Adenoid surgery for a child under general anesthesia. Removal of adenoids in children under general anesthesia. The threat of unremoved adenoids

A stuffy nose, hearing loss, and night snoring in a child are the most common complaints when visiting an otolaryngologist. If the symptoms persist for a long time, most likely, the ENT doctor will say that the baby has the second or third stage of adenoids. At the moment, the opinion of most experts is clear: you need to have an operation.

Degrees of enlargement of adenoids

To have an idea of ​​how dangerous the disease is, you should consider the structure of the nasopharynx. Along the side walls of the channel through which air enters are the mouths of the Eustachian tubes, which connect to the middle ear.

On the posterior wall of the cavity is the nasopharyngeal tonsil. It is part of the immune system, its function is the production of leukocytes that take on attacks from pathogenic microflora. In the case of frequent inflammation caused by infection, allergies or other factors, the lymphoid tissue begins to increase and gradually blocks the auditory tubes and limits air access.

In a healthy baby, the adenoids normally cover up to a quarter of the lumen of the nasopharynx canal. Depending on the severity of the disease, three degrees of pathological growth are distinguished:

• The first is that up to 33% of the lumen of the nasopharyngeal canal in the area of ​​the vomer, part of the bony septum of the nose, is blocked. In this case, the child experiences minor difficulty breathing through the nose, which may worsen at night due to swelling. Adenotomy - surgery to remove adenoids - is usually out of the question; conservative treatment is preferable.
• From 33 to 66% of the lumen is closed. This is the second degree of enlargement of the adenoids, in which the child may snore at night and his hearing is impaired. During the day, the baby’s breathing is difficult; due to nasal congestion, his mouth is constantly slightly open (the so-called adenoid type of face). A recommendation from an ENT specialist for surgical intervention is possible. If left untreated, adenoids may gradually grow.
• Third, there is almost complete blocking of the nasal canal of the respiratory tract by connective tissue. Breathing through the nose is almost completely absent; immediate medical intervention is required, as there may be consequences in the form of improper formation facial section skull, hearing impairment. With the third degree of adenoids, the baby experiences constant torment, headaches and fever are possible.

Note to parents. According to statistics, about 3% of preschoolers suffer from pathology. It matters at what age the adenoids began to enlarge. As a rule, surgery is not performed on children under 2 years of age, since there is a high probability of relapse—re-enlargement of lymphoid tissue cells.

Possible consequences of adenoid hypertrophy

The danger of the disease is that the parents of a child suffering from a constantly stuffy nose do not attach much importance to it and notice changes when the consequences become obvious.

Typical facial expressions with an adenoid face: a displacement of the chin, a constantly slightly open mouth - leads to irreversible consequences. The structure of the jaws gradually deforms, which cannot always be corrected even surgically.

Enlarged adenoids greatly complicate the child’s life; psychosomatic diseases may appear: nervous tic, enuresis, convulsive states. The baby becomes lethargic or excitable. Due to the emerging nasal tone and hearing loss, verbal communication is deteriorating; when talking, he often asks to repeat what he was told.

Hypertrophied nasopharyngeal tonsils often become inflamed under the influence of negative factors, which is the cause of adenoiditis, a disease characterized by high temperature, chronic runny nose and headache.

Adenoids interfere with the outflow of mucus, which deprives the body of its protective function. Inflammatory processes can provoke pharyngitis, tracheitis.

Is surgery necessary?

The main question that parents ask at an appointment with an otolaryngologist is whether surgical removal of adenoids in children is necessary and what the consequences will be if medical intervention is abandoned. Indications for adenotomy are changes caused by hypertrophy of the pharyngeal tonsil of II and III degrees:

• adenoiditis, otitis media, chronic diseases respiratory organs;
• disorders associated with neurological abnormalities;
• formation of malocclusion;
• adenoid cough;
• apnea, or interruption of breathing during sleep.

The indication for surgery is a condition in which tonsils grow along with the adenoids. The child speaks poorly, often has headaches, and there is a lag in psychophysiological development. A decision is made about the need for surgery only if there is no alternative treatment.

The time of year at which adenoid removal is performed also matters. Winter is preferable to summer.

Advice. Often, the otolaryngologist makes a verdict about the need for surgery after an examination and x-ray. But this diagnostic method is not always safe and objective: in the image, the lumen may be blocked by accumulated mucus or inflamed tubal tonsils, angiofibromas or other tumors. An accurate and informative way to establish a diagnosis is endoscopy: inserting a tube with a video camera into the nasal cavity.

Contraindications

In some cases, surgery to remove adenoids in children is postponed for a certain period of time:

• for 1 month – in case of acute respiratory infections and sore throat;
• for 2 months – after recovery from the flu and after vaccination;
• for 3 months – after;
• for 4 months – after scarlet fever and rubella;
• for six months - after suffering from measles, mumps, whooping cough.

The answer to the question why adenoids cannot be removed after an infection is obvious: there is a decrease in immunity, and complications are possible. Before the operation, it is determined whether the child has recently been in contact with infectious patients; if this fact is revealed, adenotomy is postponed for a period of incubation period diseases.

