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Adenotomy

Adenoid vegetations do not only occur in childhood: they also occur in adolescence and even adulthood.

Adenoid vegetation - symptoms and indications

  • runny nose;
  • snore;
  • mouth breathing;
  • frequent otitis;
  • hearing loss.

1. The child sleeps at night with his mouth open, during the day he also breathes mainly through his mouth. In the process of growth, the upper and lower jaw may form incorrectly, which often leads to an incorrect bite and adenoid type of facial structure. In addition, the child inhales the air that has not passed through the nose (not heated, not humidified), immediately into the trachea and bronchi, which can cause dryness of the oral cavity, throat, frequent bronchitis, hypertrophy of the palatine tonsils.

2. Frequent rhinosinusitis. All people have a different diameter of the nostrils and the diameter of the nasopharynx. During inhalation, negative pressure forms in the nasal cavity: air from the paranasal sinuses enters the nose and is further inhaled. During exhalation, everything happens the other way around: a positive pressure forms in the nasal cavity, which leads to the ingress of air into the paranasal sinuses (maxillary, ethmoid, frontal), where it is heated, moistened, cleansed. Then the air is circulated in the nasal cavity and paranasal sinuses. In the presence of hypertrophied adenoid vegetations, the difference in these diameters gets lost. Air circulation in the nasal cavity and paranasal sinuses is disrupted, as a result of which mucus collects in the sinuses, then the pathogenic flora provokes inflammation of the mucous membranes, which, in turn, leads to frequent rhinosinusitis.

3. Problems with the ears (otitis, tubootitis, secretory otitis). The middle ear (tympanic cavity) is isolated from the environment: it is protected by the eardrum. There is air in the tympanic cavity, which gets there from the nasopharynx through the auditory tube. During altitude changes (climbing mountains, descending the subway, taking off, and landing an airplane), the pressure in the tympanic cavity changes, and we feel stuffy in our ears. After taking a couple of sips of saliva or opening our mouth wide, we hear a cracking or clicking in our ears: the auditory tube opens, the pressure levels out, after which we begin to hear better. The auditory tube of the right and left ear opens into the nasopharynx - exactly in the place where the adenoid vegetation is located. Increased adenoid vegetations press on the auditory tubes, thereby disrupting the ventilation of the tympanic cavity.

4. Hypertrophy of the palatine tonsils. Often children with large adenoid vegetations have tonsillar hypertrophy. They increase due to breathing through the mouth, and sometimes even close, provoking a difficult passage of the food lump when swallowing. A common solution to this problem is the simultaneous reduction of the palatine tonsils. In most cases, they are not removed completely (tonsillectomy) but reduced in size (tonsillotomy).

5. Secretory otitis. If the patient has fluid behind the tympanic membranes, it is possible to simultaneously perform a shunting of the tympanic membranes with the removal of fluid from the tympanic cavity (depending on the nature of the contents and the duration of the process). The shunts are located inside the eardrum. Their appearance resembles a small spool of thread. They help to ventilate the eardrum through the external ear canal. If a child is undergoing bypass surgery, it is strictly forbidden for him to wet his ears (while showering, in the pool, at sea) during the time the shunts are in place. Shunts often do not have to be removed: they fall out on their own. This happens individually for everyone: for someone, it can happen after 6-8 months, for someone after 2 years. Apart from keeping your ears out of the water and showing yourself periodically, there are no recommendations for shunts.

Diagnostics of the nasopharynx

To accurately determine the presence of adenoid vegetations, their degree, and their effect on the surrounding tissues, the otolaryngologist should prescribe an additional study in the form of nasopharyngeal endoscopy. This is a painless procedure, but its implementation is especially difficult (especially for young children) since you need to sit quietly (an endoscope is a metal tube with a diameter of 2.3 mm with a lens system; although it is not sharp, it may cause pain with sudden movements of the child's head).

Exceptions: There are situations when a child has adenoid hypertrophy during endoscopy, but the child can breathe well through the nose, without having ear problems and frequent viral respiratory infections. Only observation is recommended for such children since there are no clinical manifestations of the disease (except for the large size of the adenoids). The opposite also happens: small adenoid vegetations press on the auditory tube, provoking congestion in the ears and secretory otitis media. Therefore, in each case, the treatment of the child is determined on an individual basis.

When removing the adenoids, it is important to make the right decision: to remove the adenoids or to wait until the child grows up.

With a change in hormonal levels during puberty, adenoid vegetations in most cases (but not 100%) tend to reverse development. If the child's age suggests that puberty is coming soon (12-13 years old), you can resort to expectant tactics.

No one wants to be operated on: neither the parents, nor the child, nor the doctors. To make the right decision, you need an objective assessment from the parents: a thorough assessment of the incidence of the child's morbidity, hearing, and breathing (both day and night). Only together with the parents can you make the right decision regarding the need for surgery.

Another clue may be the answer to the question, how many times a year a child is sick and how he is treated. If a child is sick 2-3 times a year, and mild treatment helps him (homeopathy, herbs, saline solutions in the nose, drinking plenty of fluids, vitamin C), the question of the operation can be postponed. If a child is sick 4-5 times a year, and the treatment always ends with taking serious chemistry (antibiotics, non-steroidal anti-inflammatory drugs, antihistamines, hormones), you need to choose in favor of surgery.

Preoperative examination

Before a patient is admitted to a hospital, he must undergo a series of laboratory tests and functional tests. It depends on their results whether complications can be avoided later.

Mandatory examination includes:

  • general blood analysis;
  • blood biochemistry;
  • coagulogram - blood clotting analysis;
  • general urine analysis;
  • analysis for blood group and Rh factor;
  • chest fluorography;
  • electrocardiography.
  • If necessary, the list of tests can be expanded by the attending physician.

Preparation for surgery

On the eve of the operation you must:

  1. give up alcohol and smoking;
  2. refuse heavy food, while the last meal should be at least 6 hours before the operation (low-fat broth, meat or fish, fruits and vegetables);
  3. not drink 4 hours before surgery.

Hospital checklist:

  • comfortable clothing (tracksuit, T-shirts made of natural fabric, changeable underwear);
  • comfortable shoes;
  • slippers;
  • personal hygiene products;
  • book or laptop, since after the operation you will have to spend another 1-2 days in the hospital.

Recovery period

After the operation is over, parents are not immediately allowed to take the child home. First, the patient must be fully awake: during this period, the medical staff is watching him. Then, the patient needs to be observed for a while in the clinic. It can take about an hour from the end of the operation to transfer to the ward. Eating and drinking immediately after surgery is excluded. After 1-1.5 hours, the patient can be given water.

Postoperative period in the clinic

As a rule, the otolaryngologist surgeon can let the patient go home in the evening, but the option of spending the night in the clinic must be foreseen in advance.

Postoperative period at home and recommendations

Since there is a wound surface at the site of the adenoids, the risk of bleeding cannot be excluded, but to minimize it, all recommendations must be followed:

  • Nurofen 1 dose 2 times a day (1-2 days);
  • Abundant drinking - water, dried fruit compote (2 days);
  • After tonsillotomy - dissolve Faringosept 0.5 t 4 times a day;
  • After bypass surgery, keep your ears away from water.

It is recommended:

  • to take a slightly warm shower;
  • to walk outside;
  • to eat warm food and drinks.

It is prohibited:

  1. to take a hot bath (7-8 days);
  2. go in for sports, including playing active games (8 days);
  3. consume hot food and drinks;
  4. drink carbonated drinks and citrus fruits.