Adenoid removal surgery. Endoscopic surgery to remove adenoids. Basic methods of surgical treatment

When adults get sick, it’s bad, but when it comes to a child, it’s hard for both the baby and his parents. How much worry and worry childhood illnesses bring to adults. For example, adenoids, which are growths on the tonsils, are diagnosed mainly in children under 12 years of age. These formations, consisting of lymphoid tissue, as they grow, they create noticeable problems for the child, so at a certain point there is talk of removing them (adenectomy). And since adenectomy is a surgical operation, removal of the adenoids under anesthesia is considered a common practice, preventing various complications during and after the operation.

In principle, pain relief during surgery on body tissue seems quite logical. But on the other hand, parents who are concerned about the very idea of ​​a surgical operation on a child are particularly sensitive to the idea of ​​​​injecting the baby with anesthesia, which even in adults quite often causes unpleasant and in some cases dangerous symptoms. In this regard, parents have many questions. Is it possible to do the operation without anesthesia, as was done in the old days? How justified is the use of anesthetics during adenoid removal? And is it even necessary to carry out resection of the adenoids, which traumatizes the child’s psyche, if this procedure does not exclude the possibility of relapse of the disease?

Adenoids: what are they and should they be removed?

Adenoids (or tonsils) are growths of lymphoid tissue on the surface of the tonsils. The lymphoid tissue itself is designed to retain the infectious factor in the upper respiratory tract, preventing it from descending lower, irritating the bronchi and lungs and causing inflammatory processes in them. The formation of strong immunity is also associated with adenoids.

By removing the tonsils, a person deprives himself of protection. But on the other hand, if the lymphoid tissue becomes inflamed due to frequent colds (adenoiditis), this indicates that it itself is now a source of infection.

Yes, you can fight inflammation, but this does not always give a good result. At some point, a chronic inflammatory process can lead to pathological tissue proliferation (hyperplasia), which, increasing in size, will block the nasal passages adjacent to the nasal passages. back wall throats.

It is clear that the growth of adenoids to a critical state, when they block the path of air moving through the nasal passages and almost completely block nasal breathing, does not occur in one day. The process develops gradually, passing through 3 (and according to some sources 4) stages.

Stage 1 adenoids are said to exist if the lymphoid tissue above the tonsils covers no more than 1/3 of the space of the nasal passages on the back wall of the pharynx. With grade 2 adenoids, pathological growths block nasal breathing by half or a little more.

This state of affairs allows the child to breathe through his nose, but this becomes increasingly difficult. If at the first stage the baby breathes normally daytime, and problems with nasal breathing begin only at night (in horizontal position, during sleep), as evidenced by partial nasal congestion, snoring, restless sleep etc. Then the second stage is characterized by problems with breathing through the nose even during the daytime. At night, the baby snores clearly, and during the day he tries to keep his mouth open so that air can enter the lungs through it. Attempts to breathe through the nose become increasingly difficult, accompanied by noisy inhalation and exhalation.

And yet, in the first two stages, at least some ability to breathe normally through the nose remains, which cannot be said about grade 3 adenoids, when hypertrophied lymphoid tissue blocks the nasal passages inside the pharynx almost completely. Now mouth breathing becomes a vital necessity for a child. Breathing with a closed mouth becomes impossible, which means the baby does not close his mouth at all, which contributes to the formation of a specific elongated face shape with a smoothed nasolabial triangle (adenoid face).

But this is not the worst thing. The child’s voice changes (becomes hoarse, nasal), problems with appetite begin, and, accordingly, with digestive system, sleep is disturbed, which affects general condition and physical activity, hearing deteriorates due to the adenoids blocking the Eustachian tube located nearby and the development of inflammatory process.

Due to a lack of oxygen (lack of proper breathing, especially at night), cognitive processes and mental abilities deteriorate (memory and attention primarily suffer), and academic performance decreases. It would seem quite healthy child begins to lag behind in development.

Changes in appearance and voice affect the attitude of his peers towards the child. After all, children can be cruel without realizing the consequences of their cruel jokes and twitches. A baby whose adenoids were not treated or removed at one time begins to develop psychological problems (depressive states, isolation, difficulties establishing contact, etc.).

Removing adenoids with or without anesthesia is a risk of being left without protection, which means infection, getting into the upper Airways, will be able to freely go further into the bronchopulmonary system. But if this is not done, the consequences look even sadder.

In addition, the function of retaining dust, bacteria and viruses is characteristic not only of the adenoids, but also of the nose, for which there are special villi inside the nasal passages. If a child begins to breathe through the mouth, the air does not pass through the nasal passages and does not receive sufficient cleaning and humidification. Inflamed adenoids are not capable of performing a protective function, which means that the respiratory system is again left without protection.

The absence of nasal breathing due to the proliferation of lymphoid tissue is an indication for surgery to remove the adenoids. With grade 3 adenoids, the question of conservative treatment no longer arises. Only surgery can help a child, whether the parents want it or not. Adenoiditis and its consequences must be treated in the first two stages. And in order to recognize the disease on time, you need to be attentive to your child, noting all suspicious symptoms and consulting about their occurrence with a pediatrician and otolaryngologist.

Adenoid removal surgery and its types

Removal of adenoids or adenectomy, despite its simplicity, is considered a serious surgical operation, the need for which arises mainly in cases of grade 3 adenoids. However, in some cases, the operation can be performed earlier, without torturing the child with long-term conservative treatment. Removal of adenoids is also resorted to in the absence of improvement after a course of medication and physiotherapy.

It is very difficult to determine the degree of adenoids only by symptoms from the words of parents and the baby. Symptoms of all 3 degrees overlap, and the baby can begin to breathe through the mouth even at initial stage adenoiditis, if the tissues of the nose are swollen and cause a feeling of stuffiness. Visual inspection throat with a flashlight also does not provide enough information, so doctors resort to more informative methods Diagnosis of enlarged adenoids:

• Examination of the nasopharynx using a finger (palpation of the adenoids),
• Studying the condition of the lymphoid tissue above the tonsils using a speculum inserted deep into the oral cavity (posterior rhinoscopy),
• X-ray examination of the nasopharynx and paranasal sinuses,
• Diagnostic endoscopy (examination of the area of ​​adenoid growth using a fiberscope inserted into the nasal passages from the outside).