Contraindications to adenotomy are:

• chronic infectious diseases or acute respiratory infections, acute respiratory viral infections;
• some diseases of the circulatory and cardiovascular systems;
• pathological development of the palate;
• age up to 2 years;
• untreated dental caries;
• some diseases of internal organs;
• thymomegaly.

For the above conditions, a non-surgical treatment method is chosen.

Advice. If surgery is contraindicated because the baby is allergic or the parents do not want to put him at risk, you can resort to the Buteyko method. This is a treatment program aimed at reducing the effect of hyperventilation. Its goal is to teach a small patient to breathe through the nose using a certain technique, as a result of which the growth of adenoid tissue slows down.

Preparing for surgery

Adenotomy is a surgical procedure that contains a certain risk. The necessary preparation will help to avoid the risk of bleeding, complications, and infection. To do this, a series of laboratory tests: for sensitivity to anesthetic drugs, blood tests - general and biochemical. They also determine whether the baby has hepatitis or AIDS, and determine his blood type and Rh factor.

Before the operation, the child is examined by a pediatrician and has a conversation with the parents. To exclude the possibility of developing infectious diseases, a course of antibiotics is sometimes prescribed.

Eating less than 12 hours before adenotomy is excluded, otherwise the baby may vomit. Mucous secretions are removed using the “Cuckoo” method.

Advice. Before going for adenoid removal, the child must be explained what is ahead of him, tell him why the operation is scheduled and how it will be performed. It’s not worth describing in detail what he will have to go through.

Anesthesia

Parents may be hesitant about the need for surgery due to the risk and possible suffering for the child. Those who had their adenoids removed without pain relief in childhood are especially worried. Nowadays, adenoid excision is performed under general anesthesia for patients under 7 years of age or local older children, since it is easier for them to explain the situation.

During local anesthesia, an anesthetic drug, lidocaine or novocaine, is first applied by spraying or smearing, and then injected directly into the tonsil. The child sees and is aware of everything that is happening, and the sight of tools and his own blood can cause psychological trauma. Therefore, general anesthesia is preferable. If the baby is overly excited and frightened, an additional sedative is administered.

The drug for pain relief is selected individually by the anesthesiologist; for young patients, low-toxic and relatively safe medications are used: Diprivan, Esmeron, Dormikum.

On to the pros general anesthesia include a low risk of psychological and physical trauma, the ability to safely remove the adenoids and carefully examine the throat after surgery. Modern specialists use endotracheal anesthesia, in which anesthetic substances enter both the blood and the respiratory organs.

Does it hurt to remove

Whether the baby will experience pain or not depends on the method of surgery and the type of anesthesia. In modern clinics, the following methods of adenoid removal are used: classic (Beckman knife), coblation method, laser, shaver adenotomy.

The last three methods are considered the safest and least traumatic; the risk of infection and bleeding is practically eliminated, since the vessels are cauterized during the operation. All types surgical intervention pass quickly. How long the operation lasts depends on the method, usually no more than ten minutes.

With local anesthesia, the child will feel pain and discomfort; during general anesthesia, unpleasant sensations are excluded, since the baby will sleep. But during complete anesthesia, there is a possibility of developing sudden complications associated with the administration of an anesthetic drug. Therefore, parents will have to choose between short-term discomfort, pain for the child and the danger of development anaphylactic shock. You will have to take risks in any case.

There is an opinion that it is not necessary to remove the adenoids, since as the child grows older, the pharyngeal tonsil may decrease in size. According to Dr. Komarovsky, delaying treatment until adolescence is unacceptable, since there is a high risk of developing a chronic disease and complications. Enlarged adenoids can be removed according to indications even in adulthood.

Look what a famous TV doctor says about Adenoid removal:

Surgical methods for removing adenoids

When and how adenoids are removed in children depends on the recommendations of the practitioner, the chosen clinic, the availability of the necessary equipment and the degree of pathology.

Postoperative period

As a rule, the child remains in the clinic for about three hours after the operation under the supervision of staff. After this time, in the absence of bleeding and other complications, the baby, if he feels well, is sent home. In a private clinic, a daily hospital stay is possible. How many days the rehabilitation period will take depends on the method of surgery.

Unpleasant manifestations of the consequences of surgical intervention are possible: fever up to 38 degrees, vomiting if the child has swallowed blood, weakness, pain in the throat. In order to take timely measures in case of complications, body temperature is checked twice: in the morning and in the evening for five days after adenotomy. To relieve hyperthermia, the child is given an antipyretic. Aspirin is strictly prohibited, as taking it can cause bleeding.

An increase in temperature over three to four days indicates possible wound infection. To avoid this, the doctor may prescribe an antiseptic for gargling or irrigating the throat: “Miramistin”, “Rotokan”, “Iodinol” - the list of solutions is long. Painkillers are used to relieve pain in the operated area.

