. During the operation, the child is conscious and perceives everything that happens around.

General anesthesia (narcosis)

In children under 7 years of age, adenotomy is performed under general anesthesia(anesthesia), so the intervention takes place without pain and, which is especially important for the child, without psychological stress. The clinic uses drugs that belong to a high safety class, they are non-toxic, do not give such complications, so anesthesia is easily tolerated even in childhood and feels like normal sleep.

In the photo, the anesthesia machine of the German company Drager used in the clinic.

Anesthesiologists

The clinic employs highly qualified anesthesiologists, including specialists from the pediatric clinical hospital them. N.F. Filatov, who have scientific degrees of candidates and doctors of medical sciences, many years and unique experience work. Our specialists use an anesthetic apparatus of the German company Drager, medications latest generation. All this allows for removal under general anesthesia (anesthesia) that is safe for the patient's health with a quick recovery in the postoperative period.

Used anesthetics

In their work, anesthesiologists use drugs Sevoran, Diprivan, Esmeron, Enfluron, Isofluran, Dormicum and others. The choice of a specific drug is at the discretion of the anesthesiologist and depends on each specific case, test results and other factors.

How is adenoid removal performed?

Endoscopic equipment provides good visual control, and the doctor can very accurately remove hypertrophied lymphoid tissue - this can significantly improve the quality of the operation and reduce the possibility of relapses.

Our clinic uses a combined method of removal using a shaver and a radio wave adenotome - this is a modern high-tech method. The use of a shaver and a radio wave adenotome significantly reduces the recovery time after surgery.

The postoperative period in most cases proceeds easily. In the evening after removal of the adenoids or the next morning, the patient may have a fever.

Immediately after the operation, there is a noticeable improvement in nasal breathing, however, in the following days, the child may develop nasality, nasal congestion, "squishing in the nose." This is due to the presence of postoperative edema, which subsides by 7-10 days.

Adenotomy in adults is performed mainly under local anesthesia (the removal technique is similar to surgery in children). If another intervention is performed at the same time, for example, septoplasty and adenotomy, then the operation is performed under general anesthesia. With a small size of the adenoid, it can be removed by the radio wave method. rehabilitation period proceeds easily, but, if there is chronic diseases tissue healing may be slower than in children.

Complications after removal of adenoids

by the most frequent complication after adenotomy is bleeding. It usually occurs in the first hours after the operation. Therefore, the patient should be under medical supervision for 2-3 hours after the operation. In more rare cases, acute otitis media can occur due to blood entering the auditory tube during surgery. On the first or second day after the operation, the temperature may rise to 37.5-38.0 degrees.

Stay in the hospital

After removal of adenoid vegetations, doctors recommend staying in the hospital under the supervision of a specialist on duty. Usually it takes no more than a day. The advantages of being in the hospital are that the risk of complications is reduced and the best postoperative recovery is guaranteed.

In the photo, a ward in the hospital of the Ear, Nose and Throat Clinic.

After the operation, physical activity should be excluded for one month. For three days, the child should not be bathed in hot water. It is important to observe proper nutrition. It is better to avoid exposure to the open sun and stuffy rooms.

Recommendations for maintaining health after removal of the adenoids

After surgery, to prevent recurrence, restorative and restorative therapy is necessary. General hardening of the body, breathing exercises, as well as treatment and supervision of an allergist-immunologist, especially when it comes to children with concomitant diseases such as atopic dermatitis, bronchial asthma, and allergic rhinitis. Normalization of the immune system is very important - with increasing resistance to infection and colds, reduces the likelihood of proliferation of lymphoid tissue.

Cost of adenoidectomy surgery

The price of the operation in our clinic is 55,000 rubles.

It includes:

• operation
• anesthesia
• hospital stay
• three meals a day in the hospital
• postoperative follow-up for a month (3 visits)

The final price is determined after the examination of the patient by a doctor.

- surgery for hypertrophy (growth) of the pharyngeal tonsils. The choice of method for removing adenoids in children is based on age and physiological features child.

