Adenoid vegetation occurs not only in children but also in adolescence and even adulthood. The most common complaints are runny nose, snoring, mouth breathing, frequent otitis media, hearing loss. Among the indications for removal, 3 main ones can be distinguished. The presence of one of them is an indication for adenoidectomy.

• If the child sleeps with an open mouth at night, breathes through the mouth during the day. In such a child, the upper and lower jaw may not form correctly during growth, which can lead to malocclusion, an adenoid type of structure of the face. Also, the child inhales the air that has not passed through the nose (not heated, not moistened) immediately into the trachea and bronchi, which can cause drying of the mouth, throat, frequent bronchitis, hypertrophy of the tonsils.
• Frequent rhinosinusitis – in all people, the diameter of the nostrils and the diameter of the nasopharynx are different. The diameter of the nostrils is smaller. During inhalation, negative pressure forms in the nasal cavity and air from the paranasal sinuses enters the nose and is further inhaled, respectively, and vice versa, during exhalation, positive pressure forms in the nasal cavity, which leads to air entering the sinuses (maxillary, ethmoid, frontal), where it is heated, moistened, cleaned, etc., air is circulating through the nasal cavity and sinuses. In the presence of hypertrophic adenoid vegetation, the difference in these diameters is incorrect. Air circulation in the nasal cavity and paranasal sinuses is disturbed, impaired ventilation of the sinuses leads to accumulation of mucus in the sinuses, the pathogenic flora provokes inflammation of the mucous membranes and leads to frequent rhinosinusitis.
• Problems with the ears (otitis media, secretory otitis media). The middle ear (tympanic cavity) is isolated from the environment, that is why there is an eardrum. There is air in the tympanum. This air enters the tympanum from the nasopharynx through the auditory tube. During a change in altitude, ascent to the mountains, the descent into the subway, take-off/landing of an aircraft, the pressure in the tympanic cavity changes, and we feel stuffiness in our ears. Having made a couple of swallows of saliva or having opened our mouth wide, we hear a crack or click in our ears (pressure is equalised) and we begin to hear better. A crack or click is the moment the auditory tube open, which evens out the pressure. The auditory tube from the right and left ear opens into the nasopharynx, exactly in the place where the adenoid vegetation is located. When adenoid vegetation increase, they press on the auditory tubes, thereby disrupting the ventilation of the tympanic cavity.

Hypertrophy of palatine tonsils. Often in children with large adenoid vegetations, there is additional hypertrophy of the palatine tonsils. They increase as a result of breathing by mouth and can sometimes even close together, provoking difficulty in swallowing and in the passing of food lumps. A simultaneous reduction of the palatine tonsils, in this case, is often resorted to. They are in most cases not completely removed (tonsillectomy) but reduced in size by reducing their volume (tonsillotomy).

Secretory otitis media. In the presence of fluid behind the eardrum, depending on the nature of the contents and the duration of the process, simultaneous shunting of the eardrum with removal of fluid from the tympanic cavity is possible. Shunts are located inside the eardrum. They look like spools for thread, only small ones. Through them, the eardrum is ventilated through the external auditory canal. If a child is undergoing shunting, it is strictly forbidden to wet his ears (while taking a shower, swimming in the pool, sea) for a while until the shunts are removed. Often shunts do not have to be removed, they fall out themselves, it happens individually for everyone, for someone in 6-7-8 months, for someone in 2 years. There are no other recommendations besides protecting your ears from water and undergoing occasional examinations.

Diagnostics:

Often, in addition to an otolaryngological examination, no other studies are required. To accurately determine the presence of adenoid vegetation, their degree and effect on surrounding tissues, additional research is required in the form of endoscopy of the nasopharynx. This is a painless procedure, but difficult for young children because you need to sit and do not twist (an endoscope is a metal tube with a diameter of 2.3 mm with a lens system, not sharp, but given that it is metal, with sudden movements of the child’s head, pain may occur )

Exceptions: There are situations when hypertrophy of adenoid vegetation is detected in a child during endoscopy, but the child breathes well with his nose, there are no problems with the ears, and ARI occur 1-2-3 times a year. Observation is recommended for such children since, despite the large size during the visual examination, there are no clinical manifestations. The opposite also happens – not large adenoid vegetations press on the auditory tube and provoke congestion in the ears and secretory otitis media. Therefore, in each case, the approach to the child is individual.

How to decide to remove / not to remove / will the child outgrow it?

Outgrowing: with a change in hormonal levels during puberty, adenoid vegetations in most cases (but not 100%) tend to reverse their development. If the age of the child allows us to say that puberty is coming soon (12-13 years), in this case, you can resort to expectant tactics.

Nobody wants to be operated on. Neither parents, nor child, nor doctors. To make a decision, you must make sure that you see your child every day, you know how often he is sick, how he hears, if he asks again and again, how is the breathing at night and during the day. Only together with parents can we make the right decision whether to go for surgery or not.

Another clue might be the answer to the question «how many times a year does the child get sick and how is he/she treated?» If a child is sick 2-3 times a year and light treatment helps (homoeopathy, herbs, saline solutions` instillations in the nose, heavy drinking, vitamin C), one can still think about the operation. If a child is sick 4-5 times a year and treatment always ends with taking serious chemistry (antibiotics, non-steroidal anti-inflammatory drugs, antihistamines, hormones), you need to lean toward removal.

Preoperative preparation:

If you are recommended to perform this operation, for hospitalization in the hospital and anesthesia, you must undergo a standard set of laboratory tests. There are at least 5 of them (complete blood count, general urinalysis, blood type and Rh factor, electrocardiography, documentation from the paediatrician indicating vaccinations passed). You need to take convenient things with you to the hospital: a loose tracksuit or pyjamas underwear, shoes for replacement or slippers because it will be needed to spend the night at the hospital.

Operation Day:

Children usually go in the first half of the day, neither eating nor drinking on this day is permitted, since the operation and anaesthesia are carried out on an empty stomach. If you were allowed to spend the night at home, then at 8.40 you should be in the ward or nearby in changed shoes. A professor and anaesthetist before surgery examine all patients, including your child. When the time comes (no earlier than 10:15), the child will be taken to the operating room. And 1 injection will be made (to put a catheter in the arm), the child will no longer have any unpleasant sensations.

Immediately after surgery:

After the operation is completed, the child is not given to parents or the ward immediately. The child must fully wake up, medical personnel will be monitoring and following him. From the end of the operation until the moment the child is returned, even 1 hour can pass. Immediately after the operation, the child should not eat and drink. Water can be given in 1-1.5 hours.

Postoperative period in the clinic:

Most often, the child can be let go home in the evening, but you need to pack knowing that you might have to spend the night in the clinic.

Postoperative period at home and recommendations:

Given that there is a wounded surface in place of adenoids, the risk of bleeding can never be excluded. To minimise the risk, you need to follow all the recommendations:

• Nurofen 1 dose 2 times a day – 1-2 days
• Drink abundantly for 2 days (dried fruit compote)
• In case if tonsillotomy was performed, dissolve 0.5 tab. of pharyngosept 4 times a day
• When Bypass was performed, protect your ears from water

 

Allowed	Restricted
Take a slightly warm shower	Take bath for 7-8 days
Walk, go outside, breath air	Do sports for 8 days after the operation, run, fool around
Eat warm food	Hot food and drinks, carbonated drinks, citrus