Adenotomy
Adenoids are lymphoid tissue located in the area where the nasal passages meet the nasopharynx. In the case when the lymphoid tissue grows and begins to block the nasopharyngeal lumen, the doctor prescribes an operation - adenotomy. At the K+31 clinic, nasal adenotomy is performed on patients of any age.
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Indications for adenotomy in children and adults
In the early stages of the pathology, the doctor prescribes conservative treatment - physical therapy and medications. Surgery is necessary if drug therapy has failed or if the patient has:
- Difficulty or complete absence of nasal breathing
- Hearing impairment
- Frequent inflammation of the adenoids
- Obstructive apnea syndrome (periodic cessation of breathing during sleep)
- Chronic drowsiness and fatigue due to tissue hypoxia
- Recurrent otitis, sinusitis
In adults, as a result of ineffective treatment of adenoiditis in childhood, relapse often occurs. If hypertrophied pharyngeal tonsils have not been completely removed, they will become inflamed over time in the presence of a provoking factor. Exacerbation of ARVI or allergies can also cause the adenoids to grow, in which case the ENT specialist prescribes surgery.
Symptoms of adenoid hypertrophy
Clinical manifestations depend on the stage of the pathological process in the lymphoid tissues. The following degrees of pathology are distinguished:
1 - Adenoids block 1/3 of the nasal passages, snoring appears at night, which intensifies during acute respiratory viral infections.
2 - Blocking of ½ of the lumen of the nasopharynx, accompanied by nasal congestion and periodic sleep apnea.
3 - The lumen of the nasopharynx is completely blocked, there is no nasal breathing. Lack of oxygen provokes constant headaches, irritability, fatigue, and decreased hearing acuity.
At stage 3, typical adenoid facial features are formed: the mouth is constantly open, a mesial bite is formed, the lower jaw is pushed forward and protrudes against the upper jaw, and the posture is bent.
Against the background of adenoiditis, secondary respiratory tract diseases develop: laryngitis, pharyngitis, otitis media, sinusitis, tracheitis, bronchitis. The pharyngeal tonsils are not able to fully perform their function of protecting against bacteria and viruses, so the infection descends lower.
Contraindications for surgery
- Bleeding disorders
- Intolerance to drugs used for adenotomy under anesthesia
- Exacerbation of acute respiratory viral infections or chronic diseases
- Diabetes
- Oncology
- Enlarged thymus gland, diagnosed anomaly of the hard or soft palate. The operation is planned after the patient’s condition has recovered and stabilized
Diagnostics before surgery
During the consultation, the otolaryngologist examines the patient's nasopharynx using a mirror. To make a diagnosis, the following diagnostic methods can be prescribed:
- Videoendoscopy. Insertion of a special probe into the nasal passages with an attachment in the form of a flexible tube equipped at the end with a light source and a video camera. Highly informative diagnostic method. Makes it possible to establish hypertrophy of lymphoid tissue and the degree of its growth, to differentiate pathology among other possible ones (polyps, tumors in the nasopharynx)
- Laboratory tests of blood and urine. To confirm the inflammatory process
- X-ray, CT or MRI. Necessary for assessing the condition of the nasal sinuses and bone structures
After making a diagnosis, the doctor selects a method for removing the adenoids. The cost of adenotomy and the duration of the rehabilitation period depend on this. The method is selected individually in each specific case, taking into account many indicators.
There are several ways to carry out the operation:
- Classic. The doctor removes the adenoids through the mouth using a surgical instrument shaped like a rod with a loop at the end. The process is controlled using an ENT mirror. Now the method is outdated and practically not used due to the risk of incomplete removal of the changed tissue and heavy bleeding
- Radio wave. Hypertrophied tissue is excised using a radio wave knife, which replaces a scalpel. In addition to radio frequency waves, a cold plasma flow can be used
- Laser adenotomy. Using a laser beam, the doctor acts on the hypertrophied tissue and carefully removes it layer by layer. As a result of heating, atypical cells are evaporated, and at the same time the blood vessels are sealed. This prevents the risk of bleeding and infection. Large fragments of formations are cut off and removed mechanically (manually)
- Shaver adenotomy. To remove pathological tissue, a special ENT instrument (shaver) with a thin cutting attachment in the form of a tube with a diameter of up to 3 mm is used. The method allows you to excise lymphoid tissue with its simultaneous evacuation through the apparatus tube
Among modern surgical methods for removing adenoids, endoscopic adenotomy is distinguished. The operation is performed using a laser or shaver under the control of an endoscope and transmitting an image of the working area to the screen. This significantly improves the quality of the procedure and allows only hypertrophied tissue to be excised with pinpoint precision, without affecting healthy tissue. As a result, the formation is completely removed, eliminating the risk of relapse.
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Why do adenoids grow?
Normally, in all parts of the pharynx (naso-, oropharynx and laryngopharynx) there are accumulations of lymphoid tissue, identical in their structural and functional significance. There are a pair of palatine tonsils in the pharynx, tubal tonsils in the area of the auditory tube, and lingual tonsils at the root of the tongue. Paired formations in the nasopharynx are called pharyngeal tonsils or adenoids.
With frequent inflammatory processes, the tissue increases in size and blocks nasal breathing. Nasal congestion and secondary diseases of the upper respiratory tract occur. The pathology is more common in children and adolescents.
The main reasons provoking hypertrophy of the pharyngeal tonsils:
Irritants cause swelling of the adenoids. Chronic inflammatory processes provoke hypertrophy. The cells of the lymphoid tissue begin to divide chaotically, the adenoids increase in size, and adenoiditis occurs.