Treatment of adenoids in children. What recommendations does Dr. Komarovsky give about the treatment of adenoids in children Adenoids in children Komarovsky

Adenoiditis is a disease that is characterized by inflammation of the pharyngeal tonsils of a chronic or acute type.

Since anatomically, the tonsils are located in the pharynx, they are practically invisible during a normal throat examination, so the inflammatory process can go unnoticed for a long time.

According to Komarovsky, in 80% of cases, adenoiditis occurs in children, since in adulthood the pharyngeal tonsils atrophy and no inflammatory processes occur.

What are adenoids?

It is part of the lymphoid pharyngeal ring, which protects the mucous membranes of the pharynx and larynx from viruses, bacteria and allergens. This protective circle consists of several tonsils:

unpaired nasopharyngeal, located in the posterior-superior region of the pharynx;
unpaired lingual in the mucous membrane of the root of the tongue;
paired palatine behind the corresponding arches in the depths of the mouth;
steam tube near the openings of the auditory tubes.

Immune cells are concentrated in the tonsils, which are the first to stand in the way of pathogens.

The nasopharyngeal tonsil is a lymphoid tissue with which the stream of inhaled air comes into contact. Lymphocytes produced by this organ prevent pathogens and foreign substances that enter the nasopharynx from penetrating deep into the respiratory system. If attacks of pathogens and allergens are repeated one after another, then the person will get sick more often, and the nasopharyngeal tonsil will grow. In this form, it is called adenoids, and its acute or chronic inflammation is called adenoiditis.

Figure 1. A reminder on the symptoms of inflammation of the adenoids in a child.
Source: medportal.ru Important! Acute adenoiditis (inflammation of the tonsil) quite often accompanies sore throats and colds.
Adenoids are removed in children and adults if the overgrown lymphoid tissue significantly complicates nasal breathing, and conservative treatment does not help.

Degrees of enlargement of adenoids

Normally, the nasopharyngeal tonsil is located on the back wall of the pharynx and does not interfere with the free passage of air. As the adenoids grow, they block its movement: the larger they are, the more severe the symptoms.

There are three degrees of adenoid enlargement. Having a rough idea of their symptoms, parents can determine for themselves how to help their child.

Table 1. Degrees of enlargement of the nasopharyngeal tonsil: symptoms, possible treatment

Degree of growth	How blocked is the nasopharynx?	Symptoms	Treatment
First	By a third	Difficulty breathing through the nose at night, possible morning cough	Conservative (Medicine)
Second	Two thirds	Nasal breathing is difficult even during the day, especially during outdoor games. The child breathes through his mouth. He snores at night. Coughs not only in the morning, but also throughout the day.	If conservative therapy is ineffective, surgery is indicated
Third	Fully	Due to snoring with temporary cessation of breathing, night sleep is disturbed, the child is pale, lethargic, and hears worse (due to swelling of the tissues around the hearing organs). The constant mucous discharge from the nose is disturbing; during an exacerbation of the disease, pus is mixed with it.	Surgical

Figure 2. Stages of adenoid enlargement.
Source: CC0 Public Domain Important! Do not allow adenoids to develop to degrees II–III, otherwise deformations of the facial skeleton and malocclusion may occur due to the constant need to breathe through the mouth. Bruises appear under the eyes, increased fatigue occurs, hearing deteriorates, and a constant lack of oxygen can negatively affect the overall development of the child.

Signs after removal of the pharyngeal tonsil

What do removed adenoids look like? It all depends on the extent and volume of resection.

With complete removal, the adenoids are not visually identified.
Partial resection leads to preservation of some structures of the hypertrophied tonsil.

Based on the volume of tissue left behind, adenoids after removal may look like single nodules or small compactions (the classic form of resection involves maximum excision of pathological tissue, leaving no more than 0.3-1 cm).

Rice. 1. Adenoid growths (indicated by an arrow).

Rice. 2. Adenoid vegetations have the appearance of a cock's comb.

Consequences of long-term adenoid hypertrophy

In the absence of adequate treatment, even the first stage of adenoids can threaten the child’s body with serious consequences.

