Adenotomy is one of the most common operations in ENT surgery. Removal of adenoids in children is carried out with their inflammation. Consider the features of this procedure.
The proliferation of lymphoid tissue of the nasopharyngeal tonsil are adenoids. As a rule, they occur with frequent colds, chronic runny nose and the inability to breathe normally through the nose. Surgical removal is one treatment option. The operation is prescribed for severe tissue hypertrophy, which cannot be cured with medical methods.
Nasopharyngeal tonsils are an immune organ in the nasopharynx that performs protective functions. Adenoid vegetation (growth) is diagnosed in children 3-15 years old. The disease is associated with age-related features of the development of the immune system. During this period, the glands actively grow and often become inflamed.
Features of adenoids to remove them:
- After surgery, the protective properties of the immune system in children are reduced. But after 2-3 months, immunity is gradually restored.
- Enlarged tonsils indicate that the patient often suffers from infectious and viral diseases that provoke an increase in lymphoid tissue.
- The risk of relapse, that is, secondary tissue growth, depends on the quality of the operation. If the procedure is carried out almost blindly, then in 50% of cases the particles of lymphoid tissue again grow. But modern endoscopic operations minimize this, so relapses occur in 7% of patients.
- In adults, this pathology occurs due to prolonged exposure to adverse environmental factors. For treatment, an adenotomy and medication are also performed.
Normally, the pharyngeal tonsils are several folds of lymphoid tissue that protrude above the surface of the mucosa of the posterior pharyngeal wall that enters the pharyngeal lymphatic ring. The glands contain lymphocytes - immunocompetent cells that are involved in the formation of immunity.
Difficult nasal breathing, hearing impairment, sleep problems, night snoring, deformation of the facial bones, frequent otitis media and sinusitis are the main signs of tonsil inflammation. Treatment depends on the stage of the pathological process. In the early stages of inflammation, medication, that is, conservative therapy, is performed. The operation is necessary with the rapid proliferation of adenoid tissue and the progression of painful symptoms.
General criteria for surgical treatment:
- Adenoids of the third degree.
- Adenoids of any degree with frequent exacerbation of inflammatory pathologies.
- Complications from other organs.
- Drug treatment does not give the desired results.
- High risk of malignant degeneration of the tonsils.
Consider in more detail the indications for the removal of adenoids in children:
- Difficult nasal breathing - due to the fact that the patient breathes through the mouth, the mucous membranes dry out, frequent acute respiratory viral infections and their complications. There is a restless sleep and disturbances in the psychoemotional state.
- Apnea syndrome is a delay in breathing in a dream. Hypoxia negatively affects the work of the brain and a growing body.
- Otitis - frequent infections lead to chronic and exudative inflammation of the middle ear. Enlarged adenoids block the auditory tube, causing pathologies in the middle ear. Children suffer from otitis media more than 4 times a year. Against this background, there is a persistent decrease in hearing.
- Disorders of the facial skeleton - enlarged adenoids provoke abnormal deformations in the maxillofacial bones. In medicine, there is a term denoting the above signs "adenoid face."
- Malignant changes - hypertrophic tonsils can cause an oncological process.
Removal of tonsils is carried out after a set of diagnostic measures. The otolaryngologist and surgeon are involved in the treatment. If necessary, if there are clear indications and serious reasons, then the operation is carried out even in infancy. In this case, frequent acute respiratory viral infections are not an indication for surgery, as well as saved nasal breathing.
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Like any operation, removal of adenoids in children requires careful preparation. Treatment is best done in early autumn, when the immunity of a small patient is in good condition, and the body is full of vitamins. In the cold season, the operation is not performed, as there is a risk of ARVI and other diseases. In hot weather, the risk of purulent and infectious complications in the postoperative period is increased, since bacteria actively multiply in this period.
Preparation for adenotomy:
- Dentist examination and dental treatment.
- Relief of inflammatory processes in the body.
- A set of laboratory studies.
- Instrumental diagnostics.
- Differential examinations.
Adenotomy is a fairly simple operation, which is carried out in an outpatient setting. The procedure lasts no more than 20 minutes under local or general anesthesia. After 4-5 hours after treatment, parents can take the baby home, provided that there are no complications.
The healing process takes a couple of months. Proper preparation minimizes the risk of complications, while parents should be aware of the risk of their occurrence. In the first time after surgery, immunity is reduced. Nasal congestion, separation of mucus with bloody veins is also temporarily preserved. After 2 weeks, the patient's condition returns to normal.
Tests before removing adenoids in children
Before an adenotomy, the patient is prescribed a set of laboratory tests. Analyzes before removing adenoids in children consist of:
- Blood test (general, biochemical).
- Analysis of urine.
- Coagulogram - a study of blood coagulation.
- Analysis for hepatitis B and C. viruses
- A blood test for HIV and syphilis.
The results of the tests are interpreted by the therapist or otolaryngologist. If necessary, additional studies are prescribed.
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Technique for the removal of adenoids in children
Today, there are several ways to treat adenoids. Despite the fact that the tonsils do not have nerve endings, anesthesia is used during the operation so that the patient does not feel discomfort during the procedure.
In ENT surgery, the following methods are used to remove adenoids in children:
- The classical method - during the operation there is no possibility of visual observation of the procedure. Adenot is introduced into the oral cavity - this is a ring-shaped knife. A laryngeal mirror is used to visualize the procedure. The main drawback of the operation is the intense bleeding and the inability to completely remove the lymphoid tissue. In some cases, doctors have to resort to the use of hemostatic drugs.
- Endoscopic techniques - surgical procedures with the introduction of an endoscope with a camera into the nasopharynx cavity. The image obtained during the operation significantly increases the accuracy of the procedure and its results.
- Laser removal is a highly accurate and low-traumatic method. Laser sterility minimizes the risk of postoperative complications. The recovery and healing period is much faster.
- Endoscopic treatment - with the help of a video endoscope, the doctor removes hypertrophied tissues with high accuracy. This method gives high results.
- Radio wave adenotomy - inflamed tissue is removed using a special device. The technique delivers a minimum of pain and allows you to minimize the risk of complications.
- Cold plasma treatment is a combination of cryotherapy and plasma technique. Tissue excision is performed using low temperatures. The advantages of the method include its bloodlessness and painlessness. The main disadvantage of this therapy is that there may be scars that cause problems in the throat.
Surgical intervention is recommended in early autumn, when the protective properties of the immune system are at a high level. In order for the recovery to pass quickly and without complications, you should adhere to a special diet and restorative breathing exercises.
How is the removal of adenoids in children?
The operation can be carried out both in the inpatient department and in the outpatient clinic. The treatment method depends on the degree of the inflammatory process and other characteristics of the patient’s body. The procedure is performed under general or local anesthesia. After the anesthesia has acted, the doctor determines where the deformed lymphoid tissues are and begins to excise them.
The main operational techniques and features of their implementation:
- The classic operation is the removal of tonsils through the oral cavity using a special scalpel. The procedure is performed under local anesthesia. Its main drawback is the lack of visualization of the surgical field. That is, removal is blind and there is a high risk of recurrence.