If grade 3 adenoids are diagnosed, the child is referred for surgery to remove them. The tonsil resection procedure can be performed using various methods.

The very first and somewhat outdated method of performing adenectomy is considered to be manual removal of adenoids. In fact, during the operation a special knife is used - an adenotome in the form of a loop with sharp edges, with the help of which the overgrown tissue is simply cut off from the surface of the unchanged mucosa.

Despite significant disadvantages (quite heavy bleeding during surgery and the inability to visually assess the quality of work), in some clinics adenectomy continues to be performed using the ancient method to this day.

By the way, this particular type of operation has frequent complications in the form of re-growth of lymphoid tissue if a small section of it was not removed during the operation with an adenotomy. The doctor cannot see whether all tissue is completely removed, since the operation is performed almost by touch.

In the old days, when traditional method Manual removal of adenoids was the only method of combating the disease; the operation was performed without anesthesia. Mothers and grandmothers of today's children (as well as male relatives) may still remember the “horror” of the sight of blood flowing from the mouth, which overpowered even the pain. Maybe that’s why they are so worried about their children and grandchildren who are about to undergo surgery to remove their tonsils.

Today, parents have a choice, because a sufficient number of new, more effective and advanced methods for removing adenoids have appeared:

• endoscopic (the operation is carried out under the control of an endoscope and the progress of the procedure, as well as the quality of removal of lymphoid tissue, can be monitored using a computer, to the monitor of which the image is transmitted by a mini-camera at the end of the fiberscope),
• electrocoagulation (tissue cauterization using electric current),
• laser coagulation(using a laser beam of a certain intensity, pathologically altered tissues are removed and immediately cauterized, which avoids bleeding, the beam passes to a greater depth, which avoids relapse of the disease and infection of the wound),
• cryodestruction (tissue freezing liquid nitrogen, as a result of which they die and are removed painlessly and bloodlessly).

Innovative methods have a significantly lower percentage of complications, while the removal of adenoids today is carried out mainly under anesthesia. This means that the child does not feel pain and discomfort during the operation, and does not experience those feelings and emotions that dark spot were left for a long time in the memory of their parents and other long-grown relatives.

The times of performing adenectomy without anesthesia are irrevocably gone, however, at the insistence of parents, the child may not be given anesthesia before the operation. In principle, the choice always remains with the parents: whether to agree to anesthesia or not, and if the operation is performed under anesthesia, then what type of anesthesia to choose.

Types of anesthesia for adenoid removal

Here we come to the main question that worries many parents whose children are about to have an adenectomy. Under what anesthesia are adenoids removed? On what basis can one type of anesthesia be prescribed? Why modern doctors Are they inclined to remove the adenoids under anesthesia, if previously this operation was quite successfully carried out without the administration of painkillers?

Let's start with the fact that during an adenectomy, doctors can use 2 types of anesthesia: local and general. In domestic clinics, local anesthesia is most often performed, while abroad it has long been customary to remove adenoids under general anesthesia. True, anesthesia (and especially general) is not suitable for all children; in this case, the operation is performed either without anesthesia at all, or local anesthesia is used that does not require intravenous administration, and are applied directly to the mucous membrane in the area of ​​the back wall of the pharynx and tonsils.

Oddly enough, in the memoirs of adults who had their adenoids removed in the past (without anesthesia, of course), there is virtually no mention of severe pain, after all, we are talking about excision of living tissue. Cause of loss in memories similar symptom is it complete or partial absence. The fact is that lymphoid tissue contains practically no nerve endings, thanks to which we feel pain, heat, cold and other tactile sensations.

Due to the lack of sensitivity of adenoid tissue, removal surgery is considered to be practically painless. The question becomes unclear: why do doctors insist on pain relief in this case?

The reason for such persistence of doctors is not at all the desire to “bring down” more money from patients (after all, anesthesia requires a separate payment). She has psychological reasons. After all, no matter how much you try to convince a child that it won’t hurt, the type of instruments used in surgery and the “white coat” syndrome will still create fear. And the closer the doctor comes, the more the child will want to cry, scream, or even run away from the “tormentor.”

The slightest careless action by the surgeon can damage nearby tissues, which have many more nerve endings. Damage to them is unlikely to cause much harm to the baby, but the pain can be quite severe. Will the baby be able to continue to sit quietly during the operation in such conditions?

Even minor pain sensations will seem more noticeable if they are reinforced by the contemplation of the sight of one’s own blood. And it is unknown what traumatizes the child’s psyche more: pain or the sight of blood. In many cases, blood is an even greater irritant than pain, causing a person to feel fear for his life.

If we have figured out the need and benefits of anesthesia, the question of which anesthesia to choose for your baby still remains open. Many modern clinics and medical centers our country today can offer a choice: to perform an operation under general anesthesia or limit ourselves to using local anesthetics. All that remains is to decide on the type of anesthesia.

Which anesthesia should I choose?

We are all parents, and we want only the best for our children. Everyone wants the operation to remove their child’s adenoids to be successful, and for the child not to experience discomfort and pain, which adults know firsthand. What should you rely on when deciding on the type of anesthesia on the eve of adenoid removal under general anesthesia?

Undoubtedly, when the conversation turns to children, the issue of the safety of the anesthesia procedure for the health and life of the little person comes to the fore. It is clear that any anesthetic, entering the blood or respiratory system a person will cause more harm than a local remedy, which is absorbed into the blood in smaller quantities. Adenoid removal under local anesthesia involves applying an anesthetic to the tissue that will be removed and the surrounding area. This significantly reduces the sensitivity of the mucous membrane, and with high-quality anesthesia, the baby does not experience any discomfort or pain during the operation.

Local anesthesia can be carried out using inhalation agents produced in the form of sprays, treating the surface of the pharynx with anesthetic solutions (for example, lidocaine, Tylenol, etc.) or instilling them into the nasal passages. Intravenous and intramuscular injections Anesthetics are not used in the practice of removing adenoids in children.

