Contents of the article
- 1 Indications for surgical treatment of adenoids
- 1.1 What is important to know
- 2 Adenotomy methods
- 2.1 Types of anesthesia
- 2.2 Basic methods of surgical treatment
- 3 Postoperative period
- 4 Possible complications
- 5 Price
Adenoid removal operationIn children is called adenotomy. In the environment of surgeons, it is referred to as "streaming".This is one of the most frequent, short and uncomplicated surgeries in ENT surgery. Adenotomy does not belong to the form of urgent, urgent operations. Usually it is prepared on a scheduled basis, a number of necessary examinations are scheduled, repeated diagnostics. The operation itself lasts no more than 10 minutes and is usually carried out in the morning. After removal of adenoids, the patient is under the supervision of doctors about 5 hours, and in the evening safely returns home. In rare cases, you have to stay ove
Indications for surgical treatment of adenoids
Is it worth it to remove adenoids to a child? It is worthwhile if, with all conservative methods of treatment, there is no effect, inflammation of the adenoids( adenoiditis) turns into a chronic form. And this means: there is a focus of infection in the adenoids, their puffiness remains, and a rapid proliferation of adenoid tissue is diagnosed. What symptoms and illnesses are considered indispensable indications for adenotomy?
- Difficult nasal breathing. The child always breathes a mouth that provokes drying out of mucous membranes, frequent ARVI and complications after them. Also, complicated nasal breathing leads to restless sleep, which affects the overall psycho-emotional state of the child, leads to irritability, constant fatigue.
- Delayed breathing in sleep, or apnea. A life-threatening symptom. In addition, oxygen deficiency( hypoxia) adversely affects brain function and the growing body as a whole.
- Chronic otitis media. Enlarged adenoids cover the auditory tube, which provokes inflammation in the middle ear. During the year, the child has otitis media 4 times, and hearing impairment is also observed.
- Deformation of the facial skeleton. There is a medical term for "adenoid face."Increased adenoids lead to abnormal changes in the maxillofacial bones. Such consequences can be irreversible if the operation is not carried out in a timely manner.
- Malignant tumors. Fortunately, cases of degeneration of adenoid tissue into a malignant tumor are rare.
What is important to know
The operation can be prescribed even in infancy, if there are serious causes and clear indications.
- Adenotomy is contraindicated in children suffering from bronchial asthma, heart and blood diseases. Such patients are prescribed only conservative therapy. On the treatment of adenoids in children without surgery, read in our other article.
- Frequent ARVI is not an indication for surgery. If nasal breathing persists, adenotomy is usually not prescribed.
- Not always adenoids 3 or 4 degrees must be removed. For example, a child can diagnose adenoids 1 or 2 degrees, while he has difficulty nasal breathing, snoring or nighttime apnea, complications after SARS - otitis, sinusitis, sinusitis. These are clear indications for adenotomy.
- Among the responses of parents, you can find this opinion: do not rush with the operation. It is not superfluous to have the opinion of several highly qualified otolaryngologists.
- If the parents still decide on the operation, it is necessary to consult a surgeon who will operate the baby.
- Re-diagnosis is necessary for adenoiditis. If a child underwent ARVI, and after two weeks he was diagnosed with adenoids of 2 or 3 degrees, this is not a reason to sound an alarm and urgently "cut".Enlarged adenoids - the norm after the disease. A second examination can show a marked improvement.
Methods of adenotomy
The essence of adenotomy is the complete removal of adenoid tissue from the nasopharynx. What methods are used in modern medicine? Methods for removing adenoids in children can be classified according to the type of anesthesia and the methods of adenotomy using various instruments and equipment.
Types of anesthesia
The first surgery to remove adenoids began in the late XIX century. Of course, about any anesthesia in those days it was not.
- Local anesthesia. In this case, the level of the pain threshold, the temperament of the small patient, his psychoemotional state and age are taken into account. This type of anesthesia doctors are more likely to offer older children. It is carried out in the form of spraying( smearing) anesthetic on the mucous nasopharynx. The child does not feel pain, but he can be frightened by the sight of blood, the procedure itself is horrible. Therefore, often with local anesthesia, an additional intramuscular injection of sedatives is used. A small patient is in a dulled state of consciousness and does not run wild. Adenotomy under local anesthesia costs less, is carried out more quickly, has no postnarcotic side effects and complications. Parents agree to a local anesthetic, knowing the persistent nature and endurance of their child.
- General anesthesia. In Western medicine, this type of anesthesia is practiced exclusively. It is strongly recommended and domestic doctors: not only for humane purposes( to spare the child's psyche), but also in purely practical ones - only in calm conditions can a qualitative operation be carried out and all adenoid tissue removed. Most modern clinics switch to general anesthesia. Anaesthesiological risks and sudden complications with general anesthesia exist. The doctor-anaesthesiologist is obliged to tell about it.