- Laser removal - a laser beam is used to excise tissue. It coagulates inflamed tissues or gradually evaporates them in layers. Plus this procedure in the absence of bleeding. By cons include its duration, which is more than 20 minutes.
- Microbrider - with the help of a shaver (a device with a rotating scalpel), the doctor excises adenoids. During the procedure, nearby mucous membranes are not affected. If there is bleeding, then the wound is treated with a laser or radio waves.
- Electrocoagulation - tonsils are removed by throwing special electrode loops on them. This method is absolutely bloodless, since the vessels are sealed during removal.
- Cold plasma adenotomy - I act on the tissue using a plasma beam. This method is most often used for an abnormal arrangement of tonsils. The doctor can adjust the depth of penetration of the beam.
Regardless of the method chosen, the operation lasts no more than half an hour, after which the patient begins to move away from anesthesia. Within 3-4 hours, the doctor monitors his condition, then sends him home. If bleeding or other complications occurred during or after surgery, the patient is left for 1-3 days in a hospital.
Removal of adenoids of the 2nd degree in children
A significant increase in tonsil tissue with the closure of 2/3 of the nasal cavity is the second stage of adenoids. The pathological process is manifested by impaired nasal breathing. It is difficult for a child to breathe day and night, which leads to sleep disturbances. Due to an inferior night's rest, the baby becomes lethargic and irritable. Oxygen deficiency provokes severe headaches and developmental delays.
Inflamed glands can cause symptoms that at first glance are not associated with the nasopharynx:
- Urgent urinary incontinence.
- Bronchial asthma.
- Hearing impairment.
- High body temperature.
- Bloody discharge from the nose.
- Apnea syndrome and night snoring.
In addition to the above symptoms, adenoids cause speech disorders. The patient begins to speak in the nose, that is, slurred.
Removal of grade 2 adenoids in children is one of the treatment methods. Such indications for surgery are distinguished:
- Lag in mental and physical development.
- Frequent exacerbations of adenoiditis and sinusitis.
- Bronchial asthma, incontinence and other painful symptoms.
- Respiratory arrest during sleep.
The main goal of the operation is to open the nasal passages while preserving the lymphoid tissue of the nasal tonsils to maintain a normal state of immunity. The operation is performed with partial or complete removal of deformed tissues. Treatment most often takes place under general anesthesia using endoscopic methods. Surgery is contraindicated outside the phase of exacerbation of inflammation. In other cases, preventive measures are taken to suppress the growth of adenoid tissues.
Removal of grade 3 adenoids in children
If the overgrown adenoid tissues completely block the nasal passage and the patient breathes only through the mouth, this indicates the 3rd degree of adenoiditis, which is the most dangerous. Most of all, children are affected by this disease. Adenoid growths are a source of infection that spreads quickly to the sinuses, pharynx, and bronchi. The pathological process is accompanied by allergization and seeding with bacteria.
Removal of grade 3 adenoids in children is carried out in the absence of positive results of drug therapy and with an increase in painful symptoms. The operation is performed using general anesthesia and takes no more than 20 minutes. Full recovery occurs within 1-2 months.
Without timely surgical treatment, adenoiditis leads to such complications:
- Violations of the physiological characteristics of the middle ear.
- Chronic infectious processes in the body.
- Frequent colds.
- Inflammation of the respiratory tract.
- Deformation of the bones of the face.
- Decreased performance.
The above complications are dangerous for the child's body. But a timely operation allows you to minimize the risk of their development.
Endoscopic removal of adenoids in children
One way to treat hypertrophic tissues of the pharyngeal tonsils is through endoscopic removal of adenoids. In children, such an operation can be performed at any age. The procedure is carried out in a hospital under general anesthesia.
- During the operation, the patient is in a medical dream, therefore, does not experience discomfort.
- Tissue removal is carried out using video endoscopic equipment, so the whole process is controlled by a doctor.
- To prevent relapse, adenoid tissues are completely excised.
Endoscopic adenotomy is a minimally invasive procedure. It is especially effective for tonsils, which spread along the walls of the mucosa, and do not grow into the lumen of the respiratory tract. This tissue structure does not interfere with the respiratory process, but significantly disrupts the ventilation of the auditory tube. Against this background, frequent otitis media occur, and in the advanced case, conductive hearing loss.
- The patient is given general anesthesia, which makes the operation absolutely safe and painless. Anesthesia is also introduced into the nasal cavity.
- On the lower nasal passage, the doctor introduces an endoscope and examines the surgical field.
- Hypertrophic pharyngeal tissue is removed using various endoscopic instruments: an electric knife, a resection loop or forceps. The choice of instrument depends on the structural features of the pharyngeal tonsils.
Surgical intervention lasts no more than 20 minutes. The risk of complications is minimal. The severity of the postoperative period depends on the type of anesthesia used. Many patients experience these painful symptoms: nausea and vomiting, headaches and dizziness, nosebleeds. In most cases, the baby is sent home 2-3 days after the resection.
In order for the recovery to pass quickly and with minimal complications, the doctor gives a number of recommendations. First of all, a special diet is prescribed. In the first days after the operation, only soft, crushed food is allowed: mashed potatoes, cereals, soups. After a week, the menu can be expanded. In addition to the diet, a gentle regimen of physical activity is recommended. Full recovery occurs within 1-3 months.
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Shader removal of adenoids in children
One of the varieties of endoscopic adenotomy is the removal of hypertrophic tissues by a shaver.
- The operation is carried out using a micro-cutter, which is similar to a drill and is located in a hollow tube.
- On the side of the tube there is a hole through which the cutter rotates, grabs and cuts the fabric.
- The shaver is connected to a suction, which removes the removed tissue and prevents them from entering the respiratory tract, significantly reducing the risk of aspiration.
Surgery is performed under general anesthesia with mechanical ventilation. To control the surgical field, an endoscope is inserted through the oral cavity or nasal passage.
The postoperative period lasts for 1-3 days. In the next 10 days, the patient is shown limited physical activity and diet therapy. Normal nasal breathing appears 2-3 days after surgery. To accelerate recovery, special breathing exercises and a course of physiotherapy are indicated.
Laser removal of adenoids in children
A modern method of treating inflamed tissue of the pharyngeal tonsils is laser removal of adenoids. In children, laser technology is a minimally invasive procedure with minimal complications.
Laser treatment benefits:
- Minimal trauma to the operated area.
- High accuracy of the surgeon.
- Minimal blood loss and complete sterility.
- Short recovery period.
Laser adenotomy can be performed in the following ways:
- Valorization - the upper layers of adenoid tissue are fired by steam heated by carbon dioxide. This method is used in the early stages of the disease, when adenoids are not very large.
- Coagulation - performed with grade 3 adenoids, using a focused laser beam to affect the tissue.
The procedure is performed under an insignificant proportion of pain medication, which significantly reduces the risk of complications from anesthesia, and facilitates the recovery from anesthesia. Despite all the benefits of laser treatment, some surgeons do not recommend using it. This is because the laser beam does not remove, but burns the inflamed tissue, restoring their normal size.