The advantage of local anesthesia is the possibility of performing the operation in outpatient setting, because special equipment is not required in this case. After the procedure, the child can go home immediately. Special monitoring is not required, as in the case of general anesthesia.

The big disadvantage of local anesthesia is the ability to see the progress of the operation, because the baby remains conscious. No, the child does not feel pain. Even if the anesthesia is performed poorly, minor pain occurs only if nearby healthy tissue is damaged; there are no nerve endings in the lymphoid tissue. But how can you force a child, with the curiosity inherent in all children, to close his eyes and switch to pleasant thoughts if people in white coats are scurrying around him and trying to extract something from his mouth that he has not even seen?

Natural curiosity leads to the fact that the child may see blood gushing from the mouth (especially in the case of the classic manual adonectomy method) and become very frightened even though he will not feel pain. This may negatively affect the outcome of the operation. The child will cry, try to dodge, and the doctor will not be able to efficiently remove all the particles of the overgrown lymphoid tissue.

You can convince the baby that there will be no pain, but the fear of people in white coats who once hurt him during blood sampling, vaccination, medical procedures, as well as before surgical instruments when local anesthesia will not disappear anywhere.

This one psychological factor opposes local anesthesia. But it can be bypassed by general anesthesia, which is considered preferable during adenomectomy. But general anesthesia, as everyone understands, is considered less safe, even though modern anesthetics have significantly fewer contraindications and side effects than previously used medications.

The time has come to consider all the advantages and disadvantages of general anesthesia, and figure out how to ensure that an effective anesthesia procedure, allowing for a high-level operation, does not harm the child.

Removal of adenoids under general anesthesia

When the question of choosing anesthesia arises, you want to get as much as possible more information about each method of pain relief. Having understood the features of application, as well as the advantages and disadvantages of local anesthesia, it’s time to get information about general anesthesia, which is popular abroad and in domestic advanced clinics.

Let's start, as usual, with the advantages of this method. The main advantage of general anesthesia is rightfully considered to be the physical and moral calm of the child during the operation. At the time of removal of the adenoids, the baby is already unconscious, which means he can neither see nor hear what is happening. Even if some complications arise (for example, severe bleeding or damage to healthy mucosa, accompanied by pain), the little patient will not know about it. When he comes to his senses, the operation will be completed.

The next important advantage can be considered the doctor’s peace of mind during an adenomectomy, because he will not have to be distracted by the child’s reaction, which is almost impossible to predict. The surgeon can calmly do his job, slowly removing accumulations of lymphoid tissue, leaving it no opportunity to remind itself again in the future.

General anesthesia when removing adenoids in children can significantly reduce the time of the operation, because the doctor will not have to stop every time the child begins to worry, cry, or twitch. It doesn't take time to calm down little patient.

Doctors consider removal of adenoids under general anesthesia using modern inhalational anesthetics to be the most safe method warning about this unpleasant complication, as a repeated increase in the volume of lymphoid tissue. In addition, such anesthesia protects the child’s psyche, which is also important, because a strong nervous shock can cause fluctuations. blood pressure, heart rhythm disturbances, states of shock regardless of the patient's age.

The advantages of general anesthesia can be considered the absolute absence pain(with local anesthesia this is more difficult to achieve), preventing the risk of particles of removed tissue entering the respiratory tract, a relatively low risk of bleeding from damaged tissues (if the child begins to actively move, resisting the doctor’s actions, and cry, the likelihood of bleeding increases, as does the risk of damage to healthy tissue ).

If bleeding does occur, the doctor can calmly assess the result of the operation and take measures to stop the bleeding (this is usually done with nasal tamponade using hemostatic drugs). Carry out similar manipulations with a crying child quite problematic, as well as correcting the shortcomings.

But besides positive aspects General anesthesia also has its disadvantages:

• there is a small chance of developing nosebleeds unrelated to removal of tonsils,
• fluctuations in body temperature are possible, which requires doctor control,
• There is minimal risk the development of complications such as hearing impairment, sleep and speech disorders, migraines (usually such symptoms are temporary),
• longer difficult (not always) period of recovery from anesthesia,
• quite a decent list of contraindications.

It is worth saying that general anesthesia is most preferable in children with unbalanced temperament. It is prescribed for intolerance to painkillers used for local anesthesia, as well as in cases where the anatomical structure of the pharynx and the location of the adenoids in it require a special approach to the operation, and the surgical intervention may be delayed.

But let’s return to the contraindications that do not allow adenoid removal to be performed under general anesthesia. TO this species Anesthesia is not used if:

• there are acute infectious pathologies (due to the danger of the process spreading),
• there are diseases of the upper or lower respiratory tract (in particular, with bronchial asthma),
• the child is diagnosed with rickets/hypotrophy,
• purulent rashes were found on the baby’s skin,
• the child has unknown reasons increased Body temperature,
• the patient is suffering mental disorders,
• there are exacerbations of chronic diseases,
• the child has heart problems that cannot be treated (if it is possible to stabilize the child’s condition, the operation is performed after the end of treatment and usually under local anesthesia).
• the baby was vaccinated the day before (the operation is carried out no earlier than 2 weeks after the vaccine was administered).

If there are acute pathologies, then the operation using general anesthesia is performed after full recovery or achieving remission (in case of chronic diseases). If you are intolerant to inhalational anesthetics used for general anesthesia, the operation is performed without anesthesia or using local agents.

Due to the fact that general anesthesia has a large number of contraindications and possible side effects (most often nausea, vomiting, dizziness), before it is carried out, the child is examined by an anesthesiologist and, if possible, a medical history is studied according to the medical record, including a certificate of vaccinations, or from the words of the parents. The doctor finds out whether the child has had allergic reactions to medications and which drugs caused such manifestations. Mandatory clinical trials, including blood and urine tests, blood clotting indicators, and an electrocardiogram.