Tonsil removal surgery

Indications for removal of adenoids

The need to remove adenoids arises in case of their pathological increase, strong hypertrophy overlaps Airways and presses on ear canals.

Indication for urgent removal:

1. Nasal breathing is difficult or almost impossible.
2. The jaw area of ​​the face develops incorrectly. Due to constant breathing through the mouth lower jaw bulges forward, and the shape of the face lengthens. Dolichocephaly (it develops faster in children from one to 5 years old, with a long illness it can also appear in adolescents).
3. Speech dysfunctions.
4. Retardation in physical development.
5. Persistent hearing loss, otitis.
6. Brief pauses in breathing during sleep or the child snores loudly.
7. Conservative treatment does not eliminate the recurrence of SARS.

Severe progressive forms of adenoiditis (degree 3 of the disease) is the main indicator for the removal of the tonsils. Untimely operation is fraught with hearing loss, chronic otitis, deformity of the facial skeleton, bronchial asthma and dental problems.

Suitable age for adenoid removal in children is 3 to 7 years old.

How to prepare for surgery

On the day of the procedure, the child must be healthy: a slight runny nose or cough will have a detrimental effect on the body after removal. In case of illness of a small patient, they operate on another day.

The anamnesis includes information about vaccinations or medical withdrawal from vaccination.

Preparation for the procedure includes 5 tests:

• complete blood count (ESR, leukogram, platelets);
• a blood test for clotting (KLA or coagulogram);
• general urine analysis;
• x-ray or CT scan sinuses;
• biochemical blood test (protein, creatinine, urea, electrolytes, ASAT and ALT).

If the adenoids are cut out under general anesthesia, then an additional analysis is prescribed for the blood type and Rh factor. All analyzes are collected within 2 days before surgery.

Before doing anesthesia, you need to check the blood type and Rh factor

For children, it is preferable to perform the operation under general anesthesia in order to minimize fear and stress in the child. If local anesthesia is to be carried out, then the patient is interviewed and psychologically prepared as much as possible.

For 12 hours before the procedure, you can not eat anything, on the morning of the day of the operation, you are allowed to drink a little liquid to eliminate the risk of vomiting, which pain relief can cause.

Adenoid Removal Methods

The use of modern methods of treatment: endoscopic, radio wave, coblation and laser - has not supplanted the classical method of removal.

Classic method

Standard removal is carried out using an instrument - Beckman's adenotome. For pain relief, Novocaine, Lidocaine or Ultracaine is used. The preparation of the patient's body for subsequent actions is carried out 30 minutes before the operation, which is performed under local anesthesia. During adenotomy, the patient sits in a chair, the instrument is inserted into oral cavity, adenoids are captured and removed with one sharp movement of the surgeon's hand. The blood coagulates, with severe bleeding, the place is treated with hemostatics. The operation takes no more than 10-15 minutes.

State clinics operate free of charge, private ones at a price of 10,000 rubles.

Advantage of the method can be performed on an outpatient basis under local anesthesia.

Flaw that the doctor acts blindly, the operation is accompanied by painful sensations, the risk of re-infection when partial removal and a high risk of complications in the postoperative period.

Endoscopic method

Endoscopic shaver adenotomy is less painful and is performed under general anesthesia. For the preservation of tissues, the mucous membrane of the nasopharynx is additionally anesthetized. The endoscope is inserted into the patient through the nasal sinuses and the adenoids are removed with a microdebrider (shaver). The operation lasts about 30-40 minutes.

The cost of adenoidectomy, taking into account tests and anesthesia, starts from 20,000 rubles.

Advantages of using the method: low risk of recurrence and bleeding, control of the stages of the operation, lack of fear in the child.

The main problem with the use of the endoscope- its large width (from 2 to 4 mm).

Radio wave method

The operation is performed under general or local anesthesia. For radio wave adenotomy, the Surgitron device with a special nozzle is used. Removal is carried out by cutting the overgrown tonsils with instant cauterization of the vessels. The price starts from 20 thousand rubles. The operation lasts 20-30 minutes.

