The incidence of pediatric adenoid hypertrophy is increasing year by year, and parents are now often looking for information about adenoid hypertrophy on the Internet, and they are quite familiar with the name adenoid hypertrophy. I hope to give you some help, of course, these are only my personal opinions, there will be doctors have different views, my views are only to provide you with reference.
1, children with adenoid hypertrophy or not to operate This is the most important concern of parents, generally I am based on the child’s symptoms, the course of the disease, the results of the film or nasal endoscopy, there are no other complications to decide. There are generally 3 types of nasal endoscopy or radiographs, mild, moderate and severe. Mild is generally not recommended for surgery, severe is generally recommended for early surgery, and moderate is determined by the child’s symptoms and the course of the disease and age. If the child sleeps poorly at night, has breath-holding, and has been doing so for a long time, or has been repeatedly doing so, and the nasal endoscopy or film suggests that adenoid hypertrophy is obvious, it is recommended to operate as soon as possible; however, if the child only has such a condition after the recent cold, which has not happened before, or only has snoring without obvious breath-holding, it is recommended to observe first, and immediate surgery is not recommended. Some parents say that the symptoms are obvious at night, but the test results show that the obstruction is not very heavy, so it is recommended to do a sleep monitoring before determining whether surgery is needed. If the child’s symptoms are not very obvious but are accompanied by rhinosinusitis, and there is no significant improvement after a period of medication, surgery is also recommended; if the child’s symptoms are not particularly heavy, but he or she is particularly prone to colds, and the symptoms are very heavy after each cold, surgery is also recommended. If the child has frequent episodes of otitis media and is not well treated with medication, along with hearing loss, although adenoid hypertrophy is not very heavy, surgery is also recommended as soon as possible.
2. How old a child can be operated This is also an issue of great concern to parents. Generally speaking, surgery is not recommended for children under 2 years old because it is relatively easy for children under 2 years old to relapse after surgery, but if the child’s symptoms are very severe and seriously affect the child’s sleep and growth and development, it is recommended to operate early. For us, the surgical approach and difficulty are the same, and there is no increased risk of anesthesia because of the child’s young age. In my case, the youngest age was 1 year old, and because the child could hardly sleep at night and the parents carried the child around to seek medical help, I decided to operate on the child, and the child’s sleep improved significantly after the operation. In our hospital, we have done a lot of children under 2 years old in recent years, and in my cases there have been cases of recurrence about 1 year after the operation and another operation.
This is one of the most frequently asked questions by parents. Generally, the adenoids will shrink by themselves after 6-7 years old, but it is now found that many children do not shrink and gradually increase in size, which seriously affects the children’s learning. The oldest is 17 years old. If the child’s adenoids are very large and the symptoms are very heavy, expecting that they will gradually shrink after the age of 6 and not willing to have surgery, I personally do not recommend it very much.
The child’s surgery is performed under general anesthesia. Modern anesthesia technology should be safe for such a surgery, and I personally believe that the anesthesia for children in our hospital is completely reliable. The operation is minimally invasive, with very little bleeding during the operation and very mild post-operative reactions, and there is generally little post-operative fever, bleeding or infection.
5, about tonsils Parents are also very concerned about whether the tonsils should be surgically removed or not. If the tonsils are enlarged, they can also affect breathing and lead to sleep disorders, so they need to be dealt with, especially if the tonsils are 3 degrees enlarged. Generally, if the child is 8 years old or older, or if the tonsils are frequently inflamed, it is recommended that all of them be removed. However, if the child is younger and the tonsils are not often suppurating, partial ablation of the tonsils can be performed using low-temperature plasma, mainly to improve breathing problems, but there is also a possibility that the tonsils may become hypertrophic and hyperplastic again after the operation, and the tonsils may become inflamed frequently, requiring another operation possibly, although it is not common, but we have come across such cases, which are related to the individual differences of patients. Tonsils are partially ablated using low-temperature plasma, which has the advantages of less surgical trauma, almost no bleeding during surgery, and less postoperative pain, so it is popular among parents.
6.How to make a clear diagnosis Our hospital generally uses nasal endoscopy to confirm the diagnosis. If there is already a film or nasal endoscopy in an outside hospital and it is clear and definite, further examination can be unnecessary. The operation is usually hospitalized for 4~6 days.
If adenoid hypertrophy leads to secretory otitis media, it is necessary to deal with it at the same time during surgery. Generally, if the otitis media is not very serious, the course of the disease is not very long, the intraoperative microscopic examination reveals that the liquid is not much and not sticky, and the child’s hearing is not affected, it is possible to perform tympanocentesis or tympanotomy during surgery and extract the liquid. However, if the child has hearing loss and the intraoperative examination reveals a lot of fluid or very sticky fluid, it is recommended that a tube be placed. After tube placement, generally the ears should not enter water or swim. After six months, most of the tympanic ventilation tubes will gradually fall off, if not, follow up for another six months and remove the tubes according to the situation. Most of the tympanic membrane will heal within one month after the tube is removed, but a few small perforations will remain, and after another six months of follow-up, most of them will heal, but only a few will not grow well and will remain perforated. Can otitis media recur after placement of tubes? The answer is yes, many children find hearing loss again after the tubes are placed and removed, which is mostly related to the child’s cold and rhinitis.
8.Some post-operative problems If you do adenoids surgery alone, you can eat semi-liquid 6 hours after surgery, and the next day, if the child does not have obvious sore throat, you can eat softer food and do not need to pay special attention to diet. It takes about 10 days~2 weeks to return to normal, mainly depending on the child’s recovery. The follow-up visit is usually 2 weeks after surgery. If the child is a foreigner and has adenoids surgery alone, he or she may not need to be followed up. If the tympanoplasty is performed at the same time as the otitis media, it is better to follow up every 3 months after the surgery.
After surgery, some children still snore and hold their breath at night, even more than before surgery, and parents are very worried. It is normal for such a situation to occur 1~2 weeks after surgery because there will be edema of the operative cavity, swelling of the oropharynx and swelling of the nasal cavity after surgery, etc. These conditions will slowly improve as the child gradually recovers. However, there are a few children who snore after surgery because of enlarged turbinates, rhinitis and sinusitis, or allergic rhinitis, and this is not related to the problem. But if there is no obvious breath-holding, it usually does not need special treatment, but if there is still breath-holding and oxygen deprivation, it may be more difficult to deal with these cases.