What is Adenoid?
The nasal region (nasopharynx) is the area of the upper respiratory tract that comes after the nose and is located just behind the nose. This region is in constant contact with microorganisms encountered by the airway during breathing. Just under the nasal mucosa, there are immune system (lymphoid) tissues that fight microorganisms. These lymphoid formations enlarge as a result of passive smoking, that is, the parents’ smoking near the child, allergies and especially exposure to repetitive contacts of microorganisms, that is, infections. This condition is called adenoid enlargement (adenoid hypertrophy, adenoid vegetation).
What Causes Adenoid Growth?
Since the adenoid tissue is full of immune system elements, the reasons for its growth are often the conditions that activate these cells.
The following conditions can be summarized as the causes of enlargement of the adenoid:
In the presence of all kinds of viral or bacterial infections, adenoid enlargement can be seen depending on the immune response.
Especially in cases where a common allergic reaction occurs in the nasal cavity and nasal cavity, such as allergic rhinitis, adenoid enlargement may develop.
Congenital large adenoids may occur in people with a first-degree relative with adenoid enlargement.
Exposure to chemicals:
Adenoids may enlarge as a reaction when breathing chemicals that can irritate the adenoids, such as cigarette smoke and polluted air.
Adenoid may show tumoral growth in adenoid lymphoma or nasopharyngeal (upper pharynx) cancers.
Various symptoms can be encountered in cases of adenoid enlargement:
- Continuous mouth breathing due to difficulty in breathing through the nose
- Nasal speech
- Wheezing when breathing
- Snoring during sleep
- Holding your breath for a few seconds during sleep (Sleep apnea)
It is important for the families who witness the symptoms to take a video while the child is asleep, so that the doctor can diagnose it.
What Kind Of Problems Does The Enlargement Of The Nasal Flesh Cause?
If the nasal flesh enlarges, it can cause the following problems:
Difficulty in breathing:
The overgrowth of the adenoid obstructs the airway from the nose, making it difficult to reach the trachea. Thus, children are forced to sleep with their mouths open. In addition, they have a lot of difficulty while eating and they usually have their mouths open. This reduces the quality of life in many ways.
Since the enlargement of the adenoid makes it difficult to breathe, it can cause serious discomfort in children. Frequent waking from sleep, excessive sweating and bedwetting may occur. During the daytime, there is sleepiness or hyperactivity. Apart from these, problems such as distraction, difficulty in focusing, and difficulty in the learning process may also occur. Some children may also experience sleep apnea, known as respiratory arrest, during sleep. Because the most common cause of sleep apnea in children is the adenoids and tonsils. If sleep apnea is not treated, it can cause severe diseases such as cerebral palsy, growth retardation, heart failure, as well as sudden death.
One of the problems that develop due to excessive growth of adenoid is loss of appetite.
Growth hormone secretion occurs mostly during sleep. However, due to the sleep disorders seen in children with adenoid problems, the level of growth hormone secreted also decreases. As a result, growth retardation is observed in children.
Disorders in tooth structure and jaw bones:
Nasal congestion is seen in children due to excessive growth of the adenoid. This compels children to breathe through the mouth.
If the mouth is breathed for a long time, developmental disorders such as narrowing of the upper jaw, inability to develop forward, and flattening of the middle face may occur. In the medical language, this condition is called “facies adenoides”. Defects in the tooth structure and the occurrence of caries are also among the problems that may occur due to the growth of the adenoid.
Another ailment that can occur with adenoid enlargement is chronic sinusitis. Sinusitis can be partially healed with drug treatment, but the disease may recur as a result of the slightest cold or fatigue.
Middle ear diseases:
The nasal cavity is home to the Eustachian ducts that open to the middle ear. With the enlargement of the adenoid, obstruction in the Eustachian ducts may occur. In fact, microbes in the adenoid can cause infection by reflecting on the middle ear.
How to Diagnose Adenoid?