Caring for a child after adenotomy

Caring for a baby who has undergone surgery is quite simple. The home recovery regimen after removal of adenoids in a child consists of correcting nutrition, limiting physical activity, observing hygiene rules. Here are general recommendations:

• Change your diet. For a child who has undergone surgery to remove adenoids, hot food and drink are prohibited: you need to spare the damaged area. You should not give food that can injure the throat: crackers, chips, spicy seasonings, vinegar dressings, feed dishes containing garlic, onions, etc. The duration of the diet is about two weeks.
• Due to the danger of bleeding, it is advisable to avoid overexertion and prolonged exposure to the sun, in a bath with hot water, or in a sauna. The throat and neck should not become warm. Semi-bed rest is recommended.
• Limit contact to avoid the risk of getting sick.
• Fulfill breathing exercises– to learn the technique, you can watch a video with your child. It is also important to teach your baby to breathe through his nose all the time.
• Follow all advice from your doctor.

There is no need to lie at home all the time; you can walk in places where there are no large crowds of people.

Can adenoids grow back?

Cases where adenoids re-grow are not uncommon. This is primarily due to partial or incomplete removal of tissue during surgery. It is enough to remain literally a millimeter for the palatine tonsil to begin to recover. Other reasons why adenoids may grow back after removal include:

• tendency to allergies;
• performing surgery before the age of 2 years;
• a tendency to pathology due to heredity.

Possible consequences of the operation

In most cases, the operation proceeds without complications. The negative effects of surgical intervention include:

• The occurrence of otitis media. Swelling of damaged tissue can block the ear canals and cause temporary hearing problems.
• Snoring, difficulty breathing. The baby may sniffle, grunt and cough. This phenomenon is associated with swelling of the nasopharynx after removal of the adenoids. Such symptoms usually disappear on their own after seven to ten days; if improvement does not occur, you need to consult an ENT specialist.
• Decreased immunity. Perhaps, as after any surgical intervention, including against the background of stress.
• Wound infection. To avoid secondary infection, it is advisable to limit communication with other people and follow doctor's instructions.

Approximate transaction prices

How much the operation costs depends on many factors: the size of the locality, the status of the hospital, the chosen method of treatment. According to indications, such an intervention is carried out free of charge in a public medical institution, but it is possible that a certain type of service will not be available there. In private clinics, they may charge a fee for an operation in the amount indicated in the table:

Which method do you prefer to remove adenoids from a child?

An operation to remove adenoids in a child is one of the most common surgical interventions in childhood. Due to its prevalence, as well as the presence of a lot of controversial issues when choosing exactly this radical method of treatment, adenotomy (as this technique is officially called) has managed to acquire many unreasonable expectations and fears on the part of parents.

What are adenoids in a child, in what cases and why are they removed?

Adenoids are called hypertrophied pharyngeal tonsils. She's the one in the nursery age prone to growth. This is facilitated by the structural features of lymphoid tissue in the first stages of life, the location of the tonsil (at the intersection digestive tract and respiratory tract), as well as imperfection of protective forces child's body.

The pharyngeal tonsil is located on the upper fornix of the nasopharynx and is a growth of lymphoid tissue divided into two parts by a longitudinal groove. Being part of the so-called lymphoid ring (palatine, tubal, pharyngeal and lingual tonsils), it is designed to protect the body from the invasion of harmful microorganisms and viruses coming from the external environment.

Most experts cite heredity as the main factors influencing pathological tissue proliferation, in particular the structural features of the nasopharynx passed on from generation to generation. The disease is very rare in adults - in adolescence, when the immune system fully adapts to the effects of external factors, the pharyngeal tonsil in most cases regresses on its own or at least stops its growth.

Adenoids go through three stages in their development, each of which is characterized by the degree of overlap of the choanae (internal nasal openings) and certain symptoms.

However, it cannot be said that surgical intervention is indicated at any particular stage. In addition, diagnostic errors should be taken into account. For example, the third stage (100% overlap of the choanae), established during an infectious disease, does not indicate the need for radical measures: perhaps, with recovery, the adenoids will significantly decrease.

Dangerous consequences of adenoids: snoring, stuffy nose, nasal tone, runny nose

Among negative consequences Proliferation of the nasopharyngeal tonsil should be distinguished:

Modern methods of treating adenoids, conditions for prescribing surgical intervention, optimal age for surgery

Today, there are two directions in the treatment of this pathology - conservative (medication, physiotherapy, use of folk remedies) and radical (surgical intervention). The following approach to the treatment of adenoids is generally accepted:

1. Priority is given to conservative treatment methods. And only if they are ineffective, they resort to surgical intervention.
2. Surgical treatment of adenoids can be performed at any stage if indicated.
3. It is preferable to cut out the adenoids closer to the age when they naturally begin to regress (by 5-6 years) in order to avoid relapse as much as possible.

