Called in technical language adenoidectomy (or adenotomy), this operation is particularly recommended in the presence of hypertrophic (therefore enlarged) and / or inflamed adenoids, especially when the symptoms are severe, persistent and particularly annoying or the disease does not respond to drug therapies. These guidelines apply to both adults and children.
Removal of adenoids is done through the mouth or nose, by currettage (scraping) or ablation. To seal the operative wound, the surgeon can cauterize or apply resorbable sutures.
Removal of adenoids correlates with a lower incidence and severity of throat, nose and ear infections. The treatment also improves breathing and hearing function.
, the adenoids can remain excessive in size;- Obstructive Sleep 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 mainly considered in children. In some cases, however, even adults need to surgically remove the adenoids.
Adenoids: what they are and why they inflame
- Also known as pharyngeal tonsils, adenoids are small, cluster-shaped masses of lymphatic tissue located on the posterior wall of the nasopharynx (part of the throat that communicates with the nasal passages).
- Together with the palatine tonsils, these formations contribute to carrying out an immune protective function, especially important during childhood. The adenoids constitute, in fact, a first defense barrier against upper respiratory tract infections and favor immunization against microorganisms. coming from outside, which penetrate through the nose and mouth. In some cases, however, the task of the adenoids may fail: after repeated bacterial or viral attacks, these structures can be chronically inflamed or hypertrophic.
- The excessive increase in volume of the adenoids (adenoid hypertrophy) and their inflammation (adenoiditis) are common pathological conditions in children. their removal (adenoidectomy).
Adenoidectomy: does it reduce the immune system?
Removing 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 forms in the top and back of the nasopharynx, just above and behind the uvula. At the age of about 7, the adenoids undergo an involutionary process, reducing their size due to a physiological atrophy, which makes them barely visible during adolescence. In adulthood, the adenoid tissue becomes virtually inactive.
Therefore, adenoids are not essential for the functions of the immune system, since the organism has more effective means of fighting bacteria and viruses. For this reason, if the adenoids grow excessively and cause significant breathing difficulties, it is recommended to remove them surgically.
and cortisone. In cases in which, despite the drugs or other measures indicated by the doctor, the hypertrophy becomes chronic and the symptoms worsen significantly, the removal of the adenoids is considered.
Adenoids: when should they be removed?
Pathologies involving the adenoids can cause:
- Respiratory obstruction: adenoids can increase their size in response to infectious processes, allergic reactions or various other pathological phenomena. The resulting enlargement causes a significant bulk in the cavity in which they develop, such as to occlude the back of the nose and throat. Therefore, the 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, the adenoids are more likely to encounter bacterial or viral infections. Inflammation of the adenoids (adenoiditis) can cause other health problems, such as sinusitis and serious breathing problems, especially during the night's rest.
Indications for Removal of Adenoids
Your doctor may recommend the removal of adenoids when:
- Inflammation and hypertrophy of the adenoids do not respond to drug therapies;
- Episodes of adenoiditis are repeated five or more times a year, prevent daily activities (school and work) and have persisted for at least a year;
- The patient has persistent nasal obstruction or obstructive sleep apnea syndrome (OSAS);
- Inflammations of the airways are recurrent (ie they occur several times during the year), as are their complications (in particular, more than four episodes per year of otitis media and nasopharyngitis occur).
Removal of adenoids is also appropriate when:
- There is a noticeable decrease in hearing (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 removal of the adenoids if the patient has recurrent or persistent ear, nose or throat infections that:
- They don't respond to antibiotic treatments;
- They recur more than five times a year;
- They occur three times or more over a two-year period.
Medicines
- The patient must report the drugs he usually uses (eg analgesics, anti-inflammatories, painkillers, hypotensive, cardiological, anticoagulants, etc.). This information is collected in the medical record and is then shared by the team that will be present in the operating room (surgeon, anesthetist, etc.).
- In the week preceding the adenoidectomy, no medicine that could affect blood clotting or cause bleeding (eg acetylsalicylic acid drugs) should be taken.
- The week before the adenoidectomy and in the days immediately following, antibiotics can be administered, which are useful for preventing certain ailments (such as fever), reducing recovery times and promoting 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 postoperative course.
Adenoidectomy can be performed:
- Through the mouth: this 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 tool, 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 using specific forceps.
To seal the operative wound, the surgeon may cauterize or apply resorbable sutures.
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 adenoidectomy.As for the diet, initially, semi-liquid and cold foods can be given (tea, broth, apple juice, mashed potatoes, yogurt, popsicles) and / or soft bread. Instead, acidic or spicy foods should be avoided. During the period of convalescence, it is important not to take very hot baths.
Full 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 do not go to crowded places, where there is smoke or other irritating environmental substances.
resulting from the intervention);In the first few hours after surgery, a small drain of blood from the mouth or nose may persist.
Following an adenoidectomy, some minor health problems may appear as a consequence of the endotracheal intubation required for general anesthesia, such as:
- Sore throat for 6-10 days;
- Difficulty swallowing
- Earache;
- Stuffy nose
- Halitosis (bad breath);
- Increase in body temperature (up to 38 ° C) for 3-4 days.
Most of these symptoms subside spontaneously, within one or two weeks (attention: post-operative disorders should not last more than four weeks, otherwise it is necessary to consult your doctor promptly).
The 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 palatine veil; in some cases, a 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;
- Severe sore throat that does not go away after the painkiller;
- Appearance of fever over 38.5 ° C.
In these cases, you should contact your doctor immediately.
