Generality
Adenotomy (or adenoidectomy ) is the surgical removal of adenoids. The intervention is practiced for the treatment of pathologies that limit normal breathing, does not respond to pharmacological therapies and / or lead to complications, such as snoring with sleep apnea, secretory otitis media and decreased hearing (hypoacusis).
The adenoids are small masses of lymphatic tissue, located on the posterior wall of the nasopharynx (part of the throat in communication with the nasal cavities). Together with the palatine tonsils, these formations contribute to play an immune protection function, important especially during childhood. In some cases, however, the task of the adenoids can fail. Excessive increase in the volume of adenoids (adenoid hypertrophy ) and their inflammation ( adenoiditis ) are frequent pathological conditions in children. If these diseases cause airway obstruction or recurrent and drug-resistant infections, an indication is given to their removal (adenotomy).
Surgical removal of adenoids is usually recommended starting at 18 months of age and is performed under general anesthesia. The adenotomy is performed through the mouth or nose, using currettage (scraping) or ablation . To seal the operative wound, the surgeon can cauterize or apply absorbable sutures.
After adenotomy, many people with recurrent episodes of adenoiditis or adenoid hypertrophy report significant improvement.
What's this
The adenotomy consists in the surgical removal of the adenoids. This intervention is considered especially when the symptoms are severe, persistent and particularly annoying or the disease does not respond to drug therapies. Adenotomy is also appropriate when adenoids hamper normal breathing or create airway obstruction. In some cases, even adults need to surgically remove the adenoids.
What are adenoids
Also known as pharyngeal tonsils, the adenoids are cluster-shaped structures, located in the posterior wall of the nasopharynx, above the plane of the soft palate.
During early infancy, these formations constitute a first barrier against infections of the upper respiratory tract and favor immunization against microorganisms from outside, which penetrate through the nose and mouth. Sometimes, however, this function fails and, after repeated bacterial or viral aggressions, the adenoids are chronically inflamed or hypertrophic.
Adenotomy: can it reduce the defenses of the immune system?
Adenotomy does not reduce immune defenses . The function performed by the adenoids is, in fact, transitory. Present from birth, these lymphatic formations develop progressively, reaching their maximum size at the age of 3-5 years. Normally, in children, a soft mound is formed in the upper and rear part of the nasopharynx, just above and behind the uvula. At the age of about 7, the adenoids undergo an involution process, reducing their size due to a physiological atrophy, which makes them barely visible during adolescence. In adulthood, adenoid tissue becomes practically inactive.
The adenoids are not, therefore, fundamental for the functions of the immune system, since the body has more effective means to fight bacteria and viruses.
For this reason, if the adenoids grow excessively and cause significant breathing difficulties, it is indicated to remove them surgically with the adenotomy.
Why do you run
The initial treatment of the inflammation of the adenoids (adenoiditis) involves the use of antibiotics, nasal decongestants and cortisone. If, despite the medications or other measures indicated by the doctor, hypertrophy becomes chronic and the symptoms worsen, the only therapeutic possibility is represented by the surgical removal of the adenoids.
Adenotomy is taken into consideration when the excessive enlargement of the adenoids gets to obstruct the upper airways or determines the syndrome of obstructive nocturnal apnea (OSAS), a disorder characterized by snoring, oral breathing and interruptions in normal ventilation during sleep. These indications are valid for both adults and children.
Adenoids: when should they be removed?
Adenoid dysfunction causes two main consequences:
- Respiratory obstruction : adenoids can increase their size in response to infectious processes, allergic reactions or various other pathological phenomena. The consequent enlargement determines a significant encumbrance in the cavity in which they develop, such as to occlude the posterior part of the nose and throat. Therefore, hypertrophy of the adenoids makes nasal breathing more difficult and can interfere with the correct outflow of mucus from the ear.
- Inflammation : by increasing in volume, adenoids are more likely to experience bacterial or viral infections. Adenoid inflammations ( adenoiditis ) can cause other health problems, such as sinusitis and serious respiratory problems, especially during the night.