Many parents and doctors are of the opinion that due to the tendency of lymphoid tissue to rapidly grow in childhood, performing an operation to remove adenoids may not be advisable in children under 5–6 years of age - after excision, the tonsils will quickly recover to their previous form. This position was completely justified a decade ago, when they were not widespread modern techniques treatments (laser, radio waves, microbreeder, etc.)

The classic operation (excision of tissue with a scalpel) occurs in the absence of visual observation of the field of activity (that is, blindly), so there is a high probability that small parts of the lymphoid tissue will still remain intact, and will subsequently become the basis for the self-healing of the tonsil.

Modern techniques involve the use of an endoscope - a special camera that allows the surgeon to fully control the process, while the probability of incomplete removal of lymphoid tissue is only 7-10%.

Indications for surgical removal of adenoids: inability to breathe normally, hearing problems, cough, frequent infectious processes and others

Regardless of the stage of proliferation of lymphoid tissue, indications for radical treatment of adenoids are:

• serious breathing problems (for example, frequent sleep apneas with breath holding for more than 10 seconds);
• chronic adenoiditis, exacerbating 4 or more times a year;
• hearing and speech disorders;
• developmental delay;
• the appearance of signs of the beginning of the formation of appearance features;
• frequent infectious diseases of the upper respiratory tract, otitis;
• ineffectiveness of conservative treatment (the minimum period taken into account is 1 year);
• serious neurological disorders;
• adenoid cough.

Contraindications to removal of tonsils

It should be noted that adenotomy also has contraindications. Adenoids cannot be removed:

• during a flu epidemic;
• during an infectious disease and for two months after recovery;
• if the child has blood diseases or serious pathologies of the cardiovascular system;
• when diagnosed bronchial asthma and other serious diseases of allergic origin.

We weigh the pros and cons

When faced with a choice - to remove or not to remove the adenoids, it is important for parents to understand that this operation is not at all an emergency. Even if an otolaryngologist insists on surgical intervention, there is always time to think, try another conservative method, undergo another examination, consult another specialist.

It is better to obtain additional advice regarding the advisability of adenotomy from a practicing surgeon, or even better, from the one who is expected to perform the operation on your child.

Table: pros and cons of surgical treatment of adenoids

Health school: is it necessary to remove adenoids - video

Adenoid removal surgery: preparation for the procedure

Preparation for surgery to remove adenoids includes choosing an intervention technique, a method of pain relief, as well as passing the necessary tests to determine the child’s health status and the absence of contraindications to the operation.

Anesthesia: which type of anesthesia is preferable - general or local, complications after anesthesia

Adenotomy for children is performed under both local and general anesthesia. Although general anesthesia is often associated with some risks regarding the occurrence of negative side effects, modern anesthesia techniques make it possible to eliminate them almost 100%. That is why, and also taking into account the mass of psychological benefits of general anesthesia, today this technique is recognized as the most appropriate for children.

Its advantages:

• exclusion of trauma to the child’s psyche - he will not even remember about the operation;
• absolute painlessness;
• lack of resistance on the part of the small patient, which gives the doctor the opportunity to work calmly and carefully;
• the child does not have the possibility of inhaling removed tissue particles;
• better completion of the operation - inspection, packing.

Adenotomy for children under 7 years of age is performed under general anesthesia.

Side effects of this anesthesia include drowsiness, nausea, vomiting, and nosebleeds. Some experts argue that this method negatively affects the human nervous system and can cause developmental delays in children. It should be noted, however, that the incidence of such complications is no more than 1%.

If for some reason general anesthesia is contraindicated for the child, the operation can be performed under local anesthesia. To do this, the anesthesiologist sprays a drug (lidocaine, dicaine, etc.) in the baby’s nasopharynx, after a few minutes the anesthetic begins to act. The main disadvantage is the inevitable resistance of the child when seeing a surgical instrument, which can significantly affect the quality of the operation. Such a procedure will not add peace of mind to parents, who will be forced to hold the baby and see him suffer.

The highest level of effectiveness of modern painkillers used during surgical interventions allows us to talk about the absolute painlessness of the operation for the patient.

Mandatory studies and tests that the patient must undergo before intervention

The exact list of necessary tests is prescribed by the attending (operating) doctor individually for a particular child. A sample list of studies is as follows:

• blood tests - general and biochemical;
• Analysis of urine;
• coagulogram - study of blood clotting indicators;
• blood test for hepatitis B and C viruses, HIV, syphilis;
• electrocardiogram;
• examination by a pediatrician.

Adenotomy techniques: classical, endoscopic surgery

Among the adenotomy techniques used today, the following should be highlighted:

There are frequent cases of simultaneous enlargement of both the pharyngeal and palatine tonsils. This condition in itself is not a reason for surgery, however, according to indications (for example, grade 3 enlargement of the tonsils, the presence of health-threatening symptoms), simultaneous excision of the adenoids and trimming of the palatine tonsils (adenotonsillotomy), which involves removing the most altered areas, is performed.

Surgical techniques: laser, electrocoagulation and others - table

Rehabilitation after tonsillectomy: when can you feed your baby?

