Ways to remove adenoids for children: how is the operation performed under local and general anesthesia, what methods are used? How is adenoidectomy performed in children? What kind of anesthesia for adenotomy in children.

Adenotomy is one of the most frequent operations in ENT surgery. Removal of adenoids in children is carried out with their inflammation. Consider the features of this procedure.

The growth of the lymphoid tissue of the nasopharyngeal tonsil is adenoids. As a rule, they occur with frequent colds, chronic runny nose and inability to breathe normally through the nose. Surgical removal is one of the treatments. The operation is prescribed for severe tissue hypertrophy, which cannot be cured by medical methods.

The nasopharyngeal tonsils are an immune organ in the nasopharynx that performs protective functions. Adenoid vegetations (growth) are diagnosed in children 3-15 years old. The disease is associated with age-related features of development immune system. During this period, the tonsils actively grow and often become inflamed.

Features of adenoids for their removal:

After the operation, the protective properties of the immune system in children are reduced. But after 2-3 months, immunity is gradually restored.
Enlarged tonsils indicate that the patient often suffers from infectious and viral diseases that provoke an increase in lymphoid tissue.
The risk of recurrence, that is, the secondary growth of tissues, depends on the quality of the operation. If the procedure is carried out almost blindly, then in 50% of cases the particles of lymphoid tissue grow again. But modern endoscopic operations minimize this, so relapses occur in 7% of patients.
In adults, this pathology occurs due to prolonged exposure to adverse factors. environment. For treatment, adenotomy and medication are also performed.

Normally, the pharyngeal tonsils are several folds of lymphoid tissue that protrude above the surface of the mucous membrane of the posterior pharyngeal wall, which is part of the pharyngeal lymphatic ring. The glands contain lymphocytes - immunocompetent cells that take part in the formation of immunity.

Indications

Difficulty nasal breathing, hearing impairment, sleep problems, night snoring, deformation of the facial bones, frequent otitis media and sinusitis are the main signs of inflammation of the tonsils. Treatment depends on the stage of the pathological process. In the early stages of inflammation, medication is carried out, that is, conservative therapy. The operation is necessary with the rapid growth of the adenoid tissue and the progression of painful symptoms.

General criteria for surgical treatment:

Adenoids of the third degree.
Adenoids of any degree with frequent exacerbation of inflammatory pathologies.
Complications from other organs.
Medical treatment does not give the desired results.
High risk of malignant degeneration of the tonsils.

Consider in more detail the indications for the removal of adenoids in children:

Difficulty in nasal breathing - due to the fact that the patient breathes through the mouth, the mucous membranes dry out, frequent acute respiratory viral infections and their complications. There is restless sleep and disturbances in the psycho-emotional state.
Sleep apnea is holding your breath during sleep. Hypoxia negatively affects the functioning of the brain and the growing body.
Otitis - frequent infections lead to chronic and exudative inflammation of the middle ear. Enlarged adenoids block the auditory tube, causing pathologies in the middle ear. Children get otitis media more often than 4 times a year. Against this background, there is a persistent hearing loss.
Violations of the facial skeleton - enlarged adenoids provoke abnormal deformities in the maxillofacial bones. In medicine, there is a term for the above signs of "adenoid face".
Malignant changes - hypertrophied tonsils can cause an oncological process.

Removal of the tonsils is carried out after a set of diagnostic measures. The treatment is carried out by an otolaryngologist and a surgeon. If necessary, if there are clear indications and serious reasons, then the operation is performed even in infancy. At the same time, frequent acute respiratory viral infections are not an indication for surgery, as well as preserved nasal breathing.

Training

Like any operation, the removal of adenoids in children requires careful preparation. Treatment is best done in early autumn, when the immunity of a small patient is in good condition, and the body is full of vitamins. In the cold season, the operation is not performed, as there is a risk of developing acute respiratory viral infections and other diseases. In hot weather, the risk of purulent and infectious complications in the postoperative period is increased, since bacteria actively multiply during this period.

Preparation for adenotomy:

Dentist visit and dental treatment.
Relief of inflammatory processes in the body.
Complex of laboratory researches.
Instrumental diagnostics.
differential examinations.

Adenotomy is a fairly simple operation that is performed on an outpatient basis. The procedure lasts no more than 20 minutes under local or general anesthesia. Already 4-5 hours after treatment, parents can take the baby home, provided that there are no complications.

The healing process takes a couple of months. Proper preparation minimizes the risk of complications, while parents should be aware of the risk of their occurrence. In the first time after surgery, immunity is reduced. Nasal congestion is also temporarily preserved, the separation of mucus with bloody streaks. After 2 weeks, the patient's condition returns to normal.

Tests before removal of adenoids in children

Before adenotomy, the patient is prescribed a complex laboratory examinations. Tests before removal of adenoids in children consist of:

Blood test (general, biochemical).
Analysis of urine.
Coagulogram - a study of blood coagulation parameters.
Analysis for hepatitis B and C viruses.
Blood test for HIV and syphilis.
Electrocardiogram.

Technique for removal of adenoids in children

To date, there are several ways to treat adenoids. Despite the fact that the tonsils do not have nerve endings, anesthesia is used during the operation so that the patient does not feel discomfort during the procedure.

In ENT surgery, the following methods are used to remove adenoids in children:

The classical method - during the operation there is no possibility of visual observation of the procedure. AT oral cavity is introduced by an adenoid - this is a ring-shaped knife. A laryngeal mirror is used to visualize the procedure. The main drawback of the operation is intense bleeding and the inability to completely remove the lymphoid tissue. In some cases, doctors have to resort to the use of hemostatic drugs.
Endoscopic techniques - surgical interventions with the introduction of an endoscope with a camera into the nasopharyngeal cavity. The image obtained during the operation significantly increases the accuracy of the procedure and its results.
- Laser removal is a high-precision and low-traumatic method. Laser sterility minimizes the risk postoperative complications. The recovery and healing period is much faster.
- Endoscopic treatment– using a video endoscope, the doctor removes hypertrophied tissues with high accuracy. This method gives great results.
- Radio wave adenotomy - inflamed tissues are removed using a special apparatus. The technique delivers a minimum of pain and minimizes the risk of complications.
- Cold plasma treatment is a combination of cryotherapy and plasma technique. Tissue excision is performed using low temperatures. The advantages of the method include its bloodlessness and painlessness. The main disadvantage of such therapy is that scars may remain, causing problems in the throat.

Surgical intervention is recommended in early autumn, when the protective properties of the immune system are at a high level. In order for the recovery to pass quickly and without complications, you should adhere to a special diet and restorative breathing exercises.

How is the removal of adenoids in children?

The operation can be performed both in the inpatient department and in the outpatient clinic. From degree inflammatory process and other features of the patient's body, the method of treatment depends. The procedure is performed under general or local anesthesia. After the anesthesia has worked, the doctor determines where the deformed lymphoid tissues are located and begins their excision.