Parents and children are warned not to eat food on the eve of surgery. The baby can have dinner at approximately 7 pm, but he will no longer have to have breakfast. It is also not recommended to drink water on the day of surgery (according to at least, within 3 hours before the adenoid removal procedure).

In preparation for the operation, the evening and the day before the procedure (usually an hour before the operation), the child is given sedatives, preferably plant origin. Immediately before the operation, an enema is given and you are asked to empty your bladder.

To reduce the negative effects of anesthetics for general anesthesia, the child is given an injection of the drugs “Promedol” or “Atropine”. Before making a general or local anesthesia The child and parents are explained what the anesthesiologist will do and why and what sensations the baby should have.

Both endotracheal and laryngomastic anesthesia are suitable for adenomectomy surgery. The second is used less frequently, since it somewhat limits the surgeon’s actions in the head area; moreover, this type of anesthesia is associated with the risk of pieces of excised adenoids getting into the respiratory tract.

Endotracheal anesthesia for adenoids is given to children much more often. And although this type of anesthesia is associated with some discomfort, and the duration of its implementation is longer, asphyxia during the operation is practically excluded.

To carry out intubation anesthesia, they do not use a breathing mask, but a special endotracheal tube, through which the smallest particles of drugs that can cause complete relaxation and medical sleep enter the baby’s respiratory system. So during the operation the child sleeps peacefully and does not perceive what is happening to him.

The operation to remove adenoids under anesthesia lasts about 20-30 minutes. The dose and type of anesthetics are selected so that the child wakes up after the operation. The operation is considered completed once the bleeding has stopped.

At the end of the procedure, the child is woken up and taken to the ward, where he will recover within 1.5-2 hours. All this time, the anesthesiologist monitors the little patient’s condition. His work ends when the baby comes to his senses, but the child remains under the supervision of doctors for another 2-3 hours, after which he can safely go home.

Post-operative care

As the baby recovers from anesthesia, he may experience nausea and vomiting mixed with bile. These are side effects general anesthesia, however, it must be taken into account that their intensity after endotracheal anesthesia is significantly lower than after intravenous administration of the drug. And the negative impact of anesthesia on the body in this case is less.

For some time after the procedure, the child will be lethargic and weakened, so during this time you need to limit physical activity. If the removal of adenoids took place without anesthesia, in addition to fatigue, the child is unlikely to experience any other discomfort, except that as a result of reflex swelling of the mucous membranes of the nasopharynx for 1-1.5 weeks, his nose will be stuffy. Will help in this case vasoconstrictor drops and sprays, which must be treated for at least 5 days.

If the child has postoperative period There is an increase in temperature, discomfort and slight soreness in the throat; suppositories or paracetamol-based syrup will help, which will relieve fever and pain.

The child will be able to eat no earlier than 2 hours after the operation, but it is better to wait a little longer. During the first 2 weeks, it is recommended to follow a diet that includes excluding hot, spicy, sour, and salty foods from the diet because of their irritating effect on the edematous mucosa.

For several days, the doctor will recommend replacing hot baths with warm showers, and taking walks away from crowded places where there is a risk of infection spreading. IN kindergarten the child can go 2-3 weeks after the operation, visit the pool no earlier than a month later. Active physical exercise and physical exercise in the postoperative period is undesirable. Main conditions quick recovery: high-calorie, vitamin-rich foods, quiet walks on fresh air away from roads and public institutions, good rest and sleep.

Possible complications after adenomectomy, such as bleeding or re-growth of lymphoid tissue, are most often the result of refusal of anesthesia or the use of local agents, when the child simply does not allow the doctor to do his job efficiently. Removing the adenoids under general anesthesia avoids such complications and makes the operation almost imperceptible for the child. Parents can be sure that their child will not subsequently have the same unpleasant memories that for a long time tormented them and caused unnecessary anxiety in the present.

It is important to know!

First surgical treatment inflamed tonsils carried out at the end of the 19th century. At that time, anesthesia was not used, so the patient fully felt and observed all the features of such therapy. Today, the operation is performed under anesthesia: local or general.

Sniffling nose has long been synonymous with childhood. Children get sick a lot, especially colds. Frequent inflammatory diseases in the nasopharynx lead to the appearance of adenoids.

As the disease progresses, the only way to treat it is surgical removal overgrown tissue. This often frightens both the child and his mother and father. Many parents are interested in how adenoids are removed in children.

Adenoids are pathologically enlarged nasopharyngeal tonsils, which cause breathing difficulties, hearing impairment and other disorders.

The tonsil is located in the arch of the nasopharynx and is not visible to the naked eye. Only an otolaryngologist can examine it using a special mirror.

The nasopharyngeal tonsil is part of the so-called lymphadenoid pharyngeal ring, which surrounds the entrance to the respiratory and digestive tract. It performs a protective function and belongs to the immune system.

With adenoid growths, nasal breathing is blocked. The child breathes through his mouth more and more often.Because of this they do not perform their function defense mechanisms body, the air is not sufficiently filtered and viruses and microbes penetrate the respiratory tract.

Therefore, inflammatory diseases are increasingly occurring: sore throats, bronchitis, sinusitis and others. The risk of developing pneumonia increases. Due to inflammatory processes in the nasopharynx, children often develop otitis (inflammation of the middle ear).

Adenoids can develop in children between 1 and 14 years of age, but children between 3 and 7 years of age are most often affected.

As a result of adenoid growths, the following problems appear:

• The voice becomes nasal, the child speaks as if through his nose;
• Appears chronic runny nose with difficult, often purulent, discharge;
• Due to the constant inflammatory process and weakened immune system, the child often gets sick, has difficulty recovering, and complications arise from acute respiratory infections;
• Begins to snore in his sleep;
• Hearing may be impaired;
• Frequent headaches, pale skin, and absent-mindedness occur.

There are three stages of adenoid growths:

1. initial stage. The nasopharyngeal tonsil is slightly enlarged and slightly covers the nasal passage;
2. Second stage. The adenoids cover more than half of the nasal passage;
3. Third stage. Overgrown adenoid tissue almost completely blocks the nasal passage.