Chronic adenoiditis contributes to the development of a number of unfavorable conditions:

repeated episodes of acute otitis media - inflammation of the middle ear, which causes severe pain in it and decreased hearing until it is completely lost;
conductive hearing loss - persistent hearing impairment due to damage to the sound-conducting apparatus of the ear (auditory ossicles, eardrum);
frequent tonsillitis and other diseases of the upper respiratory tract;
development of sinusitis and other diseases of the ENT organs.

Important! Persistent difficulty in nasal breathing can lead to nervous system disorders. In such cases, an urgent operation is necessary - removal of the adenoids.

Indications for surgery

Parents usually avoid surgery out of fear, and hope that the adenoids will go away on their own with age. The doctor will not insist on surgery if conservative treatment gives a good result. However, in some situations, adenoidectomy is the only way to alleviate the child’s condition and avoid complications.

Indications for adenotomy:

The child suffers from bronchitis, tonsillitis and other respiratory viral diseases more than four times a year; Infectious processes in the ENT organs arise due to the accumulation of mucus and impaired tissue respiration. A constant focus of inflammation in adenoids easily spreads to neighboring tissues and spreads throughout the body;
The child constantly breathes through his mouth. The entry of cold air into the respiratory tract, not cleared of pathogenic microflora by the villi of the nasal mucosa, contributes to colds;
Ear problems: frequent inflammation of the middle ear and hearing impairment;
Pronounced external signs of adenoids are changes in facial features, malocclusion, etc.

Surgery to remove adenoids in children is prescribed strictly according to individual indications after a complete examination.

Preparing for removal

In the first stages of the disease, it is psychologically easier for a child to tolerate drug treatment than surgical treatment.
As already stated, the operation is performed only in cases where the adenoids have not been given any attention and the infectious process has become severely affected. Before deciding on surgical intervention, a course of drug treatment is carried out. This is perceived as preparing the body for possible consequences. Without undergoing a course of treatment, the body will have a more difficult time undergoing surgery, and there will be risks of complications and relapse. Therapy consists of two main stages:

drug treatment, which is prescribed by the attending physician;
surgical intervention.

Depending on the individual characteristics of the body, the doctor will develop a treatment program. The appropriate specialist must also choose the right type of anesthesia.

Contraindications

In addition to age restrictions, there are a number of other contraindications for adenoid removal:

malignant neoplasms of any location;
exacerbation of other chronic diseases;
infections of any etiology – influenza, chickenpox and others;
decreased blood clotting rates;
some anatomical features of the structure of blood vessels in the nasopharynx;
recently received vaccinations.

The decision on when to perform an adenoidectomy is made by the doctor, taking into account all possible risks and the likelihood of complications.

How does the operation work?

Modern medicine has many advanced minimally invasive techniques for removing adenoids, but, in any case, surgery is prescribed only after a comprehensive diagnosis and in the absence of contraindications.

The operation takes place in a hospital setting, is performed by an otorhinolaryngologist and takes about half an hour. After this, the child should remain under medical supervision for at least 24 hours if the postoperative period proceeds without complications.

Diagnostics

The first step is collecting an anamnesis and examination by an ENT doctor. After this, the necessary examinations are prescribed:

Pharyngoscopy - examination of the pharynx to assess the condition of the tonsils: paired pharyngeal and tubal (according to indications), unpaired lingual and nasopharyngeal (palatine);
Anterior rhinoscopy – examination of the nasal cavity “through the nostrils” to assess the condition of the mucous membrane. Before the examination, vasoconstrictors are dripped into the nose so that the doctor has the opportunity to examine the adenoids;
Posterior rhinoscopy – examination of the nasal cavity through the oropharynx;
Radiography. An image of the nasopharynx in a lateral projection allows you to most accurately determine the stage of development of the adenoids;
Endoscopy. One of the newest and most reliable diagnostic methods. For young children, the examination is performed under local anesthesia.

The results of a comprehensive examination allow the doctor to decide whether it is necessary to remove the adenoids and choose the appropriate method for the procedure.