The main operating techniques and features of their implementation:

The classic operation - the removal of the tonsils occurs through the oral cavity using a special scalpel. The procedure is performed under local anesthesia. Its main drawback is the lack of visualization of the surgical field. That is, the removal takes place blindly and there is a high risk of recurrence.
Laser removal - a laser beam is used to excise tissue. It coagulates inflamed tissues or gradually evaporates them in layers. The advantage of this procedure is the absence of bleeding. The disadvantages include its duration, which is more than 20 minutes.
Microbreeder - using a shaver (a device with a rotating scalpel), the doctor excised the adenoids. During the procedure, nearby mucous membranes are not affected. If there is bleeding, then the wound is treated with a laser or radio waves.
Electrocoagulation - the tonsils are removed by throwing special electrode loops on them. This method absolutely bloodless, as the vessels are sealed during removal.
Cold plasma adenotomy - I act on tissues with a plasma beam. This method is most often used for abnormal location of the tonsils. The doctor can adjust the depth of penetration of the beam.

Regardless of the chosen method, the operation lasts no more than half an hour, after which the patient begins to recover from anesthesia. Within 3-4 hours the doctor monitors his condition, then sends him home. If bleeding or other complications occur during or after surgery, the patient is left for 1-3 days in the hospital.

Removal of adenoids of the 2nd degree in children

A significant increase in the tissues of the tonsils with the closure of 2/3 of the nasal cavity is the second stage of the adenoids. The pathological process is manifested by violations of nasal breathing. It is difficult for a child to breathe day and night, which leads to sleep disturbances. Due to inadequate night rest, the baby becomes lethargic and irritable. Oxygen deficiency provokes severe headaches and developmental delays.

Inflamed tonsils can cause symptoms that at first glance are not associated with the nasopharynx:

Urgent urinary incontinence.
Bronchial asthma.
Hearing disorders.
Heat body.
Bloody issues from the nose.
Sleep apnea and nocturnal snoring.

In addition to the above symptoms, adenoids cause speech disorders. The patient begins to speak through the nose, that is, indistinctly.

Removal of grade 2 adenoids in children is one of the methods of treatment. There are such indications for surgical intervention:

Lag in mental and physical development.
Frequent exacerbations of adenoiditis and sinusitis.
Bronchial asthma, incontinence and other painful symptoms.
Stops breathing during sleep.

The main goal of the operation is to open the nasal passages while preserving the lymphoid tissue of the nasal tonsils to maintain a normal state of immunity. The operation is performed with partial or complete removal of deformed tissues. The treatment is most often carried out under general anesthesia using endoscopic methods. Surgery is contraindicated outside the phase of exacerbation of inflammation. In other cases, the preventive actions that inhibit the growth of adenoid tissues.

Removal of adenoids of the 3rd degree in children

If the overgrown adenoid tissues completely block the nasal passage and the patient breathes only through the mouth, then this indicates the 3rd degree of adenoiditis, which is the most dangerous. Most this disease pediatric patients are susceptible. Adenoid growths are a source of infection that quickly spreads to the sinuses, pharynx and bronchi. The pathological process is accompanied by allergization and contamination by bacteria.

Removal of adenoids of the 3rd degree in children is carried out in the absence of positive results of drug therapy and with an increase in painful symptoms. The operation is carried out using general anesthesia and takes no more than 20 minutes. Full recovery occurs within 1-2 months.

Without timely surgical treatment, adenoiditis leads to such complications:

Violations physiological characteristics middle ear.
Chronic infectious processes in the body.
Frequent colds.
Inflammatory lesions respiratory tract.
Deformities of the bones of the face.
Decreased performance.

The above complications are dangerous for the child's body. But a timely operation can minimize the risk of their development.

Endoscopic removal of adenoids in children

One of the ways to treat hypertrophied tissues of the pharyngeal tonsils is endoscopic removal of the adenoids. In children, this operation can be performed at any age. The procedure is performed in a hospital under general anesthesia.

Benefits of endoscopy:

During the operation, the patient is in a medical sleep, so he does not experience discomfort.
Tissue removal is carried out using video endoscopic equipment, so the whole process is controlled by a doctor.
To prevent recurrence, adenoid tissues are completely excised.

Endoscopic adenotomy is a minimally invasive procedure. It is especially effective for tonsils that spread along the walls of the mucosa, and do not grow into the lumen of the respiratory tract. This tissue structure does not interfere with the respiratory process, but significantly disrupts the ventilation of the auditory tube. Against this background, frequent otitis occurs, and in an advanced case, conductive hearing loss.

Features of the procedure:

The patient is given general anesthesia, which makes the operation absolutely safe and painless. Anesthesia is also injected into the nasal cavity.
Through the lower nasal passage, the doctor inserts an endoscope and examines the surgical field.
Removal of hypertrophied pharyngeal tissues is carried out using various endoscopic instruments: electroknife, resection loop or forceps. The choice of instrument depends on the structural features of the pharyngeal tonsils.

Surgical intervention lasts no more than 20 minutes. The risk of complications is minimal. The severity of the postoperative period depends on the type of anesthesia used. Many patients experience such painful symptoms: nausea and vomiting, headaches and dizziness, nosebleeds. In most cases, the baby is sent home 2-3 days after the resection.

In order for the recovery to go quickly and with minimal complications, the doctor gives a number of recommendations. First of all, a special diet is prescribed. In the first days after the operation, only soft, chopped food is allowed: mashed potatoes, cereals, soups. After a week, the menu can be expanded. In addition to the diet, a sparing regimen of physical activity is recommended. Full recovery occurs within 1-3 months.

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Removal of adenoids in children with a shaver

One of the varieties of endoscopic adenotomy is the removal of hypertrophied tissues with a shaver.

Features of the procedure:

The operation is carried out using a micro-cutter, which looks like a drill and is located in a hollow tube.
On the side of the tube there is a hole through which the cutter rotates, grabs and cuts tissue.
The shaver is connected to a suction that removes the removed tissue and prevents it from entering the airways, greatly reducing the risk of aspiration.

Surgery is performed under general anesthesia with mechanical ventilation. To control the surgical field, an endoscope is inserted through the oral cavity or nasal passage.

Postoperative period lasts for 1-3 days. In the next 10 days, the patient is shown limited physical activity and diet therapy. Normal nasal breathing appears 2-3 days after the operation. To speed up recovery, special breathing exercises and a course of physiotherapy are shown.

Laser removal of adenoids in children

A modern method of treating inflamed tissue of the pharyngeal tonsils is laser removal of adenoids. In children, laser technology is a minimally invasive procedure with minimal complications.

Benefits of laser treatment:

Minimal trauma to the operated area.
High precision of the surgeon's actions.
Minimal blood loss and complete sterility.
Short recovery period.

Laser adenotomy can be performed in the following ways:

Valorization - the upper layers of the adenoid tissue are burned with steam heated by carbon dioxide. This method is used in the early stages of the disease, when the adenoids are not very large.
Coagulation - is carried out with adenoids of the 3rd degree, a focused laser beam is used to influence the tissues.

The procedure is performed under a small amount of anesthetic, which significantly reduces the risk of complications from anesthesia and facilitates recovery from anesthesia. Despite all the benefits of laser treatment, some surgeons do not recommend using it. This is due to the fact that the laser beam does not remove, but burns the inflamed tissues, restoring their normal size.

Removal of adenoids in children by radio waves

Another popular method of treating adenoiditis is the radio wave method. The procedure is carried out in a hospital using a special apparatus - Surgitron. Hypertrophied nasopharyngeal tonsils are excised with a nozzle with radio waves.

Benefits of removing adenoids in children with radio waves:

Minimal blood loss due to coagulation of blood vessels.
Use of general anesthesia for children under 7 years of age and local anesthesia for older patients.
Recovery period with minimal complications.