The operation is considered completed after the bleeding has completely stopped. Moreover, the most common complication after adenotomy is the recurrence of bleeding some time after the operation. That is why the child should be under the supervision of doctors for at least several hours.

After general anesthesia, the baby can get up, walk and eat after 2–4 hours.

Complications during the recovery period: fever, cough, discharge

In the first days after surgery, you may experience:

• increase in body temperature up to 38 degrees, easily relieved with antipyretic drugs;
• congestion in the nasopharynx, nasal voice caused by edema;
• mucous membranes and bleeding from the nasopharynx;
• cough and hemoptysis caused by blood draining into the respiratory tract.

List of general recommendations for a speedy recovery: caring for the baby, nutritional habits, diet, taking vitamins

• following a special diet for a week - exclude salty, spicy, hot foods, etc.;
• The child’s diet should include fortified, high-calorie foods; you can take a course of multivitamins;
• to exclude reflex swelling of the mucous membrane, use vasoconstrictor drops, silver-based drops (for example, Protargol);
• avoiding overheating or hypothermia (for example, a child should not be bathed in a bath);
• avoiding contact with virus carriers;
• the child is at home for two to three weeks;
• The child is freed from physical activity (physical education, swimming pool) for a month.

Treatment prognosis and consequences: if the child continues to snore

The most pressing issue that arises after surgery is the possibility of relapse of the disease. Today, adenoid restoration occurs in 2–3% of adenotomy cases. However, this most often occurs in children with a tendency to allergic reaction. As a rule, such children are given a course of treatment with antiallergic drugs before surgery as a preventive measure.

The need for surgical removal of adenoids often causes fear and anxiety among parents of children. Of particular concern is not only the operation itself and its complications, but also the administration of anesthesia, as well as its possible negative consequences and negative impact on the child’s health.
A lot depends on the composition of the anesthesia, including the success of the operation.

When is surgery needed?

Surgical intervention for adenoids (adenotomy) is recommended to be performed as quickly as possible.

Immediately after identifying a pathology due to the ineffectiveness of any ointments, medications or drops.

Untimely operation leads to even greater growth of the adenoids.

Important! The mistake with the need for surgical intervention is associated with parents mistaking pathological formations for a disease such as adenoiditis ().

It represents inflammation of the adenoid tissue of a chronic nature, which is amenable to conservative treatment methods.

The decision about the need for surgery should be made by the attending otolaryngologist.

The threat of unremoved adenoids

The growth of formations in children can be complemented by enlargement of the tonsils.

In the absence of necessary surgery for adenoids in children, the following problems are possible:

• difficulty and disturbance of breathing through the nose, which is observed with;
• as a result of predominantly mouth breathing, underdevelopment of the upper jaw is observed;
• the face takes on an irregular elongated shape;
• uneven teeth are noted;
• sleep is disturbed and night snoring is noted;
• pathology leads to oxygen starvation;
• the risk of developing otitis increases (it is written about the treatment of tubo-otitis);
• possible hearing impairment ().

The pathology, with a long-term effect on the baby’s body, causes rapid fatigue, frequent headaches and decreased educational information, which entails problems with the baby’s well-being and poor performance in preschool or school.

Advantages of general anesthesia

Many years ago, doctors had no drugs for pain relief, and when removing adenoids, young patients had to endure pain.

Today there are two types of anesthesia - local and general, each of which has its own application features, advantages and disadvantages.

The positive aspects of performing surgery for adenoids using general anesthesia include:

1. relieving the baby of pain during surgery, which means reducing the risk of psychological problems after medical interventions. The child falls asleep under the influence of anesthesia and does not observe the specialist’s manipulations, does not see medical instruments and blood, and wakes up when the operation is already completed.
2. The anesthesia method is safe and has a low risk of complications during surgery.
3. it becomes possible to reduce the time of surgical intervention. Usually manipulations last no more than half an hour, removal of adenoids is considered one of the shortest surgical operations.

The advantage of this type of anesthesia is the greatest convenience for both the small patient and the doctor, who during the procedure surgery will not be distracted by the baby’s reaction, since under general anesthesia the child will be immobilized while all medical procedures are performed.

Disadvantages of general anesthesia

A negative aspect of surgery under general anesthesia is the risk of complications. But they arise negative consequences are very rare, up to 1% of cases of all adenoid removal operations.

Complications of the operation itself may manifest themselves as after the intervention. The risk of dental damage, aspiration and infection is virtually reduced to zero.

During surgery under general anesthesia, there may be problems maintaining a stable body temperature, which can cause hyperthermia, a problem associated with overheating or hypothermia of the baby's body.

To prevent this complication, the doctor pays special attention to the child’s body temperature during all manipulations.

Important! Scientists say anesthesia has a negative effect on nervous system child and the state of brain cells.

After general anesthesia, children may lag behind in development for some time.

When using anesthesia, hearing and sleep disturbances may occur, immediately after waking up or some time after the operation.

When the baby comes to his senses after general anesthesia, headaches, hallucinations, and problems with hearing and speech may occur.