The procedure is carried out with the help of Surgitron

Minimizing the risk of bleeding is the main advantage of the method. As a result, the risk of complications also decreases.

The only possible downside Damage to healthy tissues is extremely rare.

Coblation or cold plasma adenotomy, depending on age, is performed under local (for adolescents) or general anesthesia (for children under 10 years old). The organ is exposed to cold plasma, which causes the tissues to coagulate (destroy). The need for highly qualified personnel and additional anesthesia of the nasopharyngeal mucosa raises the price of the operation - from 30,000 rubles. The operation takes about 30 minutes.

During the procedure, the tissues of the tonsils are destroyed.

Of the obvious advantages: no pain in the postoperative period, high accuracy of the device and a minimum of blood. This method is recommended for hemophilia.

A long exposure to plasma can leave scars on the tissues, and a short session will leave the adenoids themselves and increase the risk of relapse. Often, not completely removed outgrowths pass by themselves.

laser removal

One of the longest and most effective methods is laser removal. It takes place under general anesthesia. Adenoids of small sizes are heated by a laser: the temperature of the tissues rises, water evaporates, and the outgrowths are destroyed - the process of vaporization occurs. In severe cases, the outgrowth is excised laser beam at a time, simultaneously cauterized vessels. The operation takes about 40 minutes.

Main plus- no bleeding and reduced risk of complications and recurrence. Being under anesthesia, the child does not experience pain and stress. However, only highly qualified surgeons with the availability of equipment can perform the operation, which raises the price to 25,000 rubles.

The procedure has unpleasant consequences: risk of harming healthy tissue.

With a properly performed procedure, complete recovery occurs in 2-4 weeks.

Postoperative period

In the first few hours, the child has a fever. This is normal, it is not recommended to knock it down while the thermometer shows less than 38 degrees. If the fever gets worse, paracetamol or ibuprofen can be used.

Recovery of the body after removal of adenoids takes up to a month, during which the following measures are recommended:

1. Limitation physical activity: Do not leave the house for the first week.
2. Dieting, eating only soft food: cereals, mashed potatoes, grated vegetables. It is important that the dishes are not hot, cold or spicy and do not contain large hard pieces.
3. Refusal of hot baths and visits to baths or saunas. In the case of infants, do not bathe the child in hot water for 3 days. Heat increases local blood circulation, there will be a risk of bleeding.
4. It is advisable not to visit places with a large crowd of people for the first 2 weeks in order to protect the child from potential carriers of respiratory diseases. School and kindergarten included.
5. On the recommendation of a doctor, use vasoconstrictor nasal drops for healing (Protargol or Xilin).
6. Switching to active breathing through the nose with the help of breathing exercises 10-12 days after the operation. The first week, out of habit, the child will continue to breathe through his mouth, gymnastics will restore the respiratory reflex.
7. Sleep compliance. At least 8 hours a day. Especially important after laser removal.

After the operation, you need to switch to nasal breathing

The first few days of rehabilitation (usually from 3 to 7) the child may complain of sore throat during meals. If the pain is tolerable, then you should not sound the alarm, the wound heals.

If the treatment went smoothly, a white fibrin coating will appear on the tonsils within a few days to protect the mucous membrane during recovery. Over time, the plaque is rejected unnoticed by the child.

Possible Complications

In addition to the risk of recurrence of adenoids (about 15-20%), bleeding is possible, acute inflammation in the ear (if blood enters the ear canals during the operation), purulent processes in the throat, pain and a specific reaction to anesthesia.

One common complication is ear inflammation.

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 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. To diagnose the proliferation 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 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, clinical picture 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

AT modern medicine There are several ways to carry out the operation.

traditional method

Surgery is performed using the usual instruments of the surgeon. This removal option has significant drawbacks. Unfortunately, at 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

It's over effective 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 be due to 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.