Radio wave treatment is indicated in such cases: hearing loss, difficulty in nasal breathing, frequent viral diseases, chronic otitis, lack of effect from drug therapy. The operation is recommended for severe pathological processes that affect the upper respiratory tract, as well as for deformation of the facial skeleton and malocclusion because of the adenoids.

In order for the treatment to be effective, special preparation is carried out. The patient is examined by a pediatrician and an otolaryngologist, a complex of laboratory and instrumental research. Diet food is recommended a couple of days before the operation.

An anesthetic is administered immediately before the operation. As soon as the anesthesia takes effect, the doctor begins the treatment. Excision of affected tissues is carried out using radio waves. The procedure lasts no more than 20 minutes. After removal of the tonsils, the patient is transferred to the general ward and his condition is monitored.

Contraindications to radio wave adenotomy:

Age under 3 years old.
Oncological diseases.
Severe bleeding disorders.
Deformation of the facial skeleton.
Recent prophylactic vaccination (less than 1 month).

After the operation, the patient is prescribed plenty of fluids and, if necessary, medications for symptomatic therapy. Special attention food and minimal physical activity. It is forbidden to take a hot bath and sunbathe in direct sunlight.

Contraindications for carrying out

Difficulty in nasal breathing, frequent colds, hearing loss and a number of other painful symptoms are signs of inflammation of the tonsils. Treatment depends on the stage of the pathological process. In the early stages, drug therapy, and with a severe degree of hypertrophy - surgical treatment.

Complications after the procedure

Surgical treatment of inflamed tissues of the pharyngeal tonsils can cause various complications. After removal of adenoids in children, a temporary decrease in the immune system, the development of a secondary infection, snoring, runny nose and other problems are most often observed.

Particular attention is paid to complications after anesthesia:

Problems at the stage of intubation and induction anesthesia: damage to the mucous membranes of the trachea, larynx, oropharynx, pneumothorax due to the introduction of a tube into one of the main bronchi.
A sharp decrease in cardiac activity while maintaining anesthesia.
Hypoxia and hemodynamic disturbances.
Pain shock due to an incorrectly selected dose of painkiller.
Suffocation due to premature removal of the endotracheal tube and insufficient monitoring of the patient's condition.

Choosing the most appropriate adenoid removal method and proper preparation for surgery reduce the risk of complications.

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Bleeding after removal of adenoids in children

A fairly common complication of surgical treatment of adenoiditis is bleeding. After removal of the adenoids this symptom most often occurs on the first day after surgery. To prevent it, it is recommended to pay attention to such contraindications:

Child overheating.
Stay in a stuffy room.
Eating hot or spicy foods.
Increased physical activity.

Patients are shown bed rest and use vasoconstrictor drops into the nose. You should also do regular wet cleaning and airing the room to facilitate nasal breathing. If nosebleeds have occurred, then you should contact the ENT department for the treatment and prevention of the disorder. The speed of recovery of the child after the adenotomy performed depends on compliance with medical prescriptions. Recommendations after the operation are reduced to the following rules:

Compliance with the diet for 1-2 weeks. Patients are recommended fortified, high-calorie food. In the first days, the dishes should be soft (mashed potatoes, cereals, soup).
Plentiful drink - purified water, herbal teas from natural ingredients, fruit drinks, compotes.
The use of medications - children are prescribed vasoconstrictor drops to prevent reflex edema of the mucous membrane.
Exemption from physical activity for 3-4 weeks and bed rest for 1-2 weeks.

What is impossible after removal of adenoids in children?

The postoperative period is as important a stage of treatment as the operation itself. That is why parents should know what is impossible after removal of adenoids in children and how to speed up the recovery process.

First of all, it is necessary to understand that the postoperative period for each child has its own nuances. They depend on the complexity of the operation and the individual characteristics of the child's body.

The main contraindications for the patient for 1-2 weeks after adenotomy:

Bathing in hot water, being in hot rooms or sunbathing.
Physical activity, active games.
Hot, hard, coarse and spicy food.

The child must comply with bed rest and is under the constant supervision of adults.

Postoperative period

After the little patient was released from the hospital home, it is necessary to create the most comfortable conditions for him. First of all, ensure good ventilation of the room with an optimal temperature and subdued light.
In the first hours after adenotomy, a cold compress should be applied to the operated area. This will help reduce nasal swelling. Puffiness may appear on the eyelids, to eliminate it, a 20% solution of albucid is instilled into the eyes.
Within 3-5 days after the operation, parents should regularly measure the body temperature of their child. With hyperthermia, if the temperature is above 38 ° C, the baby should be given an antipyretic.
Particular attention should be paid to nutrition. In the first week after the operation, only puree and liquid food is shown. Dishes are best steamed or stewed so that they can be easily swallowed. The basis of the diet should be grated cereals, stewed vegetables, steam cutlets, vegetable decoctions and compotes. In order for food not to irritate the throat, it should be at room temperature.
Active movements, physical education and sports should be limited. The child needs to provide bed rest: proper rest and sleep.

In addition to the above recommendations, the doctor prescribes vasoconstrictor nasal drops, which accelerate the healing of the wound surface and facilitate nasal breathing. Most often these are such drugs: Tizin, Glazolin, Nazol, Nazivin, Naftazin and others. The duration of their use should not exceed 5 days.

Another prerequisite that must be observed after the removal of adenoids in children is breathing exercises to restore normal breathing. Subject to all medical recommendations, the patient's condition returns to normal by 7-10 days.

Breathing exercises after removal of adenoids in children

All patients after surgical treatment of hypertrophied tissues of the pharyngeal tonsils are prescribed breathing exercises. After removal of adenoids in children, physiotherapy is carried out 10-15 days after returning home. Exercises are aimed at restoring nasal breathing.

Breathing exercises should include the following exercises:

Feet shoulder-width apart, hands on the belt, and the head thrown back. Slow inhalation through the mouth and lowering mandible, exhale through the nose and raise the jaw. Inhale for 4 counts and exhale for 2 counts.
Starting position: standing, legs together. On inhalation, hands up, and legs on toes, on exhalation, lower your hands.
Starting position, as in the previous exercise. Inhale to tilt your head to the right shoulder, and exhale to the left.
Hands clasped behind the back, head thrown back. Slowly inhale through your mouth and raise your arms up, exhale through your nose.
Hands along the body, feet shoulder width apart. Slow inhalation with protrusion of the abdomen, exhalation with muscle contraction. This exercise trains abdominal breathing well.
Pinch your nose and count loudly to 10. Open your nose and take a deep breath in, and exhale through your mouth.

Exercises should be performed in a well-ventilated area in the morning and evening. The respiratory complex should take no more than 30 minutes. The load should be increased gradually, approximately every 4-6 days. The number of repetitions of each exercise is 4-5 times.

Sick leave after removal of adenoids in a child

Despite the fact that adenotomy is a fairly simple operation in ENT practice, it requires careful preparation by both the doctor and the parents of a small patient. Sick leave after removal of adenoids in a child is most often issued for up to two weeks. Its duration depends on the characteristics of the operation performed and general condition patient. If necessary, parents can extend the sick leave for child care through medical commission until the baby is fully recovered.

In most cases, adenotomy is performed on an outpatient basis, mainly in the morning. The operation itself lasts no longer than 10 minutes, after which the small patient must remain under medical supervision for about 5 hours, then, if there are no complications, he is allowed to go home. Less often, a child's hospitalization is required if there are side effects from anesthesia or bleeding.