Removing adenoids in children with radio waves
Another popular treatment for adenoiditis is the radio wave method. The procedure is carried out in a hospital using a special apparatus - Surgitron. Hypertrophic nasopharyngeal tonsils are excised by a nozzle with radio waves.
The benefits of removing adenoids in children with radio waves:
- Minimal blood loss due to coagulation of blood vessels.
- Use of general anesthesia for children under 7 years of age and local anesthesia for older patients.
- Recovery period with minimal complications.
Radio wave treatment is indicated in such cases: hearing loss, difficulty in nasal breathing, frequent viral diseases, chronic otitis media, lack of effect of drug therapy. The operation is recommended for severe pathological processes that affect the upper respiratory tract, as well as for deformation of the facial skeleton and malocclusion due to adenoids.
In order for the treatment to be effective, special training is carried out. The patient is examined by a pediatrician and otolaryngologist, a complex of laboratory and instrumental studies is prescribed. A couple of days before the operation, diet food is recommended.
An anesthetic is administered immediately before the operation. As soon as the anesthesia works, the doctor begins treatment. The excision of the affected tissue is carried out using radio waves. The procedure lasts no more than 20 minutes. After removal of the tonsils, the patient is transferred to a general ward and his condition is monitored.
Contraindications to radio wave adenotomy:
- Age under 3 years.
- Oncological diseases.
- Severe bleeding disorders.
- Deformation of the facial skeleton.
- Recent preventive vaccination (less than 1 month).
After the operation, the patient is prescribed a plentiful drink and, if necessary, medications for symptomatic therapy. Particular attention is paid to nutrition and minimal physical activity. It is forbidden to take a hot bath and sunbathe in direct sunlight.
Difficult nasal breathing, frequent colds, hearing loss and a number of other painful symptoms are signs of gland inflammation. Treatment depends on the stage of the pathological process. In the early stages, drug therapy is carried out, and with a severe degree of hypertrophy - surgical treatment.
Consider the main contraindications for the removal of adenoids in children:
- 1-2 degree of adenoiditis.
- Diseases that affect blood coagulation.
- Frequent infectious pathologies in the acute stage.
- Diabetes mellitus in the stage of decompensation.
- Acute inflammation in the nasopharynx.
- The patient's age is up to two years (surgery is possible only for health reasons).
- Severe cardiovascular disease.
- Allergic diseases.
- Tumor lesions (benign, malignant).
- Anomalies in the development of hard or soft palate
- The period of the flu epidemic.
In addition to the above contraindications, various methods of surgical treatment also have certain prohibitions on their implementation.
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Complications after the procedure
Surgical treatment of inflamed tissues of the pharyngeal tonsils can cause various complications. After removal of adenoids in children, a temporary decrease in the immune system, the development of a secondary infection, snoring, runny nose and other problems are most often observed.
Particular attention is paid to complications after anesthesia:
- Problems at the stage of intubation and induction of anesthesia: damage to the mucous membranes of the trachea, larynx, oropharynx, pneumothorax due to the introduction of a tube into one of the main bronchi.
- A sharp decrease in cardiac activity while maintaining anesthesia.
- Hypoxia and hemodynamic disturbances.
- Pain shock due to improperly selected dose of pain medication.
- Choking due to premature extraction of the endotracheal tube and inadequate monitoring of the patient's condition.
Choosing the most suitable method for removing adenoids and the correct preparation for surgery reduce the risk of complications.
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Bleeding after removal of adenoids in children
A fairly common complication of the surgical treatment of adenoiditis is bleeding. After removal of adenoids, this symptom most often occurs on the first day after surgery. To prevent it, it is recommended to pay attention to such contraindications:
- Overheating of the child.
- Stay in a stuffy room.
- Eating hot or spicy foods.
- Increased physical activity.
Patients are shown bed rest and the use of vasoconstrictor drops in the nose. You should also do regular wet cleaning and airing the room to facilitate nasal breathing. If nosebleeds have occurred, then you should contact the ENT department for the treatment and prevention of the disorder.
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The speed of recovery of the child after an adenotomy is dependent on compliance with medical prescriptions. Recommendations after surgery come down to the following rules:
- Compliance with the diet for 1-2 weeks. Vitamin-fortified, high-calorie foods are recommended for patients. In the early days, dishes should be soft (mashed potatoes, cereals, soup).
- Drink plenty of water - purified water, herbal teas from natural ingredients, fruit drinks, compotes.
- The use of medications - children are prescribed vasoconstrictor drops to prevent reflex edema of the mucous membrane.
- Exemption from physical activity for 3-4 weeks and bed rest for 1-2 weeks.
In addition to the above recommendations, after the operation, any contacts with virus carriers should be excluded. Also, do not allow hypothermia or overheating of the patient.
Diagnosis of adenoids in a child
It is simply impossible to see adenoids in a child when opening the mouth, for this there are special diagnostic methods - examination with a mirror, X-ray, finger examination and endoscopy of the nasopharynx.
- A finger test is not currently used, as it is a painful and uninformative examination.
- An x-ray is more accurate in determining the size of adenoids, but also not sufficiently informative in terms of the presence of an inflammatory process in the nasopharyngeal tonsil, in addition, even a one-time x-ray examination carries a radiation load on the fragile body of the child.
- The safest, most painless and the most informative modern method for diagnosing the proliferation of adenoids is endoscopy - while the doctor and parents can see the whole picture on the monitor screen. The only condition for conducting such an examination is the absence of recurrence of inflammation of the adenoids, it should be carried out only if the child has not been sick for a long time, otherwise the clinical picture will be false. This can lead to vain experiences and the possible direction of the operation, when this can be avoided.
- Myth 1 - After the removal of adenoids, the child's immunity decreases - yes, it decreases, but only after surgery and within 2-3 months after an adenotomy does it recover, because after removal of the nasopharyngeal tonsil, the tonsils of the rings of Waldeer Pirogov assume protective functions.
- Myth 2 - If the tonsils are enlarged, then the child often suffers from viral and infectious diseases due to their increase. Quite the contrary, from the fact that a child has frequent ARVI for some internal and external reasons, each time the baby's lymphoid tissue increases more and more.
- Myth 3 - Removal of adenoids at an early age leads to their secondary growth. A repeated increase in adenoids rather depends not on the age of the children, but on the quality of the operation, 20 years ago, when the operations were performed almost blindly, the particles of lymphoid tissue in 50% of cases remained not removed, which increased the likelihood of their further growth. Modern endoscopic operations help the doctor see the whole clinical picture and secondary growth of adenoids is now much less common, in about 7-10% of cases.
- Myth 4 - Adults do not suffer from enlarged adenoids. There are cases that adenoids do not decrease with age and similar operations are also performed in adults.
How to treat adenoids in a child - remove or not?
Adenotomy today in pediatric ENT practice is the most common surgical operation. Indications for the mandatory removal of adenoids are the following symptoms and concomitant diseases:
- If a child has a serious respiratory failure through the nose, sleep apnea appears, that is, holding the breath for 10 seconds or more, this is dangerous due to the constant hypoxia of the brain and leads to a lack of oxygen supply to all organs and tissues of the growing organism.