Preparation

An important stage of preparation is an examination by a pediatrician. Before the operation begins, the patient must undergo laboratory examination:

a general blood test to determine the presence of foci of inflammation in the body, exclude anemia, etc.;
biochemical blood test to assess the functional state of internal organs and exclude metabolic disorders;
coagulogram to determine blood clotting ability;
blood test for infections - HIV, hepatitis C and B, and others;
swab for bacterial culture from the throat and nose;
electrocardiogram to assess the state of the cardiovascular system.

Tell the doctor if your child had a cold or sore throat in the week before surgery. If your child has a fever and cough, surgery may have to be delayed until he or she is completely well.

The child should not be given any food at least 12 hours before the operation, and even water should not be drunk less than an hour before the procedure.

What anesthesia is it under?

Surgery to remove adenoids in children is performed under general anesthesia. Such anesthesia is necessary so that the child does not feel pain and does not interfere with the doctor performing the operation.

Before starting the procedure, the patient must undergo a blood test to rule out an allergy to the anesthetic drug. To prevent an allergic reaction if the child is prone to diathesis and other forms of allergies, antihistamines can be administered.

If your child has a history of severe and/or frequent episodes of tonsillitis, the doctor may suggest removing the tonsils and adenoids at the same time.

How to treat adenoiditis in children?

Without surgery, you can get rid of grade 1–2 adenoiditis. In this case, it is necessary to follow an integrated approach, combining general treatment and local effects on vegetation. Below is an approximate treatment plan.

General treatment is as follows:

immunomodulators (Immunal, Echinacea tincture);
immunostimulants for a course of 10–15 days (FIBS, Aloe extract, Apilak);
vitamins and microelements;
antihistamines for a course of 7–14 days (Fenkarol, Suprastin, Diazolin, Pipolfen);
for acute purulent adenoiditis, antibiotics and sulfonamides are indicated.

Local treatment offers the following options:

drops with an anti-inflammatory effect for adenoiditis - Protargol, Nasonex;
nasal rinsing - used both for adenoids and for their inflammation; for rinsing, you can use solutions of sea salt, Elekasol, Miramistin, Rotokan, Furacilin;
nasal drops with a vasoconstrictor effect - reduce tissue swelling, relieve a runny nose, and facilitate the subsequent procedure of rinsing the nose; you can drip your nose with Tizin, Vibrocil, Sanorin;
introduction into the nasal cavity of drugs in the form of drops, spray or solution applied to the turunda - Bioparox, Protargol, Collargol, Albucid, Sofradex, Avamis;
inhalation through a nebulizer - Cedovix, Mentoclar.

It is worth noting that as the child ages, the adenoids can decrease in size on their own. This is due to the fact that from adolescence the overall incidence of respiratory infections decreases significantly. The nasopharyngeal tonsil ceases to be in constant contact with pathogenic microorganisms and begins to regress (decrease in size).

Operation process

Adenoidectomy in children is performed in several ways:

By radio waves. Radio wave exposure allows excision of adenoids without loss of blood quickly and painlessly;
Laser therapy. The most effective method of adenoidectomy, in which the scalpel is replaced with a laser beam;
Endoscopy. The endoscope allows the surgeon to fully control the surgical process. The technique can be combined with laser therapy and tissue excision using radio waves;
Cold plasma method. During the procedure, adenoids are destroyed and removed with cold plasma, which makes it possible to quickly and painlessly eliminate their growths.

When choosing a clinic for adenotomy, parents should pay attention to the technical equipment of the ENT office and consult with a specialist to determine the optimal tactics for the operation.

The essence of the method

The essence of laser removal of adenoids is the burning of lymphoid tissue with a beam of laser radiation. In fact, during this procedure, the tissue is not cut out, but evaporated, causing the liquid inside it to literally boil.

The second name of the procedure is laser vaporization, which is explained precisely by the specific mechanism of action on tissue.

Since the tissue is destroyed from the inside, there is no risk of bleeding or infection of the wound. As such, no wound surface is formed after removal; after the laser, a dense crust or scab remains, similar to the surface of the epidermis after a burn.