When conservative treatment is powerless?

Many parents postpone the operation, trying to find an alternative in. To date, there are many methods of drug treatment, but, as practice shows, they rarely bring positive result. Difficult cases require surgery. It is after adenotomy that many health problems can be avoided.

The decision on surgical treatment is made with the following symptoms and pathologies:

the child has severely disturbed nasal breathing - he practically does not breathe through his nose;
the child snores heavily even during sleep, there are bouts of apnea - holding the breath for up to 10 seconds, which causes the development of constant hypoxia during sleep;
slurred and nasal speech;
there is a hearing loss due to the accumulation of mucus and inflammation in the middle ear - exudative;
the child is sick a lot and often there are relapses of otitis media, bronchitis, pneumonia;
overgrown adenoids cause the development of anomalies of the maxillofacial nature.

Medicines and folk recipes are not able to get rid of the adenoids, the overgrown tissue of the tonsils will not go anywhere, on the contrary, in the absence of surgical treatment, it will grow even more. Therefore, surgery for adenoids in children is a necessity.

Contraindications for the operation

Sometimes an adenotomy can cause damage to the body.

The operation is not performed in the following cases:

blood diseases;
allergy in the acute stage;
bronchial asthma;
acute infectious diseases - SARS, influenza, intestinal infection etc.;
diseases of the heart and blood vessels;
age up to 2 years;
congenital pathologies of the structure of the facial part of the skull (for example, cleft lip);
the first month after vaccination;
oncological diseases.

Features of the operation

All the excited mothers and fathers whose children are scheduled for adenotomy are interested in the question of how the operation for adenoids in children goes. Surgical intervention is carried out with the help of anesthesia - local or general.

In the first case, the mucous membrane of the operated area is treated with an anesthetic, and a sedative drug is injected intramuscularly. In the second case, general anesthesia is used: the child is immersed in a drug-induced sleep, during which he does not feel pain and does not see what is happening.

How an operation on adenoids in children is carried out depends on the equipment of the clinic and the characteristics of the pathology in a small patient.

Ways to remove adenoids in children:

Classic adenotomy - the most common way. Surgery to remove the adenoids childhood is carried out using adenotop - a steel loop with a sharp edge. The procedure lasts several minutes, the technique is simple, but it has a significant disadvantage - the adenoids are removed by touch, there is no visual observation, there is a possibility of partially damaging nearby tissues and organs.
Aspiration adenotomy . In this case, the adenoids are removed not with a loop, but with a hollow tube, at the end of which there is a vacuum suction. The minus is the same - the doctor cannot see the progress of the operation, so there is a risk of harming another organ.
Endoscopic adenotomy . The operation to remove the adenoids in this case is carried out using an endoscope - an apparatus that allows you to visually control the actions of the operating surgeon.
. Removing adenoids with a laser has several advantages - minimal blood loss and reduced risk of trauma during the operation.
Electrocoagulation . The adenoids are removed with a loop that has been exposed to heat.

How painful is the operation?

Adenotomy is performed using local or general anesthesia. For example, in the West, any operation on the ENT organs is performed under general anesthesia. This type of pain relief is also practiced in our hospitals because it does not cause psychological trauma to children. Removal of adenoids in children under general anesthesia has a significant disadvantage - the risk of complications after surgery.

In other cases, adenotomy is performed using local anesthesia. With the help of an anesthetic, mucous membranes are treated, and the procedure is almost painless. But local anesthesia has another minus - the child is conscious and observes the entire operational process.

Manipulations of medical personnel, the sight of blood and surgical instruments causes stress in many children. To minimize its effects, the child may be prescribed a sedative.

Sometimes an adenotomy is performed without the use of any anesthesia if the child has contraindications to local and general anesthesia. From the point of view of physiology, there is nothing critical in this, since there are no nerve endings in the adenoid tissue, and severe pain should not be. But still, it is better to protect the child from stress as much as possible and anesthetize the operating area with a local anesthetic.

Is surgery dangerous?

Adenotomy in children can have the following consequences:

Complications after removal of adenoids in children . Sometimes the course of the operation is complicated or ends heavy bleeding, aspiration of the respiratory organs, trauma to the palate and complications of general anesthesia.
Decreased immune protection of a temporary nature . After an adenotomy, most children forget what frequent colds are, they really begin to get sick less often. But sometimes the situation becomes reversed - the child begins to get sick more often against the background of reduced immunity. This is a temporary phenomenon, after a few months, immunity returns to normal.
Accession of a secondary infection . Immediately after adenotomy, a postoperative wound surface remains in the nasopharynx, which can turn up to secondary infection, especially if the strength of the immune system is reduced. That is why after the operation to remove the adenoids in children, you need to observe the home regimen and temporarily limit the child's contacts with peers.

Recovery period

Immediately after the operation to remove the adenoids, the child is offered ice cream. A chilled treat promotes vasoconstriction.

Pain and discomfort during swallowing will annoy the child for several more days. To reduce pain, the doctor prescribes anesthetic and painkillers during the rehabilitation period.

After surgery to remove adenoids in children, vomiting with blood may occur. Usually this happens due to the fact that during the operation the child swallowed blood. The same situation can happen with a chair.

On the first day after the operation, the body temperature may rise to 38°C. The use of antipyretic drugs with acetylsalicylic acid in this case is not recommended, as this substance can cause bleeding.

For a while recovery period Your doctor may also prescribe nasal astringents.

During the week it is forbidden to be under open sunlight, visit a bathhouse and take a hot bath. Within a month after the operation to remove the adenoids in children, it is not recommended to swim in the pool or open water.

For 2-3 weeks the child must be at home, he is exempted from visiting kindergarten or schools. You can not engage in physical activity for a month.

The doctor may prescribe a sparing diet that excludes foods that irritate the mucous membranes: these are hot, hard, salty and spicy dishes. In this case, food should be fortified and high-calorie.

The postoperative period after removal of adenoids in children will be accompanied by congestion and nasal nasality. These symptoms go away on their own after a few days.

A month later, the ENT doctor should examine the child and determine the effectiveness of the adenotomy performed. As practice shows, in most children, improvements become apparent within a week after the operation to remove the adenoids.

Are there any guarantees that the operation will permanently get rid of the adenoids?

Adenoid recurrences are not uncommon after surgery.

The reasons for the re-growth of adenoids are:

Incomplete removal of adenoid tissues due to incorrect surgical intervention. If at least a small fragment of pathological cells remains after adenotomy, adenoids may well appear again. In this case, an adenotomy in a good clinic with an experienced specialist or the use of general anesthesia, during which the child will not be able to prevent the doctor from capturing the base of the adenoids with the adenotop, can exclude a recurrence. It should be noted that after general anesthesia, the frequency of recurrence of adenoids is reduced to 30%.
Early operation. Adenotomy can be performed in children older than 3 years, of course, if there are no urgent indications for surgery.
Allergic diseases in a child can also cause a recurrence of adenoids.
Individual characteristics of the body, due to genetics.

In conclusion, I would like to say that unreasonable fears on the part of parents before carrying out an adenotomy for their child are most likely caused by personal unpleasant memories from childhood or horrific stories of acquaintances about this procedure.

Yes, several decades ago, surgery was performed without the use of any method of anesthesia, and the operation itself was accompanied by large blood loss. But today, the operation to remove adenoids in children is carried out efficiently and painlessly.

