Dr.K.O.Paulose FRCS DLO, Consultant ENT surgeon.
Adenoidal hypertrophy is a common condition in children and can cause symptoms such as mouth breathing, nasal discharge, snoring, sleep apnea, and hypo nasal speech .It can lead to sinusitis, recurrent otitis media, and otitis media with effusion with deafness.
In adults, both tonsils and adenoids shrink. However, they can remain even in adults due to repeated infections called residual adenoids
Adenoid can cause snoring and sleep apnea
Enlarged and infected adenoid swell, which can reduce the airflow through the nose. Symptoms of infected adenoids include:
• Breathing through the mouth
• Loud Snoring when asleep
• Talking with a ‘blocked nose’ sound and inability to pronounce certain consonants, including ‘m’ and ‘n’
• Mouth Breathing: Dry and sore throat because of breathing through the mouth this is often a problem in the morning after sleeping with the mouth open
• Yellow or green mucous coming from the nose.
Treatment for infected adenoids
What is done to treat infected adenoids depends on whether the child is ill or not, and what other effects the infected adenoids are causing. For example, if a child has a middle ear infection or sinusitis, and the adenoids are swollen, treatment will be aimed at reducing the pain in the ears. Antibiotics will often be used. If these treatments improve the health of the ear or the sinuses, they will usually help get rid of the infection in the adenoids as well. It is rare for ‘infected adenoids’ to be the main reason for treatment.
Adenoidectomy: Your doctor may recommend having the adenoids removed if:
• Your child has recurrent ear infections, which are interfering with language development.
• Your child is often unwell.
• Your child, or an older person, has large adenoids that are interfering with breathing, especially at night.
• Snoring and sleep apnea
Surgery to remove the adenoids is done under general anesthetic. Often, the tonsils are removed at the same time, since recurring infections tend to affect both the adenoids and tonsils. Post-operative complications may include vomiting, difficulties with swallowing, pain and bleeding.
Methods of Adenoidectomy:
Several adenoidectomy methods have been well described in the literature.
Each of these methods has its advantages and disadvantages; however, the symptoms of adenoid hypertrophy may recur or even persist after removal of the adenoid
Blind Curettage – Most adenoidectomies are done with this surgical instrument, which looks like a small garden hoe with the center of the blade cut out. The inside edge of the curette is very sharp. To see the adenoids, the surgeon guides a tiny mirror high into the throat behind the nose. He or she then positions the curette, removes the mirror, and “swipes” the adenoids from the back of the throat.
Because the surgeon cannot see the adenoids while he or she is using this method, there is a risk of damaging nearby healthy tissue.
Microdebrider Technique: This technique was developed in the early 1990s, and has several advantages over other methods. It uses a microdebrider, a powered instrument with a very small rotating tip.
The microdebrider helps your surgeon remove tissue more precisely, so procedures are generally faster, more effective, and have less bleeding. The surgeon also has a better view of the adenoids during surgery, so there’s less risk of accidentally taking too much tissue or damaging nearby tissue.
Electrocautery adenoidectomy provides the benefits of minimization of operating time and blood loss than power-assisted adenoidectomy.
Coblation adenoidectomy is a non-heat driven way to remove the adenoids. Coblation technology combines bipolar high frequency energy with a saline-based medium to remove tissue with little, if any, damage to surrounding, healthy tissue.
It is performed under general anesthetic, through the mouth with the use of a rigid endoscope or using a laryngeal mirror in the mouth. The adenoid pad is reduced with very well-controlled dissection using the radio-frequency wand. There is minimal bleeding during the adenoidectomy and none afterwards.
Coblation-based bipolar plasma devices are designed to operate at a relatively low temperature to gently dissolve and/or shrink target tissue with minimal thermal damage to surrounding healthy tissue. Coblation technology provides ablation, resection, and coagulation of soft tissue and hemostasis of blood vessels in one convenient surgical device.
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