The main feature of the laser procedure is that either the entire tonsil or only part of the hypertrophied tissue can be removed. This depends on the form of the disease and the size of the nasopharyngeal tonsil.

Advantages and disadvantages

The operation is practically safe, but it is expensive

Laser adenotomy is one of the safest and most popular methods of adenoid removal. Its advantages:

minimum contraindications;
fast rehabilitation;
high accuracy;
minimal risk of bleeding;
painlessness.

Laser removal of adenoids in adults and children has minimal contraindications. The procedure can be performed under local anesthesia or general anesthesia, due to which there are no strict age restrictions. If you choose general anesthesia, removal can be performed on a child as young as 4-5 years old.

The main advantage is fast rehabilitation. If adenoid removal is practiced under local anesthesia, the patient is discharged home on the same day, that is, the operation is performed on an outpatient basis.

Among the advantages is high accuracy. In such an operation, it is possible to control the depth of laser penetration into the tissue, which guarantees complete removal of hypertrophied areas or the entire tonsil. Thus, after surgery there is virtually no risk that the adenoids will grow back.

During the procedure, the vessels are coagulated, which reduces the risk of bleeding. Blood loss during tonsillectomy is insignificant and does not have a negative impact on health.

During the operation, the patient does not feel anything. Soreness appears after the anesthesia wears off and lasts no more than two days. In total, rehabilitation takes about 10-14 days, and normalization of nasal breathing occurs as soon as postoperative swelling subsides.

In addition, after surgery there are no strict restrictions and no need to take additional medications. Laser exposure activates local immunity, so tissue restoration occurs very quickly compared to other adenotomy methods.

The method also has disadvantages. Among them:

high price;
lack of equipment in some clinics;
low risk of relapse.

The operation is performed only in large clinics, since not everywhere there is the necessary equipment. In addition, as practice shows, such a service is not offered in small cities.

Despite the fact that the depth of laser exposure is controlled during the procedure, a slight risk of relapse of the disease still remains. This is largely due to the qualifications of the doctor, who was unable to select the optimal radiation power. Also, relapse of adenoids occurs in the case of partial removal of hypertrophied tissue. This is explained by the fact that the tonsil remains in place, which means that the lymphoid tissue continues to grow even after surgery. True, relapses occur several years after surgery, so in most cases the child will most likely simply outgrow the disease.

Contraindications

The procedure is not recommended for children with heart problems.

Before removing adenoids in children with a laser, you should consult a doctor. Despite its general safety, the method has a number of contraindications:

severe bleeding disorders;
heart failure;
epilepsy;
hypertonic disease;
acute infectious processes.

In the case of a bacterial infection accompanied by fever and inflammation, surgery should be postponed. The disease should be cured, and only then the procedure should be carried out. This is also true for adenoiditis - inflammation of the adenoids. It is impossible to use a laser on an inflamed tonsil; you must first undergo a course of antibacterial and symptomatic therapy to eliminate the inflammatory process.

Postoperative period and rehabilitation

The postoperative period passes quite quickly; the patient is discharged the next day after the procedure, and rehabilitation occurs at home.

In the first few days after the operation, some unpleasant phenomena may be observed, which, with proper control, will soon go away:

nausea, dizziness and weakness after general anesthesia;
vomiting with dark clots of coagulated blood due to slight bleeding during tissue excision;
slightly elevated temperature as a reaction to surgery;
breathing problems due to natural post-operative tissue swelling.

In the first days after adenoidectomy, the child should eat mainly liquid food; he should not play outdoor games, run or visit crowded places.

The child will need rest for several days after the operation and should be excused from school for approximately 10 days. This is necessary in order to reduce the risk of infection.

Keep your child away from people with coughs and colds, and away from smoke and air pollution.

Ice cream after surgery will not bring any benefit, but there is no need to limit the child from it - cold will help reduce swelling and relieve sore throat.

Important! These symptoms usually go away on their own, but if the temperature rises above 39° and purulent discharge appears, you should immediately consult a doctor.

Teach your child to breathe not only through the mouth. This will help reduce the risk of new respiratory diseases. Talk to your doctor about what exercises are best for this.