Useful video about the operation to remove adenoids in a child

A considerable number of parents have to deal with adenoid growth in a child. Removal of adenoids in children is of concern, since any operation at this age is fraught with complications, but in some cases there is no other way out.

There are 6 tonsils in the oral cavity and nasopharynx, each of which performs a protective function, preventing infectious agents from entering the body. Frequent colds can lead to a decrease in this function and the simultaneous growth of the tonsil. Adenoids are the growth of a single tonsil located in the nasopharynx.

It is not possible to recognize this pathology without the use of special mirrors, but it has specific manifestations, due to which it is difficult not to notice the disease.

Symptoms of the disease

To identify the growth of the pharyngeal tonsil, it is enough to pay attention to the health of the child.

The main symptoms include the following:

Voice change. The child begins to nasalize, the voice becomes unhealthy.
Nasal congestion. Due to the increase in the tonsil, the air flow is slowed down, it becomes difficult for the child to breathe through the nose.
Runny nose. One of the complications leading to rhinitis and sinusitis.
Hearing loss. Growing, lymphoid tissue can partially overlap the auditory tube, causing signs of otitis media.
Sleep disorders. The child sleeps badly and anxiously, in the morning it becomes unusually capricious and irritated. There may be attacks of suffocation and snoring caused by the retraction of the root of the tongue.
chronic hypoxia. The child himself may not recognize this symptom, but from the outside, a constant lack of oxygen will be visible, leading to problems with appetite and sometimes to anemia.
Face change. If the pathological process proceeds for a long time, there may be a violation in the development of the bone tissue of the face, the bite changes. If treatment is started on time, then these changes are reversible, but in advanced cases, the consequences remain for life.
Adenoiditis. If the body is exposed to infection during tissue growth, adenoiditis may develop. The body temperature rises, the lymph nodes increase in size.

Adenoid Removal Methods

The need for surgical intervention depends on the degree of neglect of the disease and individual indicators, which can be assessed by a specialist. If the problem is noticed in time, then an appointment is possible conservative treatment method of drug administration.

Medically

If the adenoids cover only a small part of the vomer and the child's breathing is only slightly obstructed, conservative treatment is often sufficient. On the recommendation of a doctor, immunomodulators, rinsing and gargling are taken saline solutions. If these measures are not enough, antibiotics (cephalosporins, macrolides) are prescribed.

In parallel with taking medicines, rinsing with sea water, solutions of soda or Furacilin is carried out.

Surgically

If the disease has a second or third degree of severity, they resort to surgical intervention. Method options will be discussed below, the choice depends on the degree of the disease, the chosen clinic and the individual situation.

Folk methods

The best of the traditional ways to deal with adenoids in the early stages of the disease is washing with saline solutions, which are easy to prepare yourself. For 1 glass of warm boiled water, 1 tsp is taken. table salt or 0.5 tsp. sea salt. The solution is thoroughly mixed so that the salt crystals do not damage the mucous membrane of the throat. For washing, you can use an aspirator, pipette or syringe.

Another proven method is to instill freshly squeezed aloe or Kalanchoe juice into the nose. For ease of use, you can moisten cotton turundas in juice and inject them for 10-15 minutes into the nasal passages.

When is surgery indicated?

The need for surgery depends on the degree of the disease, so it is important to identify the pathology in time. Immediately after detecting the growth of adenoids, it is imperative to consult a doctor who can say for sure whether they need to be removed and at what age this or that method can be used. Perhaps the specialist will recommend laser intervention, in which the child will not be hurt, and the likelihood of a recurrence of the disease will be low.

If we are talking about the second degree of the disease (adenoids cover 2/3 of the vomer), then the decision on the need for surgical intervention is made depending on the patient's condition. With, since they close the opener almost completely and do not allow the child to breathe normally through the nose. In this case, he constantly breathes through his mouth, which is easy to see by drying and cracking lips.

Important! If growths are found, it is imperative to consult a doctor as soon as possible and find out whether they need to be removed.

If parents are concerned about the age at which such an operation can be performed and whether it hurts, then a specialist will help to deal with this. Now such an operation is performed on the smallest children, including using modern laser equipment.

It is important to clarify how adenoids are removed in the chosen clinic, since the classical method of intervention is considered outdated today. With a runny nose, the nasal passages are pre-washed so that the procedure takes place with minimal discomfort for the child.

Preparing for the operation

Before the operation is full examination, which includes a pediatrician's examination, blood and urine tests, a coagulogram and an ECG. On the eve of the operation, you should refuse to eat from 6 pm, you can’t even drink water in the morning.

There are 3 absolute contraindications for surgery:

anomalies of the vessels of the pharynx;
oncological disease;
blood clotting disorders.

The operation is not carried out within one month after vaccination and during acute infectious diseases, regardless of whether the disease occurred in summer or winter. How long the operation lasts depends on the type of anesthesia chosen.

The type of anesthesia depends not only on the individual picture of the disease, but also on the age of the patient. The operation under general anesthesia is performed in children under the age of 7 years. Modern drugs high-class safety are non-toxic and do not give complications even in childhood.

The type of general anesthesia is endotracheal anesthesia, in which an endotracheal tube is inserted, providing safe and full access to the adenoids. The main disadvantage of this method is that after anesthesia the child comes to his senses longer and feels a little worse.

The operation under local anesthesia is performed in children older than 7 years. An anesthetic solution is sprayed into the nasopharynx, a sedative drug is injected intramuscularly, and a weak concentration anesthetic solution is injected directly into the adenoid tissue. During the operation, the child is conscious, so the procedure is faster.

Methods of surgical removal of adenoids

In total, there are 5 ways to remove adenoids:

Classical surgical method. Adenoids are removed with a scalpel using local or general anesthesia. Now such pruning is rarely used, as it is one of the most traumatic and painful.
radio wave method. In this case, a special device is used that acts on the adenoids with radio waves and excised inflamed growths with minimal risk of blood loss.
Laser therapy. This method is one of the most modern and effective, so it is preferred by many clinics. In this case, the scalpel is replaced laser beam, and the operation takes place as gently as possible, without injuring the psyche of the child.
Endoscopy. Removal of adenoids by endoscopy or adenoidectomy with a shaver is the safest and most reliable. This operation is performed under general anesthesia with minimal blood loss. Often the method is combined with laser therapy and radio wave treatment. This combination allows for the most thorough treatment of the operated area, which practically excludes the possibility of recurrence.
cold plasma method. It is considered the most progressive way to deal with adenoids. Their removal is performed by cauterization with cold plasma, the procedure is almost painless, and it takes no more than 10 minutes.

Classic operation

The traditional method of cutting out the adenoids is a short operation in which the adenoids are removed using a special scalpel, which does not take more than 2-5 minutes. Its main disadvantage is that the doctor does not see the treated area, so he may accidentally damage healthy tissues or not completely remove the overgrown adenoids, which will lead to a relapse.

The cold plasma removal method has been used in Russia for a little over 15 years. At correct execution does not cause complications and blood loss, allows you to remove even adenoids ingrown into the nose. When choosing this method of intervention, you should carefully consider the professionalism of the doctor, as inept actions can lead to damage to healthy tissues and complications.

Endoscopic adenomectomy

Endoscopic equipment helps to avoid medical errors, which are most likely in the classical excision of adenoids. The endoscope is inserted into the nasal passage and allows you to control the operation.