Preparing for surgery

To prepare for surgery using general anesthesia, the child is prescribed the following tests:

• general analysis of urine and blood;
• blood clotting study.

The doctor examines the family history, the child’s vaccination schedule, past illnesses and prescribes medical therapy for the little patient aimed at preparing the child for anesthesia.

The specialist must pay attention to the child’s allergies.

To reduce negative impact The doctor injects Promidol or Atropine into the baby’s body 30 minutes before pain relief.

Before the operation, the child is given an enema to cleanse and is released bladder. On the day of surgery, children are not allowed to eat, and they should not drink anything 3-4 hours before anesthesia.

Features and complications

After the onset of general anesthesia, the child’s mouth is opened slightly using a special medical instrument. Then the doctor examines the location of the adenoids and removes them using one of the well-known techniques:

• cauterization of formations using diathermy;
• curettage.

The operation is considered complete when bleeding from the vessels stops.

For normal air flow during the surgeon's manipulations of the respiratory tract, an endotracheal tube or laryngeal mask is used.

In the first case, more reliable protection of the respiratory tract is noted, but the unpleasant consequences of pain relief after waking up with such anesthesia are more severe and longer lasting than when using a mask.

Performing anesthesia involves the use of inhalation and non-inhalation agents.

To quickly and painlessly recover a child from anesthesia during surgery, Propofol or modern inhalational anesthetics, such as Sevoflurane, Isoflurane and others, are used.

A child's body perceives general anesthesia differently than an adult. In children's practice, only proven products are used medical supplies, safe and have undergone multiple clinical trials.

Modern drugs used for general anesthesia are quickly eliminated from the child’s body and practically do not cause adverse reactions and negative consequences after use.

Usually children come to their senses within two hours, depending on the dose of anesthetic. After waking up, the baby should be monitored by an anesthesiologist for several hours.

For a fairly “minor” anesthesia with a shorter period of action.

Awakening after such anesthesia is faster and easier than with large dosages of anesthesia, when the risk of overdose of anesthetics is increased with the possibility of developing hypoxia and negative complications from the cardiovascular and nervous systems.

After 2-4 hours after surgery under general anesthesia, children are allowed to stand up and walk, as well as eat.

Contraindications

Any type of anesthesia can cause complications, so it is important to find out whether there are any contraindications for the child to undergo anesthesia.

If the baby has chronic diseases, the doctor finds out the stage of the disease. During an exacerbation, it is prohibited to perform any surgical interventions using general anesthesia. The operation will have to be postponed until the disease enters the remission stage.

Other contraindications to surgical intervention under general anesthesia:

• acute infectious diseases;
• severe malnutrition;
• pronounced rickets;
• respiratory tract diseases in the acute stage;
• pyoderma;
• hyperemia of unknown origin;
• the period from the date of vaccination is less than 6 months.

An important condition for a successful operation with general anesthesia is the choice of a clinic with competent, highly qualified, experienced specialists who will select the correct dosage of anesthesia in order to reduce the negative impact on the baby’s body and eliminate undesirable consequences.

Another condition for a successful operation to remove adenoids using anesthesia is the positive attitude of the smallest patient, for which parents are primarily responsible.

It is advisable to use general anesthesia when removing adenoids to prevent stress and psychological trauma in the child. A competent specialist will reduce the risk of consequences and complications after anesthesia to zero.

Adenoids are called enlarged nasopharyngeal tonsils, which lead to difficulty in nasal breathing, hearing loss, and retardation in physical and mental development. Normally, the tonsils serve as a protective organ, protecting the body from infections, but frequent infectious diseases lead to repeated inflammation of the lymphoid tissue, as a result of which it grows in the form of adenoids.

Most often, children aged 3 to 7 years get sick as a result of frequent ARVI and other infectious diseases (measles, scarlet fever).

Adenoids may also be accompanied by such symptoms as a dry cough, fever, night snoring, and mucous yellow-green discharge from the nose.

Surgical intervention is necessary only when all conservative methods have failed positive result. Most effective method Treatment of adenoids - their removal.

Inflammation of the adenoids can occur in three forms of the disease: acute, chronic and subacute

What is the operation

The most common method of removing adenoids is adenotomy. It is one of the shortest operations, lasting about 5 minutes under local or general anesthesia.

Unfortunately, the operation cannot be 100% safe, as complications may arise:

1. consequences of anesthesia;
2. damage to the palate, bleeding.

It is not advisable to perform the operation during high seasons viral infections when the immune system is weakened. Best time for the operation - summer period.

The operation can be performed on patients of any age. Recovery is quick, the patient leaves medical institution on the same day. After removal of the adenoids, it is recommended to maintain a diet that excludes spicy, hot, cold and solid foods for several days.

Indications for adenoid removal

The main indications for surgery are not the size of the adenoids, but the symptoms caused by inflamed nasopharyngeal tonsils.

Adenoid growths lead to disruption of many functions in the body. A chronic focus of infection is formed, and immunity is reduced.