On early stages may be prescribed to stop tissue proliferation conservative treatment. These are usually special drops, washing the nose and nasopharynx with medicinal solutions, homeopathic medicines And so on.

If it does not help and the growth of adenoid tissue continues, then it is removed surgically.

Reasons and indications for surgery. Possible consequences

When adenoids are present, surgery to remove them is not always prescribed. The reasons for surgery are:

Adenoids of the third degree, when they block the lumen of the nasopharynx by more than 2/3;

When adenoid growths close the excretory fistula of the Eustachian tubes and, as a result, accumulate mucus in the middle ear. This leads to hearing loss and the occurrence of frequent otitis media, including purulent ones.

Possible complications

Parents are often afraid to have surgery because possible complications. Nevertheless, adenotomy (surgery to remove the adenoids) is not considered a difficult or dangerous procedure. Modern techniques make it as effective and painless as possible.

However, sometimes the following consequences arise:

• An increase in temperature above 38 degrees for more than 48 hours may indicate the occurrence of infectious inflammation;
• Continuous bleeding from the nasopharynx. Occurs when adenoid tissue is not completely removed. Additional cleaning or laser cauterization is required;
• Damage to adjacent mucous tissue, leading further to the development of atrophic epipharyngitis;
• Relapses of the disease.

To avoid possible complications, it is necessary to carefully select a specialist who will perform the operation and the method of removing adenoids in children.

Should I operate or not?

Parents often doubt and do not want to undergo surgery for their child. Certainly, surgery is stressful for the child. But it’s worth considering that there is no other alternative to getting rid of adenoids.

If the adenoid tissue has already grown, then it cannot shrink in any way and has to be removed promptly. Grade 3 adenoids cannot be cured with medications.

Sometimes parents confuse adenoid growths and adenoiditis. Adenoiditis occurs as a result of inflammation of the adenoid tissue. It can be treated and the inflammation will go away. However, overgrown adenoids cannot be treated this way.

The operation is not prescribed unless absolutely necessary. If serious violations adenoids do not cause, then their growth is tried to be stopped conservatively. If treatment is not effective and the pathology continues to grow, surgery cannot be avoided.

Therefore, if surgical intervention is necessary, then you should not postpone it in order to avoid irreversible consequences for the child's health.

Is removal painful? What painkiller is used?

Some parents who had their adenoids removed as children remember it as an unpleasant and painful procedure. They refuse to expose their child to it. But it is worth noting that in those days this operation was performed without anesthesia. That's why the memories remain sad.

Expert opinion

Smirnova Luiza Dmitrievna – medical worker

Pediatrician assistant at a private clinic

Before surgery, ask your doctor how pain relief will occur. In all modern hospitals, local or general anesthesia is used for adenotomy. General anesthesia most preferable for children. The child falls asleep after the injection, and when he wakes up, the operation is over.

This form of anesthesia has a number of contraindications. Therefore, local anesthesia is sometimes used. It provides sufficient pain relief, but the child may be frightened by the sight of instruments or blood. So, with local anesthesia, an additional injection of a sedative is given.

If an operation is necessary, but anesthesia is not possible, then the operation is performed without anesthesia. Adenoids do not have nerve endings, so their removal, although an unpleasant procedure, is not too painful.

Types of operations

Most often, the operation to remove adenoids (adenotomy) means surgical excision of tissue with a special instrument.

However, there are other methods for removing adenoids in children.

IN modern medicine The following main methods are distinguished:

• Endoscopic removal;
• Laser excision of adenoids;
• Excision of adenoid tissue using a radio wave apparatus.

During the operation, complete or partial removal adenoids.

Endoscopic removal is a surgical operation under endoscopic control.

During surgery, the doctor may use various instruments: regular adenotome, electrocoagulation, microdebrider (shaver), plasma knife and others.
However, regardless of the technique used, the essence of the operation is the excision and removal of adenoid tissue from the nasopharynx. An endoscope is used for visualization.

Laser removal of adenoids is used for small tissue growths. This procedure is less traumatic, however, most often several sessions are necessary.

In case of large growths of adenoids, it is advisable to perform surgical excision followed by cauterization with a laser.

When using a radio wave apparatus to remove adenoids under the influence of current high frequency a kind of evaporation of the tissue occurs, and the adenoids become smaller.

Dignity radio wave surgery are minimal trauma, bloodlessness, accelerated healing wounds.

Why is their absence dangerous? Dangers of untimely removal

Enlarged adenoids are most often accompanied by an increase in palatine tonsils. This can lead to difficulty breathing not only through the nose, but also through the mouth. The child suffocates especially often at night.

If the adenoids are not removed in a timely manner, then due to constant open mouth upper jaw becomes underdeveloped, teeth begin to grow incorrectly, and the jaw becomes deformed.

The worst thing is that if deformation occurs, the process is irreversible even if the operation is taken into account. Therefore, you should not delay the treatment of adenoids.

Another common complication of adenoids is hearing loss and the onset of hearing loss. However, this violation is reversible. After removal of the adenoids, hearing is restored.

Many people are afraid to remove adenoids because... they are afraid that the child’s body will lose a kind of “protective barrier” and will begin to get sick even more often than before the removal.

Among the mothers who agreed to have their child have surgery, there are also those who are not happy with the result and even think that things have gotten worse. To weigh the pros and cons of surgery, consult your doctor.

It’s good if you already have a proven one, if not, contact a doctor you trust.

Remember that if the adenoids are severely overgrown, surgery is required.

Preparing for surgery

It is necessary to prepare for the operation, first of all, psychologically. It is important for parents to remain calm themselves. It is necessary to explain to the child the need for the procedure, tell him what awaits him, but in such a way that he is not afraid. You can promise your baby ice cream after the procedure.

When planning an adenotomy, the doctor will prescribe necessary tests and examinations. On the eve of surgery, you may be prescribed medications to improve blood clotting.

On the day when surgery is scheduled, the child should not be fed or given water two hours before the procedure. This is especially important if anesthesia is expected. Otherwise, vomiting may occur.

Recovery after surgery

The operation itself does not last long, 5-10 minutes.