Using a laser

Perhaps, in a modern clinic, experts will recommend a laser. In this case, local anesthesia can be used. Laser burning of adenoids gives excellent results and minimal complications. In addition, this technique has been used for quite a long time, in contrast to cold plasma burning.

In most cases, the use of a radio wave apparatus not only does not give complications, but also avoids relapse. The operation is completely bloodless, so that the child experiences minimal discomfort after it.

Child care in the postoperative period

Regardless of which method was chosen, special care is required for the child in the first days after the operation. Parents must:

apply the drops prescribed by the doctor in a timely manner;
monitor the moderation of physical activity of the child;
regularly ventilate and humidify the air in the room;
give the child vitamin and mineral supplements to strengthen immunity;
prevent possible overheating or hypothermia;
monitor the implementation of breathing exercises.

Recovery after a classic operation may take longer due to possible blood loss, but after a few days the child can go to kindergarten. If a bloodless operation was chosen and no complications arose in its implementation, then the very next day you can walk in the fresh air.

Special breathing exercises help to speed up the restoration of normal nasal breathing. It is started 10-12 days after the operation.

Diet after surgery

After the operation, it is recommended to avoid salty, fatty, spicy foods, preferring dietary products. Best Option nutrition in the first days after the operation - mashed soups, soft cereals, steam meatballs, low-fat vegetable and meat soups, baked apples, bananas.

Any hard, dry foods that can injure the pharyngeal mucosa that has not fully healed are contraindicated. It is recommended to refuse from sweet carbonated drinks, all types of confectionery and any products with a large number of flavors and dyes.

The first meal is allowed 4-5 hours after the operation. The child should eat well, drink enough water and non-acidic fruit juices. The food should not be too hot, but not cold either. After eating, it is recommended to gargle with a decoction of sage, oak bark or chamomile. This is done to remove food debris and prevent inflammation.

If during the first two days after the procedure the child refuses good nutrition due to sore throat, you can offer him chicken broth, soft cottage cheese, yogurt, fruit puree. The question remains whether it is possible to give a child ice cream after such an operation, which can relieve swelling, doctors different countries never came to a consensus.

Contraindications and what is dangerous surgical intervention

There are a number of contraindications to the removal of adenoids:

age less than 2 years;
oncological pathologies;
blood diseases;
acute course of allergy;
any acute disease.

After the operation, the following problems are possible:

increase in body temperature;
pain in the abdomen;
bad breath after removal of adenoids;
dizziness;
vomiting with blood;
hematomas.

Most frequent complication- bleeding, it occurs in about 1% of cases and is not critical. If the appearance of fibrin plaque after removal of the adenoids is normal, then an unpleasant odor may indicate the presence of an inflammatory process, tissue decay or decay. In most cases, this situation does not pose a threat to health, but you should definitely consult a doctor with it.

Prevention of relapse prevention

If during the operation the adenoid tissue was not completely removed (which is possible with the traditional approach and rarely occurs with laser reduction and other modern methods), then there is a risk of recurrence of the disease. Adenoids can grow back after removal, and most often this occurs in children under the age of 3 years.

The main actions of parents aimed at preventing recurrence of the disease are reduced to the correct organization of the child's lifestyle. Thanks to this, it is possible to achieve the normal functioning of the immune system. These are full-fledged physical activity, feeding in accordance with appetite, hardening, limiting contact with household chemicals and dust.

With reduced immunity, general strengthening supplements are prescribed that are safe for the health and development of the child. The implementation of the doctor's recommendations in the postoperative period is mandatory, even if the procedure went without complications.

Many parents are frightened when adenoids appear in a child. However, you should not be nervous in this case, as doctors have come up with many methods of getting rid of the disease. As a rule, the disease overtakes a baby from 1.5 to 12 years after suffering diseases of the upper respiratory tract - measles, scarlet fever, influenza. If the adenoids are not cured in time, then there may be problems with hearing, speech, and even the intellectual abilities of the child.

As a result, adenoiditis develops, which brings a lot of discomfort and discomfort to the baby. When drug therapy does not help, the doctor performs the removal of adenoids in children under general anesthesia. In this regard, doctors advise to recognize the symptoms of adenoids in a timely manner and visit a specialist as often as possible. Parents always ask themselves in such cases, how will the adenoids be removed from children, and what kind of anesthesia will be used when removing the adenoids?

Indications for removal of adenoids

Is there a need for adenoid surgery? Sometimes surgical intervention not necessary, it all depends on the circumstances. For example, if the child has the first degree of the disease, then the doctor prescribes complex treatment including physical therapy and therapeutic gymnastics. This degree of disease is effectively amenable to drug treatment so there is no need to remove it.

Although the second and third degrees already have more serious signs and symptoms: snoring in a dream, breathing problems, nasal speech, discharge of pus and mucus from the nose, etc. In general, such factors cause great harm to the child's body, so several doctors examine him at once: an otolaryngologist, an immunologist, a dentist and an allergist. Many experts believe that adenoids are best treated on early stage development.

Adenoiditis has its indications for surgical intervention. But inflamed tonsils are not yet a reason to take on surgical instruments, since many examinations must be completed before the operation, and only after that the doctor will make an example of a decision.

Removal of adenoids is carried out with the following indications:

The nasopharynx with adenoids is a favorable place for the reproduction of microbes. In this regard, the baby is constantly sick colds including ARVI and ARI.
There are diseases of the respiratory tract: Pharyngitis, laryngitis and tracheitis. Pus enters the respiratory tract, causing an inflammatory process.
When the tonsil increases in size, the function of the middle ear is disturbed, multiple otitis media appears.
Persistent cough that does not go away even after taking medication. As a rule, after the operation, the cough goes away.
Formation of bronchitis and pneumonia.
Change in face, bite.
Unsatisfactory results of drug therapy.
Dizziness, headaches, breathing difficulties, nocturnal snoring, poor sleep.
The child is hard of hearing due to overgrown adenoids.
Change in speech.

It is important to know that during the operation, the doctor can remove the tonsils along with the adenoids. But this happens if the child has purulent tonsillitis or have problems chewing food and swallowing. The fact is that this process slows down due to the overgrown lymphoid tissue.

Types of anesthesia for adenotomy

Most often, doctors perform the operation under general anesthesia. Local anesthesia has many shortcomings, including a violation of the psycho-emotional state of the child. Moreover, local anesthesia can provoke screaming, crying and fear during the operation. Children in such cases are rebellious and try in every possible way to put the doctor.

Also, the anxiety of the child is very scary for parents who are worried about a well-performed adenoid surgery. The sight of tools and blood leads the little ones in state of shock, even sedative drugs in such cases do not help. However, today there are two types of anesthesia: local and general.

Despite the fact that the doctor makes his own decision about anesthesia, parents can express their opinion on this matter. Many experts still believe that general anesthesia is more preferable for babies than local anesthesia. During the operation, the child is asleep and does not feel anything. Before an operation is performed under anesthesia, the anesthesiologist performs a series of tests.

Benefits and possible risks of general anesthesia

When it comes to the method of anesthesia, the doctor carries out several crucial steps. A key factor in choosing anesthesia is the age of the patient. For example, if the child is under seven years old, then general anesthesia is done. Although in each case, the doctor decides on his own.

The most important advantage of the operation under general anesthesia is the absence of operational stress for the child. During the removal of adenoids under general anesthesia, the child does not feel and does not see the process itself. Before performing the operation, the anesthesiologist selects drugs for anesthesia on an individual basis so as not to harm the health of the baby. Now they are developing low-toxic, safe means- esmeron, dormicum and diprivan.