- If the child develops exudative otitis media, when mucus accumulates in the middle ear cavity and hearing loss in the child decreases.
- With malignant degeneration of the nasopharyngeal tonsil.
- If overgrown adenoids lead to maxillofacial abnormalities.
- If conservative treatment for at least a year does not give a tangible effect and adenoiditis is repeated more than 4 times a year.
Adenotomy is contraindicated in the following cases:
- The presence of an infectious disease or an epidemic of influenza, only 2 months after recovery, surgery is possible.
- Blood diseases.
- Severe cardiovascular disease.
- Adenoid removal is contraindicated in children with bronchial asthma and with serious allergic diseases, since the operation exacerbates the disease and worsens the condition of the child, the treatment of adenoids with such pathologies is carried out only by conservative methods.
If after the examination it turns out that the adenoids in the child are enlarged and he suffers greatly from this, does not sleep well, breathes mainly through the mouth, which interferes with normal eating and sleeping, of course this requires treatment. In each clinical case, the method of therapy - conservative or surgical, is decided individually:
When choosing - surgery or drug treatment can not rely solely on the degree of increase in adenoids. At 1-2 degrees of adenoids, many believe that removing them is not advisable, and at 3 degrees, adenotomy is simply necessary. This is not entirely true, it all depends on the quality of the diagnosis, there are often cases of false diagnosis, when the examination is carried out against the background of a disease or after a recent illness, the child is diagnosed with grade 3 and is recommended to remove adenoids. And after a month, adenoids are significantly reduced, as they were increased due to the inflammatory process, while the baby breathes normally and does not get sick too often. And there are cases, on the contrary, with 1-2 degrees of adenoids, the child suffers from persistent acute respiratory viral infections, recurrent otitis media, sleep apnea occurs - even 1-2 degrees can be an indication for the removal of adenoids.
- The child is often sick
If a child lives in a metropolis, goes to kindergarten and is often sick 6-8 times a year - this is normal, and if he is diagnosed with adenoids of 1-2 degrees, but he normally breathes during the day, and sometimes breathes through the mouth at night, this is not 100% indication for surgery. Diagnosis, preventive procedures, and comprehensive conservative treatment should be regularly performed.
- Take your time with the operation
If your attending physician insists on the operative removal of adenoids - take your time, this is not an urgent operation when there is no time for reflection and additional monitoring and diagnostics. Wait, follow the baby, listen to the opinions of other otolaryngologists, make a diagnosis after a few months and try all the medical methods. Now, if conservative treatment does not give a tangible effect, and the child has a constant chronic inflammatory process in the nasopharynx, then for consultation you should contact the operating doctors, those who do an adenotomy.
- The dangers of not removing adenoids
It should be remembered that adenoids are removed not because the baby is often sick, but because overgrown adenoids do not allow breathing through the nose, leading to complications - otitis media, sinusitis, sinusitis.
If adenoid relapse occurs after the operation, this is an obvious sign that the removal was not advisable, since it was necessary not to operate, but to eliminate the pronounced immunodeficiency in the child. Many doctors contradict themselves, claiming that recurrent adenoids must be treated conservatively, then why remove nonrecurrent adenoids, which are even easier to treat than recurrent adenoids. Therefore, when deciding whether a child needs to remove adenoids, you should carefully consider that any surgical intervention in the child's body has negative consequences and is not always justified.
In addition to the otolaryngologist, a child with adenoids should be examined by an immunologist, an allergist, a TB doctor, and an infectious disease specialist. Consultation and diagnosis at these doctors will help determine the true cause of the proliferation of adenoids and their inflammation, which can lead to the right path of therapy. Conservative drug treatment includes a number of different procedures and the use of various medicines:
- Spa therapy - it is very effective to treat children with adenoids in the sanatoriums of the Caucasus and Crimea
- Physiotherapy - laser therapy, UV, electrophoresis, UHF
- Homeopathy is the safest and in most cases very effective method of treating adenoids today.
- Rinse the nose and nasopharynx with various solutions
- Use of topical antibiotics
- Topical glucocorticosteroids topically applied as sprays
Therapy of this disease is long, painstaking, requires patience, perseverance and skill from parents. Moreover, the mother should carefully monitor what helps the child, what is not, which causes allergies or worsens the condition. The selection of methods and medicines for treatment should be individual, which helps one child, may not help another. The only thing that helps everyone is the operation, but you should try all possible methods of conservative treatment and, if possible, avoid any surgical intervention.
Rinsing the nasopharynx in a child can be done using the Dolphin device. Sometimes even a few nasopharyngeal washes can significantly improve the condition of the child. As solutions for washing, you can use pharmacy sea salt without additives, 2 teaspoons of salt should be dissolved in a glass of warm water, strain and use the Dolphin device. You can also make a similar composition of sea water from table salt - 1 teaspoon of salt, 1 teaspoon of soda and 2 drops of iodine, also in a glass of water.
You can use ready-made pharmacy solutions of sea salt in the form of sprays - Aquamaris, Quicks, Aqualor, Goodwad, Dolphin, Atrivin-More, Marimer, Allergol, Dr. Thece, Physiomer.
For washing, it is very good to use decoctions of medicinal herbs, if the child does not have an allergy to them - this is sage, chamomile, St. John's wort, eucalyptus leaf, calendula. In addition to mechanical cleansing, such solutions have anti-inflammatory effects.
You can use propolis to rinse the nasopharynx - dissolve 20 drops of an alcohol solution of propolis with 1/4 teaspoon of soda in a glass of warm water.
The pharmacy drug Protorgol is also used for adenoids, but its use helps only after thorough washing of the mucus, otherwise the effect will be insignificant.
Otolaryngologists sometimes recommend using both Protorgol, and thuja oil for adenoids, and Argolife. One weekly instill Protorgol and arborvitae oil, the second week Argolife and arborvitae oil and so on alternate for 6 weeks. Before instillation, be sure to rinse the nose, then instill 2 drops in each nostril 2-3 times a day.
Often, complex therapy includes immunomodulating drugs, local ones such as Imudon, IRS-19, or general-acting Ribomunil, Dimephosphon. These funds should be prescribed and be monitored by the attending physician.
For local treatment, sprays are also used - Propolis spray, Ingalipt spray, as well as Chlorophyllipt.
In addition to washing and using oil of thuja, Protorgol and Argolife, homeopathic treatment with the German remedy Lymphomyosot is very effective - this complex preparation has a pronounced lymphatic drainage, anti-allergic, detoxifying effect. It is taken orally 3 times a day for 5-10 drops for 2 weeks, such courses can be repeated periodically. As with any homeopathic treatment, there may first be a slight exacerbation, in this case, and also if any side effects occur, you should stop taking it and consult a doctor.
In addition to these drops, you can use homeopathic granules Job-baby. It is also a complex drug, when used in many children, even the most advanced stages of adenoids resolve, inflammation in adenoiditis decreases, and nervous excitability in children with adenoids decreases. Contraindications to their use are acute inflammatory processes in the nasopharynx - sinusitis, sinusitis.