Your doctor may recommend the adenotomy when:
- Adenoiditis or adenoid hypertrophy does not respond to drug therapies;
- The episodes of adenoiditis are repeated five or more times a year, prevent daily activities (school and work) and last for at least a year;
- The patient manifests a persistent nasal obstruction or a nocturnal obstructive apnea syndrome (OSAS);
- The airway inflammations are recurrent (that is, they occur several times during the year), as well as their complications (in particular, more than four episodes a year of otitis media and nasopharyngitis occur).
Adenotomy is also appropriate when:
- There is an obvious hearing loss (hypoacusis) in children over 3-4 years of age (a condition that could interfere with language development);
- Breathing through the nose is difficult;
- There is a risk of possible complications, such as dental malocclusion and numerous febrile episodes.
Adenotomy: when is it indicated by the doctor?
A doctor may recommend adenotomy if the patient develops chronic infections of the ear, nose or throat which:
- They do not respond to antibiotic treatments;
- They occur more than five times a year;
- They occur three times or more in a two-year period.
Adenotomy may be necessary if the adenoids become hypertrophic due to:
- Infection : although they can resolve, after an infectious disease, the adenoids can maintain excessive dimensions;
- Allergic reactions : allergens can irritate the adenoids and cause them to swell;
- Congenital : at birth, the adenoids may already be enlarged.
Other indications for the adenotomy include:
- Recurrent or persistent otitis media in children aged 3-4 years and older (may interfere with language development);
- Recurrent and / or chronic sinusitis.
Preparation
Pre-operative examinations
- The mouth and throat tend to bleed more easily than other areas of the body. The doctor who indicates the adenotomy may therefore require a preoperative blood test in order to check for any coagulation dysfunctions . Haematological analyzes must also demonstrate the absence of an ongoing inflammatory process .
- In both adults and children, the adenotomy involves the administration of a general anesthetic . To prevent any anesthesiological complications, a preoperative evaluation is important, during which the patient must report if he has previously developed allergic reactions to medicines and if he has well tolerated any previous anesthesia.
- On the day scheduled for the adenotomy, the patient will be visited by the anesthesiologist and by the otorhinolaryngologist, who will assess whether the health conditions are suitable for facing the operation. Furthermore, the subject must remember to bring with him / her the clinical documentation related to the adenoid pathology (previous analyzes or investigations, radiological examinations etc.).
Precautions and warnings
- Before undergoing adenotomy, it is important that the patient (or the parents, if they underwent surgery was a child) report the drugs they normally use (eg analgesics, anti-inflammatories, painkillers, hypotensive, cardiological, anticoagulants, etc.). ). This information is collected in the medical record, so it is shared by the team that will be present in the operating room (surgeon, anesthesiologist, etc.). Furthermore, no medicine that could affect blood clotting or cause bleeding (eg acetylsalicylic acid drugs) should be taken in the week preceding adenotomy.
- On the day of surgery, the patient must be fasting . This is essential to avoid the risks that can arise if anesthesia and surgery are performed in the presence of food in the stomach (as in the case of vomiting with inhalation of gastric material in the respiratory tract).
Before the adenotomy: drugs
- The week preceding adenotomy and in the days immediately following, antibiotics can be administered, useful for preventing certain disorders (such as fever), reducing recovery times and favoring the resumption of normal nutrition after surgery.
- Furthermore, before adenotomy, paracetamol and dexamethasone (cortisone drug) can be administered to prevent vomiting and pain that may occur in the post-operative course.
How to do it
Adenotomy is a short-term intervention that is usually performed under general anesthesia .
Normally, the removal of adenoids can be performed in two ways:
- Through the mouth : it is the traditional and most commonly used procedure, which consists in passing the adenotome (a sharp blade mounted on a special handle) behind the uvula. With this instrument, the surgeon scrapes the back of the nasopharynx;
- Through the nose : it is an alternative technique, which involves the insertion of an endoscope through the nose and the removal of the adenoids through specific pliers.
In practice, the tissue that constitutes the adenoids is separated from the one that surrounds it and removed with a special instrument.
How are the adenoids removed?