The benefits of general anesthesia include:

Careful actions of the doctor.
calm behavior of the child.
Small risk of bleeding.
Careful examination of the nasopharynx.

In children, surgery under general anesthesia does not cause much fear and anxiety. Children over seven years of age can have surgery under local anesthesia. Of course, even with the removal of adenoids under general anesthesia, sudden complications can occur. The share of risk is always present, it all depends on the individual parameters of the organism. This issue is resolved by the anesthesiologist.

Advantages and disadvantages of local anesthesia

When it comes to local anesthesia, the doctor additionally introduces a sedative medicine. Also, the nose and throat are treated with lidocaine so that the introduction of the anesthetic does not cause pain in the baby. As a rule, lidocaine or novocaine is injected into the tonsil area. The main advantage of this method is the absence of the toxic effect of the drug and the rapid removal from anesthesia.

With local anesthesia, the child sees and hears everything, that is, is conscious. Sometimes even adult children show fear - this is normal. The main thing is that the child behaves calmly and does not get annoyed. To reduce the risk of stress, the doctor calms the baby before the operation. It is worth noting that parents can also positively influence the behavior of the child during the operation, for example, provide psychological support.

Two factors can be attributed to the significant advantages of local anesthesia: low price and lack of side effects. The negative point is the unpredictability of the child's behavior - panic.

Preparing for the operation

In order to competently and effectively carry out the removal of adenoids in a child, the doctor carries out preparatory actions. First of all, the baby must pass a number of important tests. To do this, you need to get referrals from a specialist and find a hospital for painful testing:

Checking blood for clotting.
urine diagnostics.
Stool tests for the presence of worms.
Detection of hepatitis B and C.
General blood analysis.

It is important for parents to know that all tests have their own expiration date - only 10 days. If during this time the operation is not performed, then the data on the health of the child will be considered irrelevant. It is also worth remembering that the specialist may require additional examinations for the type of anesthesia - ECG and electrolyte levels. If the child is over 14 years old, then a fluorography and a document confirming the absence of syphilis are added to the list of tests.

After passing all the tests, it is necessary to contact the attending pediatrician so that he issues a certificate of the absence of contacts with infectious people. At this document valid for only a few days. The doctor also needs to provide the child's medical policy, SNILS and a birth certificate. Parents should also have their own documents with them: passport, syphilis test, vaccination certificate, fluorography.

The preparatory procedure takes 2 days to select the most effective drugs. Before the operation, the child's nasopharynx is treated with antiseptics. As a rule, during the day the child should not eat heavy food, you can only drink water. It is very important to devote some time to the baby, explaining that the operation will be quick and painless. Parents are required to set up the child and prepare for the operation.

It is worth noting that the network has many forums and portals where parents and specialists discuss the most pressing issues of adenoid surgery in children.

Features and complications

Despite the fact that the doctor independently decides on the removal of adenoids, parents are still interested in how adenoids are removed in children? The operation is called an adenotomy. Although this is not the only way to get rid of the disease. For example, there are the following methods: laser, radio wave method, microdebrider, etc. Doctors also divide the removal of adenoids into several types:

Classical removal without the use of antiseptics.
Endoscopy.
Laser adenotomy.
Shaver adenotomy.
radio wave method.

After the onset of anesthesia, the doctor, using special tools, pushes the mouth as far as possible. Then the specialist carefully examines the surface of the mucous membrane and removes excess lymphatic tissue. Burning of the formations or scraping with a curette can be used as a removal technique.

The doctor performs the operation very quickly, since this procedure is not new in modern medicine. At the final stage, the doctor stops the bleeding of the vessels. An endotracheal tube or a laryngeal airway mask may also be used during the operation.

When an endotracheal tube is used, the airway is most protected. However, after waking up, the child may feel discomfort. Also, the baby before the operation takes inhaled and non-inhaled drugs. According to experts, inhalation anesthetics, including Sevoflurane and Isoflurane, contribute to the rapid recovery from anesthesia. At the same time, all means must be carefully checked and tested, because the child's body perceives drugs differently than an adult.

Modern drugs are not only quickly excreted from the body, but also quickly anesthetize without causing side effects. Usually the child recovers from anesthesia within a few hours. The child is not immediately sent home, for some time professionals are watching him.

If a child undergoes laser removal of adenoids, then a small part of anesthesia is used. Thanks to this, the process takes place twice as fast, the body recovers quickly. The fact is that large dosages of drugs can cause the risk of an overdose of antiseptics, which are fraught with consequences - a violation of the cardiovascular system, nervous system and development of hypoxia.

The child is allowed to walk and stand up after 4 hours of rest. Also, at the discretion of the doctor, it is allowed to take light food and water. The postoperative period includes many conditions: reduction of physical activity, exclusion of spicy foods and sweets, avoidance of infected patients.

In addition to individual medications, the doctor is advised to take a vitamin-mineral complex.

Contraindications

Regardless of the type of anesthesia, the child may have some health complications. To avoid problems in the future, the doctor identifies contraindications for the child to anesthesia.

It is very important to find out the presence of chronic diseases in the baby. If an exacerbation is determined, then it is not recommended to remove the adenoids using general anesthesia. In this regard, the operation is postponed to another date.

In this case, it is worth highlighting some contraindications for surgical intervention under general anesthesia:

Acute hypertrophy.
Infectious diseases.
Rickets.
Breathing problems.
Pyoderma.
Hypermia.
Other diseases.

Parents should decide in advance with the doctor and the clinic where the operation will be performed. It is very important that the same specialists select the dosage and preparations. Thus, you can avoid problems with the health of the baby. Another favorable factor in the operation is the mood of the child and good mood.

Adenoids are called pathologically enlarged tonsils in children (most often observed between the ages of three and seven years). This ailment naturally occurs after suffering diseases of the upper respiratory tract (measles, scarlet fever, influenza) and can lead to hearing impairment, intellectual retardation, anemia, and even to a change in appearance (face shape). Diagnosis requires careful and timely treatment from an otolaryngologist who conducts diagnostics. Based on the data obtained, he makes a verdict: adenoids can be cured or they need to be removed. Parents often ask themselves the question: how does this operation go? When exactly should adenoids be removed?

Is it necessary to remove adenoids?

There are cases when surgery is not necessary at all. The disease has three stages of development. Grade 1, as a rule, does not interfere with a person’s usual life: the child breathes freely, problems appear only during sleep due to the influx of venous blood. The situation is quite fixable with the help of medicines.

Another thing - 2 and 3 stages. Children begin to breathe through their mouths all the time and snore in their sleep, as the adenoids close the choanae (rear openings of the nose) (we recommend reading:). It harms the entire body as a whole. It is necessary to consult with specialists: an otolaryngologist, a dentist, an allergist, an immunologist, so that the treatment is as effective as possible. It is important to do everything on time, because the disease negatively affects both general health and appearance child.

Indications for surgery

The presence of inflamed tonsils is not a reason to cut out adenoids in the nose. It is necessary to undergo a thorough examination, and only after that the doctor will decide on the need for surgery.