The treatment should be lengthy, homeopathic therapy is different in that only in the case of long-term continuous use of drugs is the effect achieved. A full recovery sometimes takes a whole year, in case there is an aggravation of symptoms at the beginning of the use of Job-baby, it is recommended to stop taking it for 2 weeks, then start again, if adverse reactions recur, you should change the scheme - take the medicine less often, for example 2 days to take, 5 days off. No vaccinations should be given during treatment. If a child has such a primary deterioration, homeopaths consider this a good sign, then the body is rebuilding for recovery.
What are adenoids
In medical terminology, adenoids are understood to mean pathologically enlarged nasopharyngeal tonsils in children 3-7 years old. They occur after diseases of the upper respiratory tract of the inflammatory type, measles, scarlet fever, flu. The disease causes difficulty breathing, hearing disorders, colds, otitis media. Adenoids are not visible to the naked eye, so if you suspect a disease, you should consult a doctor for an examination.
Adenoid vegetations or growths in children are manifested by the following symptoms, which parents should pay attention to:
- the baby often breathes through his mouth, especially at night,
- difficulty breathing through the nose, although there is no runny nose,
- prolonged runny nose, which can not be cured.
Without treatment, these pathological lesions threaten to develop into hearing impairment, the child will often have a cold, his performance at school or kindergarten will decrease. Chronic inflammation of the tissues will lead to adenoiditis, to which the body will react with fever, pharyngitis, bronchitis, laryngitis. In children, speech is disturbed, a cough occurs, the nervous system slows down in development, enuresis occurs, the chest develops incorrectly, anemia appears.
Indications for the removal of adenoids in children
After examining the patient, the doctor may prescribe the removal of adenoids in the child according to the following indications:
- persistent otitis media, sinusitis, hearing impairment,
- serious airway complications
- too much degree and size of tissue proliferation,
- parallel growth of palatine tonsils (tonsils),
- relapse of the disease.
How to remove adenoids in children
In the absence of a stable result of conservative treatment methods, adenoids are removed in children. It is called adenotomy, done in a short time under general or local anesthesia. For her, a special knife is used with an adenotome, which is inserted into the nasopharynx, pressed to the arch, wait for the mucous tissue to enter the rings and cut out.
Under local anesthesia
To freeze overgrown tissue, local anesthesia with Lidocaine or Ultracaine is used. With solutions, they lubricate the mucous membranes of the throat, which removes pain completely. For the baby, this method is not the most effective, because he sees what is happening, realizes, is scared of blood, cries. This is reflected in his psyche and the actions of the doctor. Local anesthesia can be supplemented with the removal of adenoids by intramuscular injection of sedatives - children remain conscious, but have a drowsy state or even sleep.
Under general anesthesia
If earlier the operation was done completely without anesthesia, even local, then now the children are prescribed general anesthesia - they are put into a state of anesthesia. It is more appropriate and safe for the doctor. The kid closes his eyes, and wakes up already with an operated throat. This is convenient, but unsafe - general anesthesia has its consequences and possible complications.
Does it hurt to remove adenoids
Parents are interested in the question of whether it is painful to remove the adenoids in the child. Doctors say the operation is pain-free. Tonsil tissue itself does not have nerve endings, you can even put an injection into it, and a person will not feel anything. Therefore, before the removal of adenoids took place without any anesthesia at all. Modern doctors do general or local anesthesia in order to preserve the psychological state of children.
Classical adenotomy is not the only way to remove adenoids. Adults and children use a laser, endoscope, radio wave method, cryotherapy, cold plasma. The most modern process is the microdebrider - a special tool with a rotating head and a blade at the end. It grinds adenoids, sucks out tissue without damaging the healthy mucous membrane of the nasopharynx.
Laser removal of adenoids
Another main modern method is the removal of adenoids by laser in children. The bloodless method increases the temperature of the tissue when exposed to a laser beam, evaporates liquid from it. The disadvantages of the method are the increase in the duration of the operation, the possible heating of healthy tissues in the area of laser exposure, high cost and complications.
A kind of adenotomy is endoscopy of adenoids in children. If with classical surgical intervention, the doctor makes movements almost to the touch and can miss pieces of tissue, then with endoscopy this is impossible. The procedure is based on the removal of tonsils with a laser or microdebrider through the sinuses using an endoscope. This device allows you to see and enlarge photos of growths to accurately remove them in children without risk of missing areas.
With endoscopy, general anesthesia is always used, the operation is painless and stress-free for children in a hospital. The advantages of the method are the absence of fear in the patient, the control of the stages of lymphoid tissue removal, and the reduction in the risk of relapse and bleeding. The disadvantages of endoscopy include the high thickness (2-4 mm) of endoscopes, which are difficult to drive through the baby’s nose, plus the requirement for anesthesia of the nasal mucosa.
Radio wave method
The operation to remove adenoids can be carried out with a special Surgitron device with a radio wave adenotome attachment. This knife cuts the tissue in a single block, as in the classical intervention, but at the same time cauterizes blood vessels to minimize bleeding. This is a plus of choosing the radio wave method, plus the risk of complications after surgery is reduced.
How is the operation on adenoids in children
Having given general anesthesia or anesthetized nasopharynx topically with intravenous administration of sedatives, the doctor begins to remove adenoids in children. Modern clinics use endoscopes and combined removal methods with a shaver and a radio wave adenotome or laser. Having cut off the tissue and sucking up the rest with a special device, the surgeon tampons the operation site.
The postoperative period is easily tolerated, sometimes in the evening or the next morning, the temperature may slightly increase. Immediately after the intervention, children breathe better with their nose, but then the tissue swells, there is nasal, nasal congestion, squelching in the nose. It goes away in a week or ten days. In the presence of chronic diseases, the healing period lasts a little longer.
Consequences of removal
After the operation to remove adenoids, do not bring down the temperature that appears in children with aspirin, so as not to provoke bleeding. Unpleasant symptoms are vomiting of blood clots, abdominal pain, and stool disorders, but they quickly pass. There are rules for caring for children after an adenotomy:
- a month to exclude physical activity,
- three days not to bathe the baby in hot water,
- not to be in the sun, heat, stuffiness,
- 3-10 days to follow a diet - exclude coarse, solid, hot food, eat liquid high-calorie vitamin food,
- for healing, use vasoconstrictor drops in the nose, astringent drying solutions,
- conduct breathing exercises.
What is impossible after removal of adenoids in children?
The postoperative period is as important a stage of treatment as the operation itself. That is why parents should know what is impossible after the removal of adenoids in children and how to speed up the healing process.
First of all, you need to understand that the postoperative period for each child has its own nuances. They depend on the complexity of the operation and the individual characteristics of the child's body.
The main contraindications for the patient for 1-2 weeks after adenotomy:
- Bathing in hot water, staying in hot rooms or sunbathing.
- Physical activity, active games.
- Hot, hard, rough and spicy food.
The child must comply with bed rest and is under the constant supervision of adults.