After the intervention

The postoperative period after adenotomy of any type proceeds almost the same.
According to reviews from parents and young patients themselves, the severity of the postoperative period depends on the type of anesthesia, and not the method of removal. Sometimes children come out of anesthesia for a long time, screaming, crying. In the postoperative period, there may be vomiting (often with swallowed blood), nausea, and dizziness. If the child was operated on under general anesthesia, then after the intervention he is transferred to the intensive care unit for observation; if under local anesthesia, he is transferred directly to the department. 2-3 days after the operation, young patients are discharged home. For a favorable course of the postoperative period at home, you must follow the correct diet. Despite the fact that the adenoids were “in the nose” and not in the oral cavity, nutrition plays a big role for a speedy recovery. In the first postoperative days, you can give your child only soft, pureed food: mashed potatoes, baby cereal. After 5-7 days, you can diversify the menu with “soft” dishes: pasta, regular cereals, soufflé, omelet, and so on. During the entire postoperative period you should not give:

Hot and cold foods, although some doctors recommend giving ice cream for a cooling and pain-relieving effect.
Carbonated drinks, concentrated compotes and juices.
Solid foods: crackers, chips, cookies.
Salty and spicy dishes.

All of the listed products, except cookies and crackers, cause a rush of blood to the mucous membranes of the mouth and nasopharynx, which can cause late postoperative bleeding. Cookies, chips and crackers injure the mucous membrane of the oropharynx.

In addition to diet, in the postoperative period, the child must follow a gentle physical regimen. Visiting the swimming pool, bathhouse, sauna is prohibited; You should not sit in a bath or under a hot shower for a long time. Physical activity should be moderate - it is not necessary to force the baby to sit or lie all day, let him move in accordance with his well-being.

For proper tissue regeneration after adenotomy, no medications are usually needed. There is no need to rinse your nose or somehow try to get into the nasopharynx. The wound surface is covered with fibrin plaque, new tissue is formed under it, the plaque is gradually rejected, unnoticed by the child himself. If pain is severe, you can give your child paracetamol or ibuprofen (there are also good reviews about the drugs Panadol and Ibuclin).

Before consulting a doctor, you can only gently rinse the nasal cavity (Aquamaris, Salin, Rinolux, Delufen). It is not advisable to rinse your nose with a syringe, douche or other “violent” methods. A strong jet of liquid can damage the fibrin layer and cause bleeding.

Video: endoscopic adenotomy

Adenotomy is a necessary intervention for complicated adenoid hypertrophy. Complications of adenoid hypertrophy include: frequent otitis media, impaired hearing and nasal breathing, changes in the facial skull and bite. What type of adenotomy to choose and what anesthesia to use - the choice remains with the parents and the attending physician. Reviews from doctors about endoscopic surgery indicate the advantages of this method for “flat” adenoids or readenotomy. The early postoperative period is more difficult in children who have undergone general anesthesia; the late postoperative period proceeds the same for any type of anesthesia. Timely adenotomy is a direct path to recovery and effective prevention of complications.

What complications can there be?

In the vast majority of cases, the operation takes place without complications, but their possibility cannot be completely excluded.

Main complications after adenotomy:

allergic reaction to an anesthetic drug;
bleeding;
infection in the wound and the development of inflammatory processes.

To prevent bacterial infectious complications, the doctor may prescribe a course of antibiotics.

Also among the complications that do not require special treatment are pain in the ear, nasal congestion, limited movement of the lower jaw, changes in the timbre of the voice and bad breath.

Does the operation give results for life, or are relapses possible?

Under the influence of negative factors, in 4–5% of children after adenoidectomy, the pharyngeal tonsil grows again. Most often this is due to weak immunity and poorly performed surgery.

Due to the developmental characteristics of the child’s body, repeated intervention is usually not required. This is due to the following factors:

lymphoid tissue grows only a year after removal;
During the rehabilitation period, nasal breathing normalizes and hearing is restored;
The child grows, and the lumen of the nasopharynx increases accordingly, so the growth of the pharyngeal tonsil does not cause the same discomfort.

