The most common cause of snoring in children is enlarged tonsils and adenoids, and the common symptoms include nasal congestion, snoring, inattentiveness, coughing, and reduced learning ability. This has a great impact on the growth and development of children. When it comes to surgery, parents are often very worried and afraid. When it comes to tonsil and adenoidectomy, parents often ask, “Is the surgery very invasive?” “Is it a minimally invasive surgery?” “Is it a plasma radiofrequency procedure?” “Can my child tolerate this surgery?” “Is it better to use laser surgery or plasma surgery?” And so on. In response to these questions from parents, I will now talk about the surgical treatment of tonsils and adenoids. This is also the reason why I am writing this article.
1. Do adenoids have to be operated?
Surgery should only be considered if medication has proven ineffective. Generally, if there is no significant improvement after two weeks of medication, or if the symptoms are not relieved by more than half after four weeks of continuous treatment, surgery is more likely to be required.
2.Does the tonsil have to be operated?
Tonsil hypertrophy, or recurrent tonsillitis, require surgery. The drugs are not effective for recurrent tonsillitis and tonsillar hypertrophy. If you don’t have surgery, it will lead to chronic rhinitis and affect nasal ventilation.
3.Can adenoid surgery solve all the problems?
The best effect of surgery is to solve the problem of transnasal breathing difficulty, that is, to solve nasal congestion, especially nasal congestion at night and snoring and apnea (breath-holding). This is followed by runny nose, cough, and then ear symptoms such as hearing loss. Surgery is only an important part of the treatment. After surgery, review and follow-up treatment will be conducted according to the doctor’s recommendation, such as the use of nasal hormones and oral antihistamine medication.
4.What problems can tonsil surgery solve?
Like adenoidectomy, removal of tonsils can lift the obstruction of the upper airway and make snoring significantly relieved or disappear. In addition, if there are recurrent attacks of tonsillitis in the past, the surgery will stop the attacks.
5. Do both adenoids and tonsils have to be removed at the same time? Is it possible to leave one of them?
Generally speaking, if the reason for surgery is snoring in a child over four years old, it is best to remove all three (one adenoids and two tonsils) so that the tonsils or adenoids left behind will not grow again (compensatory hyperplasia) and require a second surgery.
6.Wouldn’t the immunity be affected if all the above three things are cut out?
Removal of tonsils and adenoids in children over 4 years old will not affect immunity. This is a reliable conclusion from research, so there is no need to doubt. It has been confirmed by numerous clinical studies. We have also done many children from 2 to 4 years old and have not found much effect on the children in the post-operative follow-up.
7.It is said that tonsillectomy can lead to pharyngitis, is that true?
In traditional surgery, the patient is under local anesthesia, which is painful and uncooperative, and the bleeding is difficult to control. The surgeon performs the surgery under very difficult conditions, and sometimes a mucus-secreting gland at the lower pole of the tonsil is accidentally cut off as well. The method we currently use can avoid these shortcomings (general anesthesia, good exposure and vision, easy to control bleeding, and no accidental cutting of mucus glands), and the removal of adenoids is done under a 70 degree nasal endoscope.
8.How dangerous is the surgery?
For adenoid surgery and tonsil surgery itself, the biggest risk is bleeding, which occurs at a very low rate of less than 1%. However, because of the general anesthesia, the risk of anesthesia is much higher than the surgery itself, especially for children under three years old. In fact, the younger the child is, the lower the complications and the faster the recovery after surgery, while the older the child is, the heavier the post-operative reaction and the slower the recovery.
9.I heard that general anesthesia can affect the child’s intelligence, is there such a thing?
No, there is no such thing. The effect of anesthesia drugs on children is limited to the period of anesthesia and 24 hours after the end of anesthesia, after that there is no longer any effect on the body, let alone on intelligence.
10.How painful is the surgery?
Adenoids surgery alone is not very painful. Generally, children can move freely in the afternoon of the day of surgery and can eat semi-solid food that night and normal food the next day. Most children do not look like they have just had surgery the day after surgery. Postoperative analgesia is usually not needed. If combined with a tonsillectomy, the pain can be greater. However, recently we have been using post-operative analgesia, and at the end of the surgery, the anesthesiologist will connect your child to an analgesic pump, which releases a small amount of pain relief into your child’s body through a vein on a continuous dose basis, making it possible to be virtually pain-free for two days after surgery. You can eat semi-solid food the night of the surgery, usually for about a week. In the case of plasma surgery, it is generally recommended to eat for two weeks.
11.