Indications for removal of adenoids

So, we list the main indications for surgical intervention when adenoids are removed in children:

ARI and SARS. The mucus that protects the body from inflammation and the reproduction of microbes encounters an obstacle in the form of adenoids, which is why nasal cavity becomes a breeding ground for infections.
Pharyngitis, laryngitis, tracheitis - diseases of the respiratory tract. Pus gets into them, affecting the mucous membrane, and as a result, the inflammatory process begins.
Multiple otitis. The tonsil grows in size and interferes with the normal functioning of the middle ear.
adenoid cough. It appears when the nerve endings of the pharynx and nasopharynx are irritated, and if the bronchi are not inflamed, then this is not a sign of a cold, but of the adenoids. After the operation, this cough is eliminated.
Pneumonia, bronchitis.
Formation of a malocclusion.
Poor results from conservative, traditional treatment.
Headaches, snoring, breathing difficulties and, as a result, sleep disturbances.
Hearing loss. Adenoids do not allow air to penetrate to the middle ear, due to which eardrum loses its mobility.
Speech disorders are another indication for removal.

Sometimes, along with the adenoids, it is also necessary to remove the tonsils. For example, if a child often suffers from purulent tonsillitis, suffers from rheumatic disease, or has problems chewing food and swallowing: overgrown tonsils interfere with these processes.

Preparing for the operation and taking tests

Before the operation to cut out the adenoids in a child, the baby will be forced to pass a series of tests. Parents should find a medical facility in the city where they can be safely removed. The baby in the hospital will need to pass:

blood clotting test;
Analysis of urine;
feces for the presence of worms;
blood for the presence of hepatitis B and C;
general and biochemical analyzes blood.

The results of the above tests are valid for ten days, so calculate in advance the time and date of the operation. An important role is played by the type of anesthesia: general anesthesia requires an ECG and an analysis of electrolyte levels. After 14 years, fluorography and a certificate of the absence of syphilis are added to this list.

After the tests are passed, you need to come to the pediatrician and take a certificate stating that the child had no contact with infectious patients. Please note that it is valid for three days. You should have a policy, SNILS, a birth certificate with you. An adult accompanying person must have a passport, fluorography, a syphilis test and a children's vaccination certificate.

The first few days are spent preparing for the operation, during which doctors give medicines for better blood clotting. Antiseptics are used to treat the throat (as a rule, Miramistin is used).

The day before the operation, the child's diet should be light, without junk food. In the morning, they take blood from him (you can’t eat before that, you can only drink water to avoid dehydration). Of course, psychological support is also important: explain to the child why the operation is needed and calm him down.

Below is a video that discusses the issue of deletion: watch it to save yourself the excitement and, if necessary, explain to the child that everything is not so scary.

The use of anesthesia

How is the operation performed - under anesthesia or without sedation? This has always been a subject of controversy. General anesthesia is a strong stress even for the body of an adult, and even more so for a child. Nevertheless, doctors offer new gentle methods of anesthesia. In the end, general anesthesia will be preferable: it will save the baby from negative memories and give the doctor the opportunity to work without distractions. However, local anesthesia is also used.

Advantages and disadvantages of local anesthesia

This type of anesthesia is most often offered to older children, as they have developed endurance and self-control. In addition, it takes into account pain threshold child, his individual characteristics. Doctors administer sedatives if the baby is afraid of the sight of blood or is simply horrified by the process. Undoubted advantages of local anesthesia:

relatively low price compared to other types of anesthesia;
no side effects after surgery.

The downside is that you can never guess how the child will react to the operation, because he is faced with this for the first time. Having a calm nature, the baby can still panic.

How is the excision of enlarged organs performed? The overgrown tissue is frozen with Lidocaine or Ultracaine. There will be practically no pain, but, as mentioned above, there is a risk that the child will not be able to withstand the test from a psychological point of view.

Benefits and possible risks of general anesthesia

It's hard to believe, but before such operations were performed without anesthesia at all. Now, of course, doctors advise parents to have general (endotracheal) anesthesia. In Europe, it has been used for a very long time for a number of reasons:

this will ease the psychological burden on the little patient;
will provide the doctor the necessary conditions for a proper operation.

Sudden complications and associated risks undoubtedly exist. This issue should be discussed in advance with the anesthetist, who will advise you based on your specific situation and individual circumstances. You need to understand that there is always some risk involved.

Removal Methods

How are adenoids removed in children? The generally accepted method of removal - adenotomy - is not the only option. Today, there is a large selection of removal methods. People are operated on using a microdebrider, a radio wave method, laser adenotomy is used ... Let's consider the methods for removing adenoids in more detail.

Classical removal without the use of anesthetics

With the classic version of tissue excision, the removal takes place quite quickly. Parents often ask how long the procedure takes. The entire removal process takes no more than ten minutes. The child is escorted to the office, he sits down or lies down on a pre-prepared place (sometimes standing).

Young children are given a sedative and an anesthetic spray up their noses. Then a curved object is inserted into the oral cavity - an adenoid. The knife is pushed to the soft palate and the unnecessary tissue is cut off. Bleeding after these manipulations is insignificant. The child is taken to the ward so that he can lie down and move away from the effects of the drugs.

The advantage of the method is the quick actions of the doctor and the possibility of a small patient to immediately return to an “active” life. Minus - the doctor does not see the oral cavity completely and can do something wrong.

Endoscopic removal

Endoscopic adenoid removal procedure

Endoscopic removal used if the tissue grows again after removal. A special camera is inserted into the mouth, which broadcasts the picture on the monitor screen, and the doctor sees the full picture. Surgery in children is usually performed under general anesthesia. Endoscopic removal prevents the possibility of recurrence.

Laser adenotomy

Today, laser adenotomy is a popular and effective method of removal. The method of removing tissue with a laser almost completely eliminates the risk of bleeding, because not a scalpel is used, but a laser beam.

Coagulation (fixed beam) is selected with a large volume of tissues, and vaporization (layer-by-layer removal of adenoids) - with a small volume. Laser surgery does not cause pain, does not require hospitalization, the tissue recovers quickly after the process. The risk of complications is low.

Shaver adenotomy (cutting)

To cut tissue, the doctor inserts a curved scalpel or shaver through the nasal passages. After the operation, turundas are inserted. The advantages of this method: the doctor observes the excised tissue, bleeding is minimal or non-existent, and complications are rare. This is the “classic” version of getting rid of adenoids.

radio wave method

In this case, the operation is performed using the Surgitron apparatus. It has a special attachment (radio wave adenome). The adenoid is cut off in one motion, while the vessels are cauterized so that there is no bleeding. This is a modern, technically advanced method. The recovery period after such an operation is very short.

Complications after surgery and recovery

The most common complication after excision of adenoids is bleeding. As a rule, it is observed within a few hours after the last operation. If blood enters the auditory tube, then there is a risk of otitis media. The possibility of the appearance of consequences depends on the professionalism and attentiveness of the doctor.

In rare cases, the patient's body temperature rises, but it does not last long. Among other things, re-growth of adenoid vegetations may occur, but this can be avoided if you treat the choice of anesthesia and the method of removal responsibly.

The postoperative period in children usually proceeds without discomfort. There may be breathing problems due to swelling, but these can be corrected by using nasal drops.

Contraindications for removal of adenoids

Surgery to remove adenoids is not available to everyone. It is contraindicated in tuberculosis, severe infectious inflammation, decompensated form diabetes. It is also forbidden to carry it out to patients with diseases of the cardiovascular system and with such an ailment as low blood clotting. The age of the patient can become a hindrance: up to three years, surgical intervention is undesirable. And finally, the operation is not carried out within the first month after any vaccination.