Adenoidectomy- Indications, Contraindications, Techniques, and Recovery

What Are the Adenoids?

Adenoids are glands situated behind the nose, above the roof of the mouth. They resemble small tissue lumps and have a vital role in young children. Adenoid glands help the immune system and aid in defending the body against bacteria and viruses. Around the ages of five to seven, adenoids start to diminish and may disappear by the end of adolescence.

What Is Adenoidectomy?

The adenoid glands are surgically removed during an adenoidectomy or adenoid removal. Adenoids aid the body's defense against viruses and bacteria, but can occasionally swell, expand, or develop a chronic infection. Infections, allergies, or other factors may be responsible for this. Additionally, some children may be born with abnormally huge adenoids.

What Are the Indications of Adenoidectomy?

Enlarged or swollen adenoids need an adenoidectomy. The enlarged adenoids can lead to the following symptoms-

• Blockage of the airway.

• Breathing problems.

• Recurrent ear infections and chronic fluid in the ear.

• Temporary hearing loss.

• Snoring.

• Sleep apnea (breathing stoppage during sleeping).

• Chronic (long-term) nasal drainage.

• Congestion and sinus infections.

Most children who get an adenoidectomy are between the ages of one and seven. This is because the adenoids start to shrink by the age of seven, and in adults, they are regarded as vestigial organs (a remnant with no purpose).

What Are the Contraindications of Adenoidectomy?

• Although there are no definite contraindications for an adenoidectomy, palatal insufficiency must be carefully considered.

• After an adenoidectomy, people who have a known cleft palate or an undiscovered submucosal cleft palate are far more likely to experience velopharyngeal insufficiency, which can cause prolonged hypernasal speech and nasal regurgitation. A lower third of the choana-only partial adenoidectomy has been suggested for these patients.

• Significant bleeding disorders and active infections are also contraindications for adenoidectomy.

What Is the Procedure for Adenoidectomy?

The following steps are involved in the process of surgical removal of adenoids (adenoidectomy) -

• A thorough physical examination of the child is performed to check for all the signs and symptoms of infected, swollen, or inflamed adenoids.

• An ENT (ear, nose, and throat) surgeon would typically do an adenoidectomy, a simple, quick treatment, as an outpatient procedure.

• For the procedure, the child will be administered general anesthesia.

• While the child is unconscious, the surgeon will use a retractor to expand the mouth wide. The adenoids will then be removed using one of many techniques. To help stop the bleeding, the doctor could employ an electrical device.

• The child will be brought to a recovery room until the anesthetic wears off. Most children will be allowed to return home on the day of their surgery.

What Are the Various Techniques Used for Adenoidectomy?

The adenoidectomy procedure can be performed using various methods, such as laser ablation, coblation, endoscopic excision, and power-assisted (microdebrider) excision. The techniques are explained as follows:

1. Monopolar Suction Diathermy- Controlled excision of the adenoids with monopolar suction diathermy is possible in almost a bloodless environment.

2. Curettage- A specifically made curette is used to scrape the tissue pad away from the posterior wall of the nasopharynx during an adenoidectomy, which is generally done through the mouth while under general anesthesia. The nasopharynx is then packed for five minutes to stop the inevitable bleeding.

3. Plasma Ablation (Coblator)- An adenoidectomy treatment called plasma coblation involves removing tissue using radio frequency wavelengths.

4. Endoscopic Adenoidectomy with Microdebrider- The endoscopic power-assisted adenoidectomy is a safe, quick, precise, and minimal blood loss technique. Under visual guidance, it completely removes obstructive adenoids, reliably restoring nasopharyngeal patency.

5. Laser-Assisted Adenoidectomy- Doctors will use a curette to remove 90 % of the hypertrophied tissue of the adenoid before employing a fiber laser to melt the remaining 10 % from the nasopharynx roof during a laser-assisted adenoidectomy.

What Are the Complications of Adenoidectomy?

The risk of problems following adenoidectomy surgery is often modest in healthy children. However, the risks and potential adverse effects of an adenoidectomy include -

• Difficulty in swallowing.

• Fever.

• Vomiting.

• Sore throat.

• Ear ache.

• Bad breath.

• If the child bleeds from the mouth or nose after removing their adenoid, they must see a doctor immediately.

• A small percentage of patients experience adenoid regrowth; on occasion, a revision adenoidectomy is required.

How Is Recovery After Adenoidectomy?

• Stitches are not required because no incision is made during the procedure. Following surgery, the kid can experience pain or discomfort in the throat, nose, and ears for a few days.

• The doctor may prescribe painkillers or suggest over-the-counter drugs to deal with the pain. Aspirin should never be prescribed as it raises the risk of developing Reye's syndrome (Reye's syndrome is a rare condition that can seriously harm all body organs, especially the brain and liver) in children.

• Most children recover from adenoid removal within one to two weeks on average. The following actions could aid in a child's recovery-

  • Soft meals can soothe a sore throat, although drinking is more vital than eating in this situation. After a few days, the child will probably resume eating regularly.

  • Offer a lot of liquids to the child to prevent dehydration. Popsicles may be helpful if the child is not drinking enough or feeling unwell. Contact a doctor right away if any signs of dehydration are present.

  • Avoid flying for at least two weeks following surgery since air pressure varies when traveling at great altitudes.

  • Preventing the child from attending daycare or school until they can eat and drink properly, are no longer in need of pain medication, and are sleeping soundly.

• On the day of surgery, a minor fever is usual; however, if the fever is more than 102 degrees Fahrenheit or the child appears extremely ill, it is crucial to call a doctor.

• After surgery, it is normal to snore and breathe loudly for up to two weeks, but this typically stops as the swelling goes down.

Conclusion:

Removing enlarged adenoids may be the best course of action if they are causing breathing difficulties, swallowing challenges, or recurring ear infections. For the majority of kids, the procedure is secure and successful. A child who has had an adenoidectomy usually makes a full recovery and returns to a healthier lifestyle with fewer breathing and ear issues. As the child heals, they can experience temporary earaches, foul breath, a stuffy nose, and sore throats. However, the outlook is positive overall.