When should adenoids in children be removed?

When should adenoids in children be removed?
Fonte: shutterstock

What are adenoids

Le adenoids they are immune organs located at the bottom of the nose, in the nasopharynx, made up of lymphatic tissue which has the task of producing antibodies to defend against respiratory infections. In pediatric age they tend to increase in size in order to better perform this immune defense task, after which they spontaneously regress towards the age of 9-10 and in fact after this age they are no longer talked about.

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When should adenoids in children be removed?

The child breathes badly and speaks with a typical nasal voice, is often with his mouth open, has abundant nasal secretions and frequent inflammation: these are the symptoms which give the adenoids or rather theadenoid hypertrophy. Symptoms that, if particularly intense, make you opt for removal surgery. Otherwise, with the passing of age, the adenoids tend to regress spontaneously and no longer cause any disturbance. But when to remove adenoids in children?

Because they can become a problem

Their maximum growth occurs around 3-6 years, when, in some children, a real one can occur adenoid hypertrophy, which can cause various problems: "The adenoid child breathes badly, has a nasal tone of the voice, is often with the mouth open, has thick secretions from the nose because the adenoids obstruct the nasal cavities, preventing the drainage of mucus" points out Gaetano Paludetti, director of the Otolaryngology Clinic of the Gemelli Polyclinic of the city. "Furthermore, at the level of the middle ear, the adenoids can sometimes compress the outlet of the Eustachian tube and cause a stagnation of phlegm, which causes secretory otitis media, the main manifestation of which is not pain (as happens in bacterial otitis), but the hearing loss, due precisely to the accumulation of mucus ".

How to diagnose adenoid hypertrophy

Being such small patients, it is not easy to visualize the adenoids and therefore make a certain diagnosis, since it would be necessary to use a tongue depressor and look at the adenoids with a mirror facing up, or pass a flexible endoscope through the nostrils: all difficult maneuvers to perform under 4-5 years.

"That's why most of the time we do one presumptive diagnosis of adenoid hypertrophy only on the basis of the symptoms reported"observes the otorine." It is also recognized that difficult nasal breathing could also be caused by an allergic rhinitis, which causes swelling of the nasal mucous membranes and turbinates and which can be associated with an inflammatory reaction of the adenoids which, being one of the first lymphatic stations that the air meets, it is also the first organ to develop the allergic manifestation. For this, in case of doubt, it will be necessary to thoroughly analyze the clinical symptoms and confirm the suspicions with a nasal endoscopy before deciding for the intervention. "

When to remove the adenoids

L'adenoidectomy surgery it is taken into consideration when the disturbances are important and annoying: breathing is difficult, both during the day and at night, so much so as to force the child to breathe with his mouth open, secretions are particularly abundant and hearing loss is found.

"Some specialists argue that breathing with the mouth can in the long run deform the facial massif, giving a more ogival palate, although not everyone agrees on this thesis since the shape of the face could also depend on hereditary characteristics" he notes. the professor. Paludetti. "On the other hand, it is true that the loss of hearing of catarrhal origin, linked in part to adenoid hypertrophy in part to a concomitant allergic disease, could, in the long run, become permanent".

Are there any useful measures to avoid surgery on the adenoids?

It can certainly help to make the child blow his nose well, take him to the sea in the summer (marine iodine and the inevitable washing with water and salt are good for this pathology), carry out therapies with mucolytics, cortisones and sometimes aerosol antibiotics; however, if the ailments are particularly intense, it is very unlikely that these remedies alone will be sufficient. In any case, each situation must be assessed on its own: if you can, wait up to 7-8 years before intervening; if, on the other hand, the symptoms are very evident, it is better not to postpone.

Read also: If the tonsils get enlarged

What is the intervention?

L'adenoidectomy it can be done in two ways:

  1. the first is the classic intervention through the mouth, which consists in passing the adenotome (a sharp blade mounted on a special handle) behind the uvula with which the posterior part of the nasopharynx is scraped;
  2. Alternatively, an endoscope can be inserted through the nose and the adenoids can be removed under endoscopic vision using specific forceps. This technique is more laborious and altogether less effective than the first.

In both cases the surgery lasts no more than 5-10 minutes, but is always done under general anesthesia, considering the age of the child. Already on the same evening of the operation, the little one is well, eats semi-solodic and cold foods and rests well; the only ailment that he could complain of in the first few hours is earache, possibly to be appeased with a little paracetamol. Post-surgical bleeding is very rare, however, as a precaution, the child remains under observation for a few hours after surgery, after which he can go home.

If the tonsils also cause problems, such as tonsillitis, it may be decided to remove both adenoids and tonsils with a single operation.

  • children and adenoids
  • adenoid operation
  • remove adenoids
  • 3-5 children years
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