Repeated surgery to remove adenoids in children is extremely rare. . Preventive measures play an important role in preventing relapses of adenoids. Risk factors for the development of pathology are significantly reduced by following simple recommendations:

timely and competent treatment of acute respiratory diseases and infectious pathologies of the ENT organs;
observing precautionary measures in crowded places, avoiding close contact with sick people;
proper balanced diet, eating plenty of vegetables and fruits;
physical activity - swimming, running, sports games;
timely wet cleaning and ventilation in the children's room.

It is necessary to completely avoid self-medication and consult a doctor at the first sign of difficulty breathing. Timely medical care will allow you to cure the pathology at an early stage, without resorting to surgery.

Visual cues

Much depends on the stage of development of the process in a person. Where to look for adenoids, in the throat or nose and is it possible to find them yourself?

The pharyngeal tonsil in its normal state appears as a comb-like structure covered with small hairy papillae.

Some definitions

What do grade 1 adenoids look like?

Enlarged adenoids at the first stage do not grow to such a significant size that they can be seen with the naked eye.

When conducting an examination using mirrors, a hyperemic area of lymphoid tissue measuring 0.5-2 cm is determined. It grows unevenly.

We can talk about the first degree of adenoids when no more than a third of the vomer and choanae are closed.

Inflamed adenoids of the first degree cause almost no discomfort to the patient, which is why the diagnosis is rarely made at such an early stage.

What do grade 2 adenoids look like?

Growths of the pharyngeal tonsil of this degree are visible even without the help of special equipment. Visually, the enlarged pharyngeal tonsil looks like a structure represented by many rounded formations that were once papillae.

A diagnostic examination is carried out through both passages for a more accurate assessment of the process (adenoids are visible in both the nose and throat). The 2nd degree is characterized by the closure of half of the vomer and choanae.

What do grade 3 adenoids look like in children?

This is the most advanced stage of the disease. The pharyngeal tonsil is visible even during a cursory routine examination with a spatula.

Immediately behind the soft palate, numerous rounded formations of various sizes, pink or crimson-red in color, are identified. The choanae and vomer are completely or almost completely blocked.

In this case, making a diagnosis is not difficult.

What do adenoids look like in the nose?

Sources

Portenko G.M., Portenko E.G., Grafskaya N.A. On the issue of persistence of adenoids // Russian Rhinology. 2002. No. 2. pp. 192–193.
Karpova E. P. Possibilities of topical therapy for chronic adenoiditis in children / Abstracts of the 11th Russian National Congress “Man and Medicine”, 2004. 663 pp.
Microbiological profile of adenoid hypertrophy correlates to clinical diagnosis in children // Biomed Res Int. 2013; 2013: 629607.
https://www.nhs.uk/conditions/adenoids-and-adenoidectomy/
Karpova E. P., Tulupov D. A., Voropaeva E. A. A new look at the prevention and treatment of chronic adenoiditis in children // Bulletin of Otorhinolaryngology. 2011, 1: 66–69.

Treatment of adenoids according to Komarovsky

Treatment of adenoiditis in children is their removal. Therefore, parents who discover the initial stage of adenoiditis in their child must adhere to a number of rules that will help prevent this disease:

In the child’s room, wet cleaning should be carried out,
purchase and install a device in the baby’s bedroom that monitors the air humidity in the room,
the child should regularly, every day, spend some time outside,
When the child recovers, you need to carefully monitor the condition of the adenoids. Have they returned to the same state they were in before the illness?

Every parent should remember that there is no cure for adenoids. Inflammation can only be prevented. If this was not possible, then the only way out of this situation could be surgical intervention.

There are no magic remedies that can cure or shrink adenoids. No medicine has been invented that could prevent the enlargement of adenoids or a drug that can influence the size of the adenoids, reducing them.

Only in a single case is it possible to treat adenoiditis. This is when the cause of its occurrence is an allergic reaction. Accordingly, taking antiallergic drugs can reduce swelling of the adenoid tissue.

When someone offers to cure adenoids non-surgically, it means he wants to make money and not help the patient. It is impossible to cure adenoids.