After an adenotomy, the patient is given a series of recommendations that should be followed in order for recovery to go without complications. The postoperative period and care consist of the following rules:
- After the small patient was released from the hospital home, it is necessary to create the most comfortable conditions for him. First of all, to ensure good ventilation of the room with optimal temperature and dim light.
- In the first hours after an adenotomy, a cold compress should be applied to the operated area. This will help reduce swelling of the nasopharynx. Swelling may appear on the eyelids, to eliminate it, a 20% albucide solution is instilled into the eyes.
- Within 3-5 days after the operation, parents should regularly measure the body temperature of their child. With hyperthermia, if the temperature is above 38 ° C, the baby should be given an antipyretic.
- Particular attention should be paid to nutrition. In the first week after surgery, only puree and liquid foods are indicated. Dishes are best steamed or stewed so that they can be easily swallowed. The basis of the diet should be ground grits, stewed vegetables, steam cutlets, herbal decoctions and compotes. In order for food not to irritate the throat, it must be at room temperature.
- Active movements, physical education and sports should be limited. The child needs to provide bed rest: a good rest and sleep.
In addition to the above recommendations, the doctor prescribes vasoconstrictive drops in the nose, which accelerate the healing of the wound surface and facilitate nasal breathing. Most often these are such drugs: Tizin, Glazolin, Nazol, Nazivin, Naftazin and others. The duration of their use should not exceed 5 days.
Another prerequisite that must be observed after the removal of adenoids in children is breathing exercises to restore normal breathing. Subject to all medical recommendations, the patient's condition normalizes to 7-10 days.
Respiratory gymnastics after removal of adenoids in children
After surgical treatment of hypertrophic tissues of the pharyngeal tonsils, all patients are prescribed breathing exercises. After removal of adenoids in children, physiotherapy is carried out 10-15 days after returning home. Exercise is aimed at restoring nasal breathing.
Breathing exercises should include the following exercises:
- The legs are shoulder-width apart, the hands are on the belt, and the head is thrown back. Slow inhalation with the mouth and lowering of the lower jaw, exhale through the nose and raising the jaw. Inhalation should be done in 4 counts, and exhalation in 2.
- Starting position: standing, legs together. On inhalation, arms up, and legs on socks, exhale, lower your hands.
- Starting position, as in the previous exercise. On inspiration, tilt your head to the right shoulder, and on exhale to the left.
- Hands are locked in the lock behind his back, his head is thrown back. Slow breath by mouth and raising hands up, exhale through the nose.
- Hands along the body, feet shoulder width apart. Slow breath with protrusion of the abdomen, exhalation with contraction of muscles. This exercise trains abdominal breathing well.
- Pinch your nose and count loudly to 10. Open your nose and take a deep breath in and out through your mouth.
Exercises should be performed in a well-ventilated area in the morning and evening. The respiratory complex should take no more than 30 minutes. The load should be increased gradually, approximately every 4-6 days. The number of repetitions of each exercise is 4-5 times.
Hospital after removal of adenoids in a child
Despite the fact that adenotomy is a fairly simple operation in ENT practice, it requires careful preparation by both the doctor and the parents of a small patient. A hospital certificate after removal of adenoids in a child is most often issued for a period of up to two weeks. Its duration depends on the features of the operation and the general condition of the patient. If necessary, parents can extend the sick leave for child care through a medical commission until the baby is fully recovered.
Numerous reviews of parents who have experience after surgical treatment of inflamed tonsils in children confirm the effectiveness of radical therapy. Some note that children are less likely to get sick and easier to endure colds. Others indicate that the child has completely gone through the nasal voice and restored nasal breathing.
Removing adenoids in children is especially necessary if the pathological process has caused complications, and conservative therapy has been ineffective. In this case, excision of hypertrophic tissues of the pharyngeal tonsils allows you to restore the health of the baby.
The degree of increase in adenoids
To have an idea of how dangerous the disease is, you should consider the structure of the nasopharynx. On the side walls of the channel through which air enters, the mouths of the Eustachian tubes are located, connecting 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 white blood cells that take on the attack of pathogenic microflora. In the case of frequent inflammation provoked by infection, allergies or other factors, the lymphoid tissue begins to grow and gradually blocks the auditory tubes and restricts air flow.
In a healthy baby, adenoids normally close up to a quarter of the lumen of the nasopharynx. Three degrees of pathological growth are distinguished depending on the neglect of the disease:
- The first is blocked up to 33% of the lumen of the nasopharyngeal canal in the area of the vomer - part of the nasal septum. In this case, the child experiences minor difficulties breathing through the nose, and at night, deterioration due to edema is possible. About adenotomy - an operation to remove adenoids - there is usually no talk, preferably conservative treatment.
- Closed from 33 to 66% of the clearance. This is the II degree of increase in adenoids, in which the child can snore at night, his hearing is impaired. During the day, the baby’s breathing is difficult, due to nasal congestion, his mouth is constantly ajar (the so-called adenoid type of face). A recommendation of an ENT specialist for surgical intervention is possible. If untreated, adenoids can gradually grow.
- Third - there is an almost complete blockage of the nasal canal of the respiratory tract by connective tissue. Nose breathing is almost completely absent, immediate medical attention is required, as there may be consequences in the form of incorrect formation of the facial part of the skull, hearing impairment. With the third degree of adenoids, the baby experiences constant torment, headaches, fever are possible.
Parents note. According to statistics, about 3% of preschool children suffer from pathology. It matters at what age adenoids began to increase. As a rule, children under 2 years old do not have surgery, since there is a high probability of relapse - a repeated increase in lymphoid tissue cells.
Possible effects of adenoid hypertrophy
The danger of the disease is that the parents of the baby suffering from a constantly stuffy nose do not attach any particular importance to this and notice the changes when the consequences become apparent.
Typical facial expressions with an adenoid face: displacement of the chin, constantly ajar mouth - leads to irreversible consequences. The structure of the jaws is gradually deformed, which is not always able to be corrected even by surgical means.
Overgrown adenoids greatly complicate the life of the child, psychosomatic diseases may appear: nervous tic, enuresis, convulsive conditions. The baby becomes lethargic or excitable. Due to the nasal nuisance and hearing loss, verbal communication worsens, during a conversation he often asks to repeat what he was told.
Hypertrophic nasopharyngeal tonsils under the influence of negative factors often become inflamed, which is the cause of adenoiditis - a disease characterized by high fever, chronic runny nose and headache.
Adenoids interfere with the outflow of mucus, which deprives the body of its protective function. Inflammatory processes can provoke otitis media, pharyngitis, tracheitis.
Do I need an operation
The main question that parents ask at the otolaryngologist’s appointment is whether surgical removal of adenoids in children is necessary and what consequences will be if medical intervention is abandoned. Indications for adenotomy are changes caused by hypertrophy of the pharyngeal tonsil of the II and III degree:
- adenoiditis, otitis media, chronic respiratory diseases,
- neurological abnormalities
- adenoid cough
- apnea, or sleep interruption.
An indication for surgery is a condition in which tonsils grow together with adenoids. The child speaks poorly, he often has a headache, there is a lag in psychophysiological development. Decide on the need for surgery only in the absence of alternative treatment.
