Adenoid removal - G.Bertelli's adenoidectomy

Generality

The removal of adenoids is a surgical procedure indicated to treat diseases that hinder normal breathing or create airway obstruction .

Called in technical language adenoidectomy (or adenotomy ), this operation is particularly recommended in the presence of hypertrophic adenoids (therefore enlarged) and / or inflamed, especially when the symptoms are severe, persistent and particularly annoying or the disease does not respond to drug therapies. These indications are valid for both adults and children .

Removal of the adenoids 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.

The removal of adenoids correlates to a lower incidence and severity of throat, nose and ear infections . The treatment also allows an improvement in breathing and hearing function.

What's this

Removal of adenoids: what is it?

The removal of adenoids (or adenoidectomy) is an intervention performed for the treatment of diseases that:

Involve these lymphatic formations, resulting in excessive swelling 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 hypertrophy : at birth, the adenoids may already be enlarged.
They limit normal breathing, obstructing the upper airway;
They do not respond to drug therapies ;
They cause complications, such as:
- Obstructive nocturnal apnea syndrome ( OSAS ), a disorder characterized by snoring, oral breathing and interruptions in normal ventilation during sleep;
- Secretory otitis media ;
- Decreased hearing (hypoacusis) .

Adenoidectomy is considered especially in children. In some cases, however, even adults need to surgically remove the adenoids.

Adenoids: what they are and why they become inflamed

Also known as pharyngeal tonsils, the adenoids are small masses of lymphatic, cluster-shaped 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. The adenoids are, in fact, a first defense barrier against infections of the upper respiratory tract and promote immunization against microorganisms from outside, which penetrate through the nose and mouth. In some cases, however, the task of the adenoids can fail: after repeated bacterial or viral attacks, these structures can be chronically inflamed or hypertrophic.
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 ( adenoidectomy ).

Adenoidectomy: reduces immune defenses?

The removal of the adenoids does not reduce the immune defenses .

The function performed by the adenoids is, in fact, transitory : these lymphatic formations are present from birth and 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 recommended to remove them surgically.

Why do you run

The inflammation of the adenoids (adenoiditis) is treated initially with antibiotics, nasal decongestants and cortisone. In cases where, despite medications or other measures indicated by the doctor, chronic hypertrophy and symptoms are significantly aggravated, the removal of adenoids is taken into consideration.

Adenoids: when should they be removed?

Diseases involving adenoids can cause:

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.

Indications for Adenoid Removal

Your doctor may recommend the removal of adenoids when:

Adenoid inflammation and hypertrophy do 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).

Adenoid removal 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.

A doctor may recommend the removal of adenoids if the patient experiences recurrent or persistent infections of the ear, nose or throat that:

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.

Before the surgery

Adenoid removal: intervention planning

The mouth and throat tend to bleed more easily than other areas of the body. For this reason, during the planning of the intervention, the doctor who indicates the removal of the adenoids may require a blood test, in order to check for any coagulation dysfunctions . Hematological analyzes are also useful to demonstrate the absence of an ongoing inflammatory process .
In both adults and children, the removal of adenoids involves the administration of a general anesthetic . To prevent complications, it is important to have a preoperative assessment, during which the patient (or parents, if they were to have a child) must report if they have allergies to specific medicines and if they have well tolerated any previous anesthesia.
On the day scheduled for the removal of the adenoids, 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.
On the day of adenoidectomy, 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).

drugs

The patient must report the drugs he habitually uses (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.).
In the week before adenoidectomy, no medicine should be taken that could affect blood clotting or cause bleeding (eg drugs based on acetylsalicylic acid).
The week preceding adenoidectomy 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.
Before adenoidectomy, paracetamol and dexamethasone (cortisone drug) can be administered to prevent vomiting and pain that may occur in the post-operative period.

How it is performed

Removal of adenoids is a short-term procedure that is usually performed under general anesthesia .

Adenoidectomy is performed through the mouth or nose and involves the removal of the adenoids through currettage (scraping) or ablation with a heat transfer instrument.

In both cases, the tissue that constitutes the adenoids is separated from the one that surrounds it and removed with a special instrument.

Despite being almost complete, removal is never complete, to avoid 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 the secretions .

Adenoidectomy can be performed:

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.

To seal the operative wound, the surgeon can cauterize or apply absorbable sutures.

After the operation

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).

Post-operative care is generally very simple and involves taking some drugs 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 adenoidectomy.

As for the diet, initially, semi-liquid and cold foods can be administered (tea, broth, apple juice, mashed potatoes, yogurt, popsicles) and / or soft bread. On the other hand, acidic or spicy foods should be avoided. During the period of convalescence, then, it is important not to take very hot baths .

Complete recovery from an adenoidectomy 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: an infection could lead to complications. Finally, for at least three weeks after surgery, it is advisable to avoid swimming and not to go to crowded places, where there is smoke or other irritating environmental substances.

Post-operative complications

Adenoidectomy 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 chance that they may occur during or immediately after the removal of the adenoids:

Early bleeding (within the first six hours from the adenotomy) or late (after the fall of the escara which results from the intervention);
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.

In the first hours after surgery, a small drainage of blood from the mouth or nose may persist.

Following an adenoidectomy, some minor health problems may occur as a result of endotracheal intubation necessary for general anesthesia, such as:

Sore throat for 6-10 days;
Difficulty swallowing;
Earache;
Closed nose;
Halitosis (bad breath);
Increased body temperature (up to 38 ° C) for 3-4 days.

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 adenoidectomy can 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?

In the post-adenoidectomy 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;
Traces of blood mixed with saliva;
Sore throat severe that does not recede after the painkiller;
Fever over 38.5 ° C.

In these cases, contact your doctor immediately.