The child will recover from anesthesia for some time. If everything went well, then 2-3 hours after the baby came to his senses, he was sent home.

After adenotomy, cold has a calming effect on the nasopharyngeal mucosa, relieves swelling, and stops bleeding.

But if the child has difficulty swallowing or does not feel well after anesthesia, there is no need to insist.

On the first day after surgery, you may cough up blood or vomit blood. This occurs because blood entered the stomach during surgery.

Are you for or against removal?

AgainstBehind

Wounds on the mucous membrane have not yet healed and may bleed a little, especially when irritated.

On the first day after surgery, the temperature may rise and weakness may be present.

In the first days, the child is prescribed to rest more, not walk outside, avoid stress, and do breathing exercises.

To normalize nasal breathing function, vasoconstrictor drops are prescribed for 5 days.

Restoration of nasal breathing and hearing usually occurs within 7-10 days after surgery.

Relapses – secondary appearance

Sometimes relapses occur after adenoid removal in children. Re-growth of adenoid tissue is possible if

• The lymphoid tissue was not completely removed;
• Surgery on a child under 3 years of age;
• The presence of factors that cause adenoid growths (allergies, heredity, frequent illnesses).

Such cases do not happen often and require specialist consultation.

Adenoids in children are a “scourge” almost as common as frequent acute respiratory viral infections. Moreover, one is closely related to the other. How and why do adenoids occur in babies? Is there a cure for this? And how are adenoids removed in children? We'll tell you in detail!

Adenoids in children are directly and very closely related to nasal breathing. More precisely, with its absence. However, these difficulties have nothing to do with a runny nose. And you will notice it right away - the child will desperately try to blow his nose, but still will not be able to breathe through his nose...

What are adenoids and where to look for them

If you, sitting at the mirror, open your mouth wider and look, literally, into yourself, you will see two plum-shaped growths on the edges of the nasopharynx. These are tonsils (sometimes called tonsils), special accumulations of lymphoid tissue.

It is believed that the tonsils perform a certain protective function (prevent various pathogens from entering the body), and also participate in the development of immunity. Although medical scientists have not yet achieved clarity on the last question - that is, how exactly the tonsils behave when created in humans immune defense, no one knows yet.

When inflammation of the tonsils, which we see in the mirror, occurs, the disease tonsillitis occurs (the bacterial version of which is well known to everyone under the code name “”). Most often the tonsils become inflamed.

We are used to thinking that tonsils are the two “cream” that we can see in our mouth. But in fact, every person has not two tonsils, but six! And they are all located in the nasopharynx. Three of these tonsils are very small and few people are interested in, but the other three are rather large clots of lymphoid tissue that very often make themselves felt.

Two of these three large tonsils- these are the paired palatine tonsils (the same ones that we see in the mirror and on which sore throat usually “thrives”), the third is the so-called unpaired nasopharyngeal tonsil. That's when this nasopharyngeal tonsil in children becomes inflamed and grows, increasing in size - this is usually called adenoids.

Adenoids (sometimes adenoid growths) are a pathological enlargement of the nasopharyngeal tonsil due to the proliferation of lymphoid tissue. In young children, adenoids appear quite often, and in children after 6-7 years of age - much less often. Adults do not have adenoids at all.

The most important facts about adenoids in children

• 1 When a baby gets sick with ARVI, the nasopharyngeal tonsil increases in size, growing with lymphoid tissue. In medicine, this phenomenon is called acute adenoiditis. Most often, after recovery, this tonsil gradually shrinks back to its normal state. But sometimes the nasopharyngeal tonsil grows so large that it prevents the child from breathing, or causes constant serious illnesses(for example, or otitis media), in which case the adenoids are removed surgically. But don't be scared! The operation to remove adenoids lasts about 10 minutes and is one of the simplest and safest operations in medicine.
• 2 To the greatest extent, adenoids are characteristic of frequently ill children. Simply due to the fact that the child is infected again and again with one or another respiratory virus, and at the same time, the nasopharyngeal tonsil simply does not have time to shrink to a normal state, so over and over again the adenoids become larger and larger.
• 3 Until the age of 6-7 years, adenoids in a child can appear several times. It turns out that even after the adenoids are removed from a child under 6 years old, they may well grow back. And it is not uncommon for children to then have to undergo the procedure of adenoid removal again.
• 4 And only after the age of 7, the growth and activity of the nasopharyngeal tonsil drops sharply.... Now the adenoids are no longer able to increase in size as rapidly as before, even if the child continues to get sick often. After 8 years, lymphoid tissue completely loses its ability to grow - even if by this time the adenoids were dangerously large, from now on they will gradually decrease.
• 5 To refer a child for adenoid removal, the doctor’s opinion alone is not enough! There are specific indications that clearly regulate the reasons and conditions surgical intervention. We will list them below.

Adenoids in children: symptoms

A doctor can see a child’s adenoids (and assess the degree of their growth) using a special mirror - dentists also use something similar when counting holes in our teeth. Parents, as a rule, do not have such mirrors, so for mothers and fathers there are other ways to detect adenoids in children.

The very first and most obvious symptom of adenoids in children is the child’s lack of nasal breathing.

The diagram of the location of the organs shows that the nasopharyngeal tonsil is in close proximity to two extremely important “paths” - the nasal passages and the so-called Eustachian tube, which connects the nasal cavity and the ear cavity. As long as the nasopharyngeal tonsil is normal, these pathways are free. But as soon as adenoids appear, their mass blocks either the nasal passages or Eustachian tube, or both at once.

Considering this circumstance, it is quite understandable why the following symptoms indicate dangerous adenoids:

• the child has no nasal breathing (without signs of a runny nose or nasal congestion);
• the child has ear pain and hearing has deteriorated (as with incipient otitis media);
• the child experiences relapses;
• The baby's voice becomes nasal.

These phenomena in themselves are symptoms of adenoids in children. But you can also add several accompanying signs to them:

• the child began to snore in his sleep;
• the child constantly breathes through his mouth, which makes it difficult for him to eat - he loses his appetite;
• the child experiences pauses in breathing during sleep;
• the baby suffers from headaches;

What circumstances contribute to the appearance of adenoids in children?