The time of year at which adenoid removal is performed also matters. Winter is preferable to summer.
Tip. Often, the otolaryngologist makes a verdict on the need for surgery after examination and an x-ray. But such a diagnostic method is not always safe and objective: in the picture, the accumulated mucus or inflamed tube tonsils, angiofibromas, or other tumors can cover the lumen. An accurate and informative way to establish a diagnosis is endoscopy: insertion of a tube with a video camera into the nasal cavity.
Parents may doubt the need for surgery due to the risk and possible suffering of the child. Those to whom adenoids were removed without pain relief are especially worried. Now, adenoid excision is performed under general anesthesia for patients under 7 years of age or for local older children, as it is easier for them to explain the situation.
During local anesthesia, the anesthetic drug, lidocaine or novocaine, is first applied by spraying or lubrication, and then injected directly into the amygdala. The child sees and is aware of everything that happens, and the appearance of instruments and his own blood can cause psychological trauma. Therefore, general anesthesia is preferable. If the baby is overly excited and scared, a sedative is additionally introduced.
The drug for pain relief is selected individually by the anesthetist; for small patients, low toxic and relatively safe medications are used: Diprivan, Esmeron, Dormicum.
The advantages of general anesthesia include a low risk of psychological and physical trauma, the ability to safely remove adenoids and carefully examine the throat after surgery. Modern experts use endotracheal anesthesia, in which anesthetics enter both the blood and respiratory organs.
Surgical Adenoid Removal Techniques
When and how to remove adenoids in children depends on the recommendations of the practitioner, the chosen clinic, the availability of the necessary equipment and the degree of pathology.
- A method is considered classic in which an overgrown pharyngeal tonsil is removed with a Beckman adenotome, a ring-shaped surgical scalpel. With one confident movement, the doctor cuts off the overgrown lymphoid tissue, using a laryngeal mirror for examination. The disadvantages of the method include increased bleeding, for stopping which it is necessary to use special means, and difficulty in examination, which increases the risk of injury. Due to the limited view, incomplete removal of the tissue is possible, which leads to the repeated growth of adenoids.
- In modern surgery, radio wave adenotomes (the Surgitron device) are used, which are able to simultaneously remove the tonsil and burn a damaged area. The advantage of the method is that the risk of blood loss with this method is minimized, and the recovery period is short. The review is carried out using an endoscope - a miniature camera.
- Laser adenotomy is performed by two methods. If the pathological array is large, coagulation is used, if insignificant, then vaporization is chosen - layer-by-layer excision. Since the operation is performed without the use of tools, the risk of tissue infection is reduced, blood vessels are cauterized by a laser, which makes the intervention less traumatic and safe. Possible slight heating of tissues located next to the adenoid massif.
- Cutting out adenoids by the cold plasma method, or by the coblation method, means applying a practically painless type of intervention. Destruction and removal of pathological formations by cold plasma occurs without damage to adjacent tissues. The endoscopic method allows you to monitor the damaged area.
- With adenotomy with a shaver tool with the introduction of an anesthetic, the adenoids are cut with a curved scalpel, which is inserted through the nasal passages. Recovery with this method is fast.
Baby Care After Adenotomy
The baby who underwent surgery is easy to care for. The home recovery mode after removing the adenoids in a child is to correct nutrition, limit physical activity, and observe hygiene rules. Here are some general guidelines:
- Change the diet. For a child who has undergone an operation to remove adenoids, hot food and drink are forbidden: you need to spare the damaged area. You can not give food that can injure the throat: crackers, chips, spicy seasonings, vinegar dressings, feed with dishes containing garlic, onions and more. The diet lasts about two weeks.
- Due to the risk of bleeding, it is advisable to avoid overloads and prolonged exposure to the sun, in a bath with hot water, in a bath. The throat and neck should not be warmed up. Half bed mode recommended.
- Limit contacts to avoid the risk of getting sick.
- Perform breathing exercises - to learn the technique, you can watch a video with your child. It is also important to teach the baby to breathe through his nose all the time.
- Follow all the advice of your doctor.
There’s no need to lie at home all the time, you can walk in places where there is no crowded place.
Can adenoids grow again
Cases where adenoids re-grow are not uncommon. This is due primarily to partial or incomplete removal of tissue during surgery. It is enough to stay literally a millimeter for the palatine tonsil to begin to recover. Other reasons why adenoids can grow after removal include:
- allergic tendency
- surgery under the age of 2 years,
- tendency to pathology due to heredity.
Possible consequences of the operation
In most cases, the operation takes place without complications. The negative effects of surgical intervention include:
- The occurrence of otitis media. Edema of damaged tissue can block the ear canals and cause temporary hearing problems.
- Snoring, shortness of breath. The baby can sniff, grunt and cough. This phenomenon is associated with swelling of the nasopharynx after removal of adenoids. Such symptoms usually disappear after seven to ten days, if improvement does not occur, you should consult with the 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 the doctor’s instructions.
Estimated transaction prices
How much the operation costs depends on many factors: the size of the settlement, the status of the hospital, the chosen treatment method. According to indications, such an intervention is carried out free of charge in a state medical institution, but it is possible that a certain type of service will not be available in it. In private clinics, they can charge for the operation in the amount indicated in the table:
A logical question arises: "How to deal with adenoids in the nose?" Here it all depends on the degree of growth of the tonsil. If it does not greatly block the lumen of the airways, then medication, physiotherapy, respiratory gymnastics and spa therapy can be dispensed with. But in fairness it must be said that all these measures are not always effective. If within six months no improvement from their use is observed, and the child continues to suffer from the disease, then it is time to think about a surgical solution to the problem.
The operation to remove adenoids (adenotomy - partial removal or adenectomy - complete removal of the nasopharyngeal tonsil) is performed today under local anesthesia or under general anesthesia. The first is considered safer from a physiological point of view. But most doctors believe that monitoring the progress of an operation in an untrained baby can cause serious psychological trauma. The memory of the execution and the fear of people in white coats will remain for many years. That is why more and more often in hospitals resort to general anesthesia, as a more humane way of pain relief in relation to the child.
The operation is carried out quickly: in just a few minutes with local anesthesia and 20-30 minutes with endoscopic intervention. The first three postoperative days, the child should not be given hot food: it can cause vasodilation and bleeding.
It is also excluded the reception of sharp, cold dishes. Heated soups and cereals are fed, starting from the fourth day, not earlier. This mode is set for the baby for 9-10 days. Then he will be able to return to his usual way of life.
Side effects and complications from an adenotomy or adenectomy are rare. Initially, after removal of the tonsil, the child will breathe through the mouth. This does not mean that the operation was useless. It's just difficult for the baby to immediately switch to nasal breathing. In addition, postoperative edema appears at the site of removed adenoids. It blocks the nasopharynx and makes it difficult to take a full breath in the first days after surgery. But by the tenth day, everything passes, and the child breathes freely.
There is another problem: the removed tonsil can grow back. And she, too, is not immune from hypertrophy and inflammation. But this does not always happen, and newly appeared adenoids are repeatedly removed infrequently. In such cases, doctors try to limit themselves to conservative treatment.