The adenotomy is performed through the mouth or nose and involves the removal of the adenoids through currettage (scraping) or ablation with a diathermic instrument that exploits the heat. To seal the operative wound, the surgeon can cauterize or apply absorbable sutures.
Removal, although almost complete, is never complete in order not to run the risk of causing injury to the Eustachian tube, the conduit that makes the middle ear communicate with the outside, allowing the ventilation and drainage of secretions.
Adenotomy: how long does it last?
The adenotomy is performed in about 30 minutes. The duration of hospitalization is variable, but, in most cases, the patient can go home the same day as the operation, without overnight stay (day surgery).
Complementary adenotomy procedures
- Adenotonsillectomy . If the patient is subjected to severe or frequent attacks of tonsillitis (tonsil infection), the simultaneous removal of tonsils and adenoids could be indicated.
- Trans-tympanic drainage . In the case of otitis media, the adenotomy can be completed with a tympanostomy: through a small cut in the eardrum, a small ventilation tube is placed in the ear to drain serous, mucous or purulent secretions. Trans-tympanic drainage helps to drain the fluid that accumulates in the middle ear, during the inflammatory process, and reduces infection.
Post-operative care
Post-operative care is generally very simple and involves taking some medications to reduce pain and swelling (avoiding, however, the use of aspirin or its derivatives that can promote the onset of bleeding). The patient will normally be able to start drinking fluids 2-3 hours after the adenotomy.
As for the diet, initially, semi-liquid and cold foods can be administered (eg tea, broth, apple juice, mashed potatoes, yoghurt and popsicles) and / or soft bread. On the other hand, acidic or spicy foods should be avoided. During the convalescence period, it is important not to take very hot baths.
Complications and Risks
Adenotomy is a low-risk procedure that rarely causes complications. This is a relatively common, fast and easy to do operation. However, as with all surgical procedures, there is a small risk that infections, bleeding or allergic reactions to anesthesia may occur.
Adenotomy: adverse effects and risks
During the post-operative course, it is possible that premature bleeding (within the first six hours of the adenotomy) or late (after the fall of the eschar resulting from the intervention) occurs.
Other risks that may occur during or immediately after adenotomy include:
- Small lesions of the tongue or lip, due to the instruments used to perform the surgery;
- Acute otitis or nasopharyngeal infections;
- Blood inhalation, which can be followed by a bronchopulmonary infection;
These adverse effects are not frequent, but they are still possible.
Possible post-operative complications
In the first hours after surgery, a small drainage of blood from the mouth or nose may persist.
Following an adenotomy, some minor health problems may occur as a result of the endotracheal intubation necessary for general anesthesia, such as:
- Sore throat;
- Difficulty swallowing;
- Earache;
- Closed nose;
- Halitosis (bad breath).
Most of these symptoms regress spontaneously within one or two weeks ( attention: post-operative disorders should not last more than four weeks, otherwise it is necessary to contact your doctor promptly).
Removal of very large adenoids by adenotomy may induce a change in the timbre of the voice with increased nasal resonance (rhinolalia), due to insufficiency of the palatal veil; in some cases, speech therapy rehabilitation may be necessary.
When to worry and seek medical attention?
In the post-adenotomy course, symptoms of possible complications are:
- Bleeding (abundant bright red blood from the nose or mouth) that does not resolve within a few minutes;
- Important difficulty in swallowing, which prevents the intake of liquids;
- Intense pain that does not respond to painkillers;
- Fever over 38.5 ° C.
In these cases, the doctor should be notified immediately.
Results
After adenotomy, most patients experience fewer and milder infections of the throat, nose and ear. The treatment also allows for improved breathing and auditory function by resolving the nasal obstruction.
After adenotomy, when can one return to normal activities?
Following an adenotomy, the patient will need a few days off. Complete recovery from an adenotomy usually takes 1-2 weeks.
When the patient returns to school or work, it is important that he is not exposed to people who cough or have a fever, because an infection could lead to complications. Adenotomy effectively reduces the incidence and severity of infections, but it must be considered that adenoids represent the first barrier against bacterial invasion and, if removed, germs can rapidly reach other districts.
Finally, it is advisable to avoid swimming for three weeks after surgery and not go to places where there is smoke.