Scientists have identified several factors that, to varying degrees, influence whether a child will be prone to developing adenoids or not. These factors include:

• Heredity (if one of the baby’s parents himself “suffered” from adenoids in childhood, then with a high degree of probability the same problem will affect the child);
• Frequent respiratory viral infections, as well as such past illnesses like measles, whooping cough, scarlet fever, tonsillitis and the like;
• Predisposition to allergic reactions(although in this case the adenoiditis will be allergic in nature, and it will be quite possible to “defeat” it with the help of antihistamines);
• Systemic overfeeding of a child.

Adenoids in children: treatment

The severity of adenoiditis in a child (inflammation and increase in size of the nasopharyngeal tonsil) is directly related to the severity of ARVI. If you treat your child correctly and promptly for viral infections, then the adenoids will not bother you unnecessarily - the child’s ARVI will go away, and the adenoids will gradually decrease in size.

It is important to remember that lymphoid tissue is extremely sensitive and responds to two factors:

• 1 ARVI diseases (during viral infections, lymphoid tissue begins to grow - these are the adenoids);
• 2 The quality of the air that a child prone to adenoiditis breathes (by inhaling moist and cool air, the child helps the adenoids enlarged due to ARVI to quickly decrease to normal).

As in the treatment of ARVI, air parameters play a role great importance. Moist, fresh and cool air promotes quick recovery, dry and warm - on the contrary, it will cause the mucous membrane to dry out and cause additional education mucus in the nasopharynx.

Alas, for the treatment of adenoids in children as such, there are no “magic” drops, syrups, tablets or any other means - it is in no way possible to “spur” the lymphoid tissue to shrink.

There is only one exception to this rule - allergic adenoiditis. That is, when the adenoids increase in size not due to the growth of lymphoid tissue, but due to swelling in this tissue. In this case antihistamines can help reduce swelling and restore the previous size of the nasopharyngeal tonsil.

There are only two treatment options for adenoids in children: remove them surgically or not remove them. There are clearly defined indications for removal.

Indications for adenoid removal in children

All over the world, adenoids are removed according to strict indications - if they are present, then the child needs to have their adenoids removed and this is not disputed. If there are no such indications, then there is no need for removal either.

So, in what cases is surgical intervention to remove adenoids for a child necessary and mandatory:

• prolonged absence of nasal breathing;
• snoring during sleep;
• sleep disturbances (they are also associated with the fact that the child cannot breathe freely through his nose during sleep);
• shortness of breath during sleep;
• hearing impairment;
• recurring otitis media;
• chronic;
• deformation of the facial skeleton in a child (the so-called “adenoid face”).

The main indicator among this “bouquet” is a persistent lack of nasal breathing.

If the child continues to breathe through the nose, the need to remove the adenoids is negligible.

If adenoids are removed before the age of 3-4 years, there is a high chance that they will grow back. If the operation is performed on a child aged 6-7 years or older, then the adenoids are unlikely to reappear - the activity of the lymphoid tissue by this time is already significantly reduced. But if a child has indications for surgery to remove adenoids, his age does not matter! It is criminally dangerous not to perform the operation, for example, at 4 years old, and wait until the age of 6 (so that the adenoids do not grow back after the operation). If there are indications for surgery, it must be removed as soon as possible. Otherwise, you can “earn” a lot most dangerous complications, including hearing loss, chronic otitis media, deformation of the facial skeleton and others.

What is an “adenoid face” in a child? Doctors use this term to designate a specific facial deformation in children who have long time there is no nasal breathing. In the vast majority of cases, such a transformation occurs precisely because of enlarged adenoids, which block the nasal passages with their mass. Such children begin to sleep differently, eat differently, speak differently, their bite gradually changes and facial features acquire characteristics. If the adenoids are removed and the baby’s nasal breathing is restored, in most cases it is possible to “return” the child’s previous face, but sometimes the changes become irreversible - the facial skeleton not only transforms, but also strengthens as the child grows older.

How to remove adenoids in children: nuances of the operation

Removal of adenoids in children became common practice around the beginning of the 19th century. Of course, in those days there was no talk of any anesthesia. Over the years, doctors began to use local anesthesia (a special solution was instilled into the nose, which temporarily “froze” the nasopharynx area. But no local anesthesia can relieve children from the fear of a doctor with a “knife” in his hands.

Therefore, in our humane times, they practice short-term general anesthesia when removing adenoids in children, which allows the baby not to be scared and not remember the operation itself, and for the doctor to carry out all the manipulations as accurately and quickly as possible.

How long does it take to remove adenoids in children? The operation itself to remove adenoids (adenotomy) in children takes 5-7 minutes maximum. Moreover, laser and endoscopic removal are becoming increasingly widespread these days. In the first case, a laser beam acts as a “tool”; in the second, the cutting of the adenoids itself is carried out using a scalpel, but then the cut sites are “cauterized” in a special way (this is called electrical coagulation), which helps to avoid heavy bleeding And reappearance adenoids in the same place.

Modern surgical operations to remove adenoids in children are extremely low-traumatic and do not pose any threat to children. negative consequences for health or psyche. This is confirmed by millions of similar operations that are carried out annually all over the world.

Theoretically, after the operation, the child can almost immediately return to his everyday life and normal diet - the fact of removal of the adenoids does not imply any special dietary restrictions.

If your child has difficulty swallowing some time after surgery, paracetamol or ibuprofen can be given as a pain reliever. But if you believe the statistics, this problem (pain after adenoid removal) affects only 25% of operated children. Everyone else feels no pain or discomfort when swallowing.

Often, after surgery to remove adenoids, doctors recommend giving the child something soft and cold to eat - ideally ice cream is suitable for this purpose.

It's hard to imagine a more suitable occasion to allow a child to eat ice cream to his heart's content than an operation to remove adenoids. On the one hand, ice cream has a slight anesthetic property, on the other hand, it helps healing (the cold product causes the blood vessels to constrict and thus minimizes possible bleeding), and finally, ice cream perfectly compensates for all children’s fears and worries about the surgery.