Indications for adenoid removal in children:

• Hearing loss. The nasopharyngeal tonsils block the passage of the Eustachian tube, thus preventing the passage of air into the middle ear. Eardrum loses its mobility, hearing deteriorates.
• Chronic adenoiditis. Inflamed adenoids are a favorable environment for various viruses and bacteria.
• Frequent otitis. Due to the growth of adenoids, middle ear dysfunction occurs, and favorable conditions for viruses and bacteria appear.
• Speech impairment.
• Deterioration in mental and physical activity.
• Incorrect bite, formation of an “adenoid face.”
• Adenoid cough.
• Respiratory tract diseases (bronchitis, pharyngitis, tracheitis, pneumonia). With inflamed nasopharyngeal tonsils, mucus and pus are constantly formed, which flow into the lower sections respiratory system. Thus, they cause inflammation, which leads to infectious diseases respiratory tract.
• Frequent ARVI.
• No results conservative methods treatment.

Adenoid removal methods

Instrumental method of removal - Adenotomy

Adenotomy is carried out using a special ring-shaped knife, which is called an adenotomy. It is introduced into the nasopharynx area and when the adenoid tissue enters the ring, it is cut off with one movement of the hand. After this, the adenoid is cut off. The operation lasts about 5 minutes. The bleeding stops within a few minutes.

It is performed under local anesthesia on an outpatient basis. A hospital stay is not required. Among the disadvantages of such an operation, it can be noted that the doctor operates blindly, without seeing the nasopharyngeal cavity. Very often small areas of lymphoid tissue remain, which lead to re-growth of the adenoids in the future.

Radio wave removal of adenoids

The operation is carried out using the Surgitron device, which has a special attachment for removing adenoids - a radio wave adenoid. Using this attachment, the entire adenoid is cut off at once, as with adenotomy, and the radio wave cauterizes the vessels, thus reducing bleeding. Among the advantages of the operation:

1. reduction of blood loss during surgery;
2. reducing the risk of postoperative bleeding.

Laser treatment is the best achievement in surgery. The operation occurs under the influence of laser irradiation. There is an increase in temperature in the tissues and, thus, evaporation of fluid from it. Among the disadvantages of the method:

1. longer operation;
2. heating of neighboring healthy tissue occurs.

Children under 7 years old are operated on under general anesthesia, over 7 years old - under local anesthesia.

Removal with a shaver (microdebrider)

A microdebrider is a tool with a rotating head and a blade at the end. The instrument crushes the adenoid, which is then placed into a suction reservoir. The microdebrider allows you to completely remove the adenoids without damaging the mucous membrane, that is, without bleeding. The operation is performed under anesthesia with endoscopic control. This method is one of the most effective, in which the risk of re-growth is practically absent.

Children under 7 years old are operated on under general anesthesia, and over 7 years old - under local anesthesia.

Preparing for surgery

Removing adenoids is not an emergency operation. You need to prepare for it, carry out full examination child:

• general and biochemical analysis blood;
• Analysis of urine;
• blood test for infections such as hepatitis, HIV;
• coagulogram;
• examination by a pediatrician.

The day before surgery you should not eat or even drink water. The day before, you should refrain from eating dinner after 6 pm.

Anesthesia for adenoid removal

Local anesthesia

Possible for children over 7 years old:

1. taking a sedative;
2. applying an anesthetic solution to the nasopharynx (10% lidocaine solution);
3. injection of a less concentrated anesthetic solution into the adenoid tissue (2% lidocaine).

During the operation, the child is conscious.

In children aged 2 to 7 years, surgery to remove adenoids is performed under general anesthesia, which does not cause psychological trauma to the child and completely eliminates pain. To quickly return to consciousness, it is better to use propofol or some other modern inhalational anesthetic for general anesthesia.

Complications after surgery

The most common complication is bleeding. Most often it occurs within three hours after surgery, so this is the amount of time the child should be under the supervision of a doctor.

Acute otitis media rarely occurs because blood may enter the auditory tube. Sometimes in the first 2 days after surgery the temperature rises to 38 degrees.

Adenoids - parents of preschool and younger children often face this problem. school age. Exhausted by constant nasal congestion and frequent colds child, sooner or later they are faced with a dilemma: “Should I remove the adenoids or not?” On the one hand, overgrown adenoid vegetations give the child a lot of unpleasant symptoms, on the other hand, after the age of ten, the adenoid tissue begins to atrophy. So what should we do? Let's find out!

Despite the fact that the word “adenoids” is used in plural, this name hides one single nasopharyngeal tonsil. In the human pharynx there are several more tonsils, which together form a lymphoid ring. This ring performs an important function - it controls that pathogenic microorganisms do not enter the body through the mouth or nose. In the process of child growth, the main protective function falls precisely on the nasopharyngeal tonsil, and only from the age of seven to ten years does it hand over the reins to the tonsils, and it itself begins to decrease. Therefore, many parents look forward to this age, in the hope that their son or daughter will simply outgrow this condition.

How do adenoid vegetations work? The nasopharyngeal tonsil is part of the human immune system. As soon as viruses and bacteria enter the surface of the tonsil, its tissue increases in size. After destroying the enemy, the tonsil tissue returns to its original size. This is a perfect picture. In reality, the body in childhood is very often attacked by pathogenic microorganisms, and the pharyngeal tonsil simply does not have time to return to its original size. In this case, hypertrophy (enlargement) of the pharyngeal tonsil is diagnosed, and the child begins to show the following signs of the disease:

• the appearance of nasal congestion;
• the baby practically stops breathing through his nose and breathes through his mouth;
• he begins to snore in his sleep;
• the voice becomes nasal.

Degrees of adenoid proliferation

When does the question arise about the need for surgical intervention? Before radically solving a problem, you need to determine its scale. To do this, a diagnosis of the disease in the child is carried out.

The most informative and in a modern way To examine adenoid vegetations is a video endoscopic examination.

The ENT doctor examines the baby’s nose and throat using a thin tube with a flashlight at the end and a video camera that displays everything seen by the endoscope on the monitor. Such a study helps determine the degree of proliferation of adenoid vegetations and understand whether it is possible to avoid conservative treatment without surgery, or surgery is necessary.

Modern otorhinolaryngology distinguishes three stages of growth of adenoid vegetations. In the first stage, there are practically no symptoms. The child periodically snores at night and only experiences difficulty breathing through the nose during sleep. In this case, vegetations grow to one third of the lumen of the nasopharynx.

Adenoid vegetations themselves are not dangerous. The complications they provoke are dangerous.

At the second stage, they block half of the lumen of the nasopharynx. At the same time, difficulty breathing through the nose is observed even during the day. During sleep, the baby snores with slight pauses in breathing during sleep. At this time, parents begin to notice that something wrong is happening with the child: he does not get enough sleep, is irritable, capricious, complains of headaches, has a nasal voice, and often asks again. Most often, it is at this time that parents turn to an otolaryngologist to diagnose the disease and treat the adenoids.

Vegetations of the third degree completely block the nasopharynx: it is simply impossible for air to pass through the nose, and the patient breathes only through the mouth. A constantly open mouth should alert parents first. The facial features take on a characteristic “adenoid” appearance: an emotionless, detached expression, the mouth is slightly open, the face is elongated with the jaw pushed forward. The inability to breathe through the nose not only changes facial features, but also causes brain hypoxia. Schoolchildren begin to lag behind in their studies and get tired quickly. Hearing loss is observed.

Friends! Timely and correct treatment will ensure your speedy recovery!

How to understand that surgery is needed?

Overgrown vegetation should be removed strictly if there are certain indications:

• persistent hearing loss - this problem not only creates discomfort when communicating with other people, since the child constantly has to ask again, but also creates a serious danger to life, since the baby may simply not hear the noise of an approaching car;
• the formation of an adenoid type of face, when due to the lack of nasal breathing the structure of the facial skeleton changes;
• development chronic diseases- stagnation of mucous masses in the nasopharynx is a constant source of inflammation in the body, the infection spreads to healthy tissues, triggering the inflammatory process in them;
• sleep apnea is a condition in which a person stops breathing for a while while sleeping, which is a real threat to life;
• frequent inflammation of adenoid vegetations - adenoiditis (more than four times a year);
• fast fatiguability, constant feeling fatigue, lack of sleep - staying in this state affects not only school performance, but also the psycho-emotional state of the patient.

The operation to remove vegetations is not urgent: parents have enough time to weigh the pros and cons, as well as carry out conservative treatment.

Carrying out the operation

Surgical removal of adenoids in a child's nose is called adenotomy. The operation is not a complex intervention and does not require special preparation. Adenoids are usually removed for no longer than twenty minutes under endoscopic control. It can be performed on an outpatient basis. Local or general anesthesia is used as anesthesia: it all depends on the patient’s age and psycho-emotional state. Adenoids are literally cut off with one movement of the hand using a special knife - an adenoid. Immediately after removal, the child begins to breathe through his nose. True, after some time, nasal congestion temporarily returns - it is associated with the appearance of postoperative edema.

Treatment of adenoids without surgery

First and second degree growths respond well to treatment without surgery. But in the practice of our ENT clinic there were many cases when vegetation of the third degree was reduced to the second. Therefore, before removing the adenoids, it is worth treating conservatively.

In this case, the treatment regimen may include:

• antibacterial agents;
• nasal drops (“Polydexa”, “Isofra”);
• vasoconstrictor drops;
• solutions for rinsing the nasal cavity (“Aquamaris”, “Aqualor”);
• physiotherapeutic procedures (infrared laser therapy, ultraviolet irradiation, vibroacoustic effects, photodynamic therapy);
• use of folk remedies (in consultation with an ENT doctor).

If you are faced with the acute issue of the growth of adenoid vegetations, come to the ENT Clinic of Doctor Zaitsev: we treat adenoids without surgery: with high quality and best prices in Moscow.