- Absence of anesthesia. Today this fact can shock. Although more recently in Russia, the adenotomy was performed without anesthesia. This is because lymphoid tissues do not contain nerve fibers."Allegedly not painful," but very scary. At parents' forums, you can read the living and unforgettable memories of childhood: tying to a chair, bloody aprons and stuff. Many parents want to save their own child from such heartbreaking scenes and generally prefer a general anesthesia.
Basic methods of surgical treatment
- Classical operation with the help of an adenotome. Adenotom is a ring-shaped knife that is used to remove adenoids. The classical method uses a guttural mirror, a confident hand and a sharp vision of the doctor. Minus of such operations: more intensive bleeding at removal( some surgeons dispute this fact), insufficient review, as a result of which it is not always possible to remove adenoid tissue in a qualitative way. If there remains a small piece of tissue, there is a risk that the adenoids will grow again. During the operation, sometimes it is necessary to resort to hemostatic agents( powder powders, cauterization of vessels by laser or radio waves).In modern surgery, radio wave adenotomes have appeared, which simultaneously remove tissues and stop bleeding.
- Laser removal. Instead of an adenotomy, a laser is used. There are different types of laser instruments that the doctor chooses, depending on the category of complexity of the operation. Laser removal of adenoids is considered a low-traumatic and highly accurate method. Laser sterility gives the lowest risk of secondary infections after surgery. Tissue healing after laser adenotomy is much faster.
- Endoscopic removal of adenoids in children. The main advantage of the method is the visibility of the operating field. Most modern operations are performed with the help of endoscopic control. Thanks to the video endoscope, the surgeon conducts the adenotomy with high accuracy, effectively and qualitatively removes the adenoid tissue.
- Cold-plasma method, or cobalt. The last word in otolaryngology. It is performed with the help of a coblator - a cold-plasma tool. Has a number of advantages: bloodlessness, painlessness, the most careful removal of adenoid tissue, reducing the risk of postoperative complications, rapid recovery after surgery. The only negative is the price.
How is the postoperative period?
- As a bonus for "trying", the patient gets ice cream. Cold contributes to the narrowing of the vessels, which is shown after the removal of adenoids.
- Pains, discomfort in the throat during swallowing can remain for several days. The doctor prescribes local anesthetics and painkillers.
- Vomiting with an admixture of blood is possible. This happens if the child swallows blood during an operation. For the same reason, stool disorders are possible.
- In the first days, temperatures may rise to 38 ° C.It is strictly forbidden to use antipyretic drugs containing acetylsalicylic acid, since it can provoke bleeding.
- It is necessary for the doctor to take astringent and vasoconstrictive drugs in the nose.
- Within a week after the operation it is forbidden to take a hot bath, go to the bath, visit the open sun.
- Also the doctor will recommend a sparing diet: hot, hard, mucosal irritating food is excluded.
- Nasal congestion and congestion due to swelling of the mucous membranes after surgery. Usually these symptoms disappear in a week.
- Special breathing exercises, which the ENT will tell, will be useful.
- Fresh air is shown! Excluded large physical activity during the month.
Possible complications of
What could be the consequences of adenoid removal in children?
- Severe complications. Only in rare cases there are intense bleeding during and after operation, aspiration of the respiratory tract, complications after general anesthesia, trauma to the sky.
- Temporary reduction of immunity. Doctors-otolaryngologists assure that there are no negative consequences after adenotomy: the child will not get sick more often if he has adenoids removed. Immunity after adenotomy is reduced, as after any other operation. After a few months, the immune system returns to normal.
- The baby snores after removal of adenoids. If snoring and squelching in the nose last for ten days after surgery - this is normal. Swelling will disappear - snoring will disappear. If snoring after adenotomy remains for a longer time, a compulsory consultation of the otolaryngologist is necessary.
- Secondary infection. After the operation, a wound remains in the nasopharynx, which, against the background of weakened immunity, can cause a secondary infection. Therefore, doctors recommend a home treatment and a temporary restriction of contact with the children's team in the postoperative period.
How much does it cost to remove adenoids for a child? It makes no sense to name specific figures. Because they depend on many factors: the complexity of the operation, the doctor's qualification, the choice of anesthesia, the method of adenotomy, the clinic, the region. The more progressive the method and the higher the specialist's qualification - the higher the cost. Russian parents who have gone through the financial costs of surgical treatment for children often share personal experiences in networks. What is special about this purely Russian experience?
- If this is a private, non-governmental clinic, then in the price-list all services should be taken into account. Often, only the cost of the surgeon's work is indicated, the rest - pops up later.
- If it is a state polyclinic( hospital) and money is given in an envelope, it is important to consider: to whom, how much and when to give. Separate and special "gratitude" is given to the anesthesiologist and surgeon. Do not forget about the nurses who will look after the child. This is Russian reality.
It is necessary to specify the full financial costs immediately, so that later there are no surprises and mutual claims.
The removal of adenoids in children is often repeated, especially if the operation is performed at an early age( up to 3 years).The secondary growth of adenoids is not always due to a poorly conducted operation. There may be other reasons. For example, relapse after adenotomy is more common in allergic children and patients with a genetic predisposition to intensive growth of adenoid tissue.