Diagnosis is easily made by flexible endoscopic examination performed through the nose under office conditions. No special preparation is required for this procedure. It is not a painful or painful procedure.
In earlier years, the diagnosis was tried to be made by radiological imaging (by taking a film) or by finger examination. Thanks to the endoscope examination, the nature of the tissue is also observed and its differential diagnosis can be made from tumor, infection, cyst and similar lesions.
Adenoid treatment is usually done with surgery. But sometimes there are cases where drug therapy is applied. When diagnosing adenoids, at first glance, the doctor checks whether there is a structural disorder in the facial area.
Endoscopic techniques, direct radiography, CT imaging are among the techniques used. The diagnosis is made on the basis of the symptoms identified by the family and the problems experienced by the child.
At the first stage, the doctor may recommend a spray for adenoid enlargement. The spray can reduce the adenoid to a certain extent. However, in cases where it is not possible to shrink with a spray, surgery can be decided. Before the operation is performed, the frequency of tonsil infections in the patient should be investigated.
The ears should also be examined to see if there are any problems. In case of a problem, surgery should be performed after the necessary procedures are performed.
Adenoid treatment and surgery without losing time is very important for the health of the patient.
Adenoid surgery is performed under general anesthesia. The process of removing the nasal flesh is completed in three to five minutes.
The application is carried out orally. No part of the body is opened. The mouth is opened with a material called a mouth opener. The adenoid behind the uvula is removed with another material called curette. The blood may not be stopped during the operation.
With immediate and on-site intervention, this situation can easily be made normal. If necessary tests are applied to the patient before the operation, such problems can be prevented. Bleeding may also occur after surgery. However, the probability of this happening is very low.
In Which Situations Is Adenoid Surgery Decided?
It is extremely important to see the following conditions in the person when making the decision for adenoid surgery:
- Difficulty in breathing
- Frequent recurrent adenoid inflammation
- Sleep apnea
- Speech disorder
- If the child has recurrent adenoid infections and related ear infections and tonsillitis,
- If positive results were not obtained from the antibiotic treatment,
- Adenoid surgery is considered if the enlarged adenoid causes obstruction in the airways and makes breathing difficult.
Since the nasal flesh provides defense against germs and infections, it is aimed that this tissue remains “protective” during periods when children are heavily exposed to upper respiratory tract infections.
However, if this situation has started to harm the child and one of the above situations is in question, adenoid surgery can be performed at any age, provided that it is not younger than 2 years old. In children younger than 2 years old, the immune system is not yet fully mature.
It is of great importance that the adenoid, which is described as lymphoid tissue (the tissue that plays a role in the immune system), fights microorganisms taken from the mouth and nose in children at this age.
How is Adenoid Surgery Performed?
Any surgery, no matter how simple it may seem, is often frightening for children and parents. You can help your child prepare for surgery by telling them what to expect.
In adenoid surgery;
- Your child will be put to sleep with general anesthesia. This means that the surgery will be performed in an operating room and your child will be monitored by an anesthesiologist during the surgery.
- Your child will sleep for approximately 20 minutes
- The surgeon will remove the adenoid from your child’s mouth. There is no need to make an incision in the skin for adenoid surgery.
Your child will wake up in the recovery room. In case of breathing difficulties or signs of bleeding, it may be necessary to be taken back to the operating room. Generally, the total hospital stay is between 5-10 hours.
What Awaits The Patient After Surgery?
Adenoid surgery, sometimes together with tonsils, is the most common operation among pediatric ear nose and throat surgeries all over the world. The operation itself is short-lived. The average time to sleep and wake up in the operating room is about 60 minutes.
After approximately 6 hours after recovery from anesthesia, patients can usually be discharged. Patients can usually eat many things on the same day, provided they are not hot and solid.
Individuals feel pain in their throats rather than nasal passages for 2-3 days due to the endotracheal intubation tube used for anesthesia rather than the surgical wound. It would be appropriate for children not to go to school for about a week due to open wounds.