At 3-4 years of age, adenoids bother many children - this is very common childhood disease. main reason occurrence of adenoids - frequent viral diseases, in everyday vocabulary - “endless colds.”

And despite the fact that the most common result of the “struggle” with children’s adenoids is surgery, there is no point in being afraid and avoiding removal. If there are indications, you need to cut! Moreover, it is difficult to imagine a simpler and less traumatic pediatric “surgery”...

Adenoids are a collection of lymphoid tissue located in the nasopharynx. When performing their function normally, the adenoids protect the body from upper respiratory tract infections.

Adenoids and anesthesia

In most Russian hospitals, surgery to remove adenoids is performed under or without any anesthesia. It should be noted that local anesthesia when removing adenoids is difficult to carry out efficiently, therefore, when using it, some sensation of pain still remains.

In Europe and the USA, adenoid removal is most often performed under (anesthesia). Carrying out anesthesia when removing adenoids ensures that the patient loses consciousness and ensures that there is no pain during the operation. All manipulations during an adenoidectomy operation are performed on the head, which limits access to the respiratory tract, therefore, to reliably maintain the passage of air through the respiratory tract, endotracheal anesthesia or a laryngeal mask are used. At removal of adenoids under anesthesia with an endotracheal tube, the airway is protected more reliably, but the time to awaken from anesthesia is longer and waking up is more uncomfortable, in contrast to the removal of adenoids under general anesthesia using a laryngeal mask airway.

When carrying out anesthesia during the removal of adenoids, it is possible to use various ones - both inhalation and non-inhalation. To quickly recover from anesthesia and quickly return to a normal state, it will be better if propofol or some modern inhalation anesthetic (isoflurane, sevoflurane, desflurane) is used for anesthesia when removing adenoids.

Unfortunately, in many domestic clinics there is still the practice of removing adenoids without anesthesia. And this is quite painful. To this day, I remember all the sensations of pain from the operation to remove the adenoids, performed on me in childhood without any pain.

Indications for adenoid removal

The most common indications for removal of adenoids under anesthesia are frequent rhinitis, difficulty in nasal breathing, and associated sleep disturbances.

Features of adenoidectomy

An adenoidectomy is a minor operation in which the adenoids are removed. After induction of anesthesia, the patient’s mouth is opened slightly using a special instrument. The adenoids are removed after determining their position, using one of the techniques: curettage or cauterization of the adenoids using diathermy. The operation is completed when bleeding from the vessels stops.

Operation time

The duration of the adenoid removal operation under anesthesia is about 30 minutes.

Complications of adenoidectomy

Removing adenoids under anesthesia is a fairly safe operation. The most common complication is bleeding (0.4-1% of cases). The risk of developing serious complications such as aspiration, infection, or dental damage is very low.

Adenoids, or adenoid vegetations – pathological changes pharyngeal tonsil, caused by hyperplasia of lymphoid tissue. It usually occurs in children aged 3 to 14 years; it is very rare in adults. Causes difficulty in nasal breathing, hearing loss and other disorders. Effective method The treatment for adenoids is their removal.

Types of adenoid removal operations

Currently, adenoid removal is adenotomy- carried out in several ways. The most common:

• Standard- using a special instrument, Beckmann's adenotomy.
• Endoscopic— using a shaver or microdebrider and visual control surgical field endoscopes.
• Coblation– tissue dissection using so-called “cold” plasma.

Standard operation

Can be carried out both in inpatient and outpatient settings, under local anesthesia or To remove adenoids, it is used - Beckmann's adenoid.

Stages of standard adetomy:

1. The tongue is fixed with a spatula at the bottom of the mouth, the adenoid is inserted into the nasopharynx along the midline and moved along the posterior edge of the vomer up to the dome of the nasopharynx. When the scalpel is pressed against the nasopharynx and vomer, the tissue to be removed enters the adenotomy ring.
2. With a short and sharp movement, the instrument is moved downwards along the posterior wall of the nasopharynx. In this case, the adenoid tissue is cut off; if it remains hanging on a thin strip of tissue, it is removed with forceps.
3. After this, the patient needs to clean out the nasal passages. If the operation is performed under topical anesthesia, then he can do it independently, exhaling forcefully in turn through each nasal passage.

After surgery to remove the adenoids, there is slight bleeding, which quickly stops. After the follow-up examination, the patient can leave the medical facility 2-3 hours later.

Endoscopic surgery to remove adenoids

IN Lately Endoscopic adenotomy is increasingly being used, with visual control of the surgical field using endoscopes. As a rule, such an operation is performed under general anesthesia, which allows for painless and quick removal of the adenoids.

Stages of endoscopic adenotomy:

1. Before surgery begins, an endoscope is inserted through the oral or nasal cavity.
2. To remove adenoids, a shaver (microdebrider) is used - this is a special cutting instrument for surgical operations in the nasal cavity and nasopharynx. The tip of the shaver is inserted into the nasal cavity up to the nasopharynx. Design allows cutting pathological tissue without damaging healthy areas, and also suction blood and cut tissues.

How endoscopic surgery to remove adenoids is performed on YouTube video.

Coblation adenotomy

Coblation, or “cold destruction,” is one of the most modern technologies, based on the treatment of tissues with “cold” plasma. As a rule, it is performed under endoscopic control and local anesthesia.

Stages of coblation adenotomy:

1. Inserting an endoscope into the nasal or oral cavity.
2. Insertion of a special device connected to the apparatus into the nasopharynx.
3. Dissection and removal of adenoid tissue using a plasma beam, which does not damage healthy tissue and has a coagulating effect, which reduces bleeding after surgery.

Coblation adenotomy video is available on YouTube.com

After the operation, there may be an increase in body temperature, abdominal pain, and vomiting of blood clots. As a rule, symptoms go away on their own within a day or two. Because of postoperative edema The mucous membrane may experience nasal congestion and a nasal voice. By day 10, the swelling subsides and nasal breathing is completely restored.