Sometimes it happens that the baby’s parents refuse to perform the operation, having learned that with age, the nasopharyngeal tonsil decreases in size, and in most adults it generally atrophies. Indeed, why remove the problem, which itself may disappear over time? First you need to remember that excessive categorization has not brought anyone to good. It is not speculation and prejudice that should prevail in making the final decision, but common sense.
We must weigh everything, carefully think through it and, together with the children's doctor, come to a certain, and most importantly, reasonable conclusion.Doctors know that up to 5 years the nasopharyngeal tonsil plays a big role in the formation of children's immunity and adhere to the golden rule: if the child can do without surgery, then it is better not to appoint it. Surgery is a last resort. If the doctor insists on it, then this is really necessary.
For small and medium sized adenoids (grade 1 and 2 disease), conservative treatment is prescribed: instillation of a 2% solution of protargol in the nose, rinsing of the nasal cavity, the use of children's vasoconstrictor drops, which save the nose from nasal congestion.
With washing of the nose against the background of adenoids in a child should be approached with extreme caution. An improperly done procedure can lead to the solution getting into the middle ear cavity and the development of acute otitis media. In 100% of cases, this situation occurs with adenoids 3 and 4 degrees. Therefore, it is important to remember that in severe forms of the disease, nose washing is prohibited. Also, how can this be done with frequently occurring nosebleeds and chronic otitis media in young patients.
How to rinse the nose of the child
Most children treat this method of treatment with hostility and are even afraid of it. Therefore, it is important to approach the issue gently, to explain to the child that it is necessary for his health - so that the nose breathes better. It is good if the process is carried out in a playful way or one of the parents shows by example that washing the nose is absolutely painless. A vivid demonstration of the procedure by father or mother should convince the child that doing it is not at all scary.
Many parents are interested in the question, at what age can a child wash his nose at all? The answer is simple. From the moment you can explain the procedure for him and you will be sure that the baby will be able to understand you correctly. Doctors advise doing this no earlier than 4 years. Up to this point, special baby droplets are used to cleanse the nasal cavity, which soften thick secretions of the mucous membrane, cotton wicks and aspirators.
For washing, you can use ordinary boiled water, decoctions of herbs (chamomile, eucalyptus, calendula, sage, St. John's wort), sea water, isotonic solution or special ready-made compounds that are sold in a pharmacy. It is allowed to alternate different means: use one or the other. Solutions are selected together with the otolaryngologist, based on what allergic reactions were manifested in the child's history. The finished product should be a little warm (temperature 34-36 °). A volume of 100-200 ml will be enough for one procedure.
Very well, it not only removes accumulated mucus, but also relieves swelling and has a bactericidal effect of sea water. It can be prepared from dry sea salt (1/2 tsp. Diluted in a glass of water) or, for lack of it, from ordinary food (1/3 tsp. Dissolved in a glass of water and add 2 drops of iodine).
Before starting the procedure, make sure that the nose of the child is not blocked. Otolaryngologists advise you to pre-clean the cavity from secretions either with an aspirator or by thoroughly stripping it. If even after this the patency of the nasal passages remains difficult, it is allowed to instill the baby with vasoconstrictive drops (one drop in each nostril). After that, you can start washing.
The procedure is carried out, standing above the sink. The solution is collected in a small syringe with a thin nose or use a special pharmacy device (it is also called a “nasal shower”). The child needs to lean forward 90 °. The head should be kept strictly upright; it is impossible to tilt it during the procedure to the right or left. Ask your child to take a deep breath and squeeze a small amount of the solution into one of the nostrils. The fluid will completely fill the nasal passage and flow from another.
If water gets into the mouth, you can advise the child to pronounce a lingering “and-and” during injection. The soft palate thus rises and delimits the nasopharynx. After this, you need to blow your nose and repeat the procedure from the second nostril. And so - several times. Complete the rinsing by blowing the nasal passages, which will remove the remaining solution from the mucosa.
If this is a flow-through method of washing (from one nostril to another) - it is difficult, you can try a simpler method: inject a small amount of liquid into the child’s nose and ask him to blow his nose right away. Make sure that the head is again in an upright position and in no case throws back. The solution should not get into the mouth, nor even into the ears. Even a small amount of fluid in the middle ear cavity will provoke serious otitis media, which will then be very difficult to cure.
After 15 minutes after washing, the turn of aniseptic or antibacterial agents prescribed by the doctor comes. Antiseptic include colloidal preparations of silver, in particular protargol.
Unlike vasoconstrictor drops, which need to be instilled in the baby on the side so that they do not get into the mouth and act only on the nasal mucosa, protargol is instilled on the back. This is done so that the substance glass from the nasal cavity into the nasopharynx and reaches the surface of the tonsil. Silver ions contained in the protargol kill all pathogens, as well as slightly dry the inflamed lymphoid tissue, reducing its size. 2-6 drops of the drug are instilled into each nostril (depending on the age of the patient and the severity of the disease).
It is recommended that the child then lay on his back for some time without raising his head. Ideally - about 15 minutes. But if the baby is naughty, you can limit yourself to 5 minutes. The instillation is carried out on the recommendation of a doctor, usually 2 times a day for 2 weeks. A second course of treatment can be prescribed in a month. Do not forget that the shelf life of a 2% solution of protargol is very short. Only 30 days from the date of manufacture. Therefore, the old bottle with the drug for the new course will no longer be used.
Do not neglect respiratory gymnastics, which is recommended by specialists for the treatment of adenoids. It is better for mom to conduct it simultaneously with the baby, turning the process into a fun game. Gymnastics strengthens the respiratory muscles, stimulates blood circulation in the sinuses, helps prevent sinusitis. In addition, during the exercise, the diseased organism is saturated with the oxygen it lacks.
Unfortunately, in children, adenoids are often accompanied by another disease - hypertrophy of the tonsils (folk, tonsils). In this case, breathing is difficult not only through the nose, but already through the mouth. Palatine tonsils, like nasopharyngeal, protect the baby from pathogenic microorganisms, but do it much more actively. Therefore, their removal is a more noticeable loss for the body. Without them, the child is more at risk of bronchopulmonary diseases.
Inflamed palatine tonsils are a much greater danger than possible colds. They are a source of chronic streptococcal infection, which, periodically exacerbating, provokes the development of fever and sore throat. The latter, in turn, can give complications to the kidneys and heart. So in the case of a “double set” of the disease, it may be wiser to go for surgery than to expose the child’s health to serious risk.
In conclusion, I want to note that enlarged tonsils are a very delicate issue. Much depends on the competence of the doctor and the sanity of the parents. The decision on treatment should be made by a competent specialist. Not grandmothers who “raised you healthy and will take care of your grandchildren”, not friends who had “exactly the same situation” and especially not numerous forums with virtual mothers.
The doctor’s side is thorough knowledge of the problem and experience. Believe me, he will fight to the last to bring the tonsils “to life” without a scalpel. But if the treatment does not help, and the adenoids continue to undermine the health of the child, then postponing surgery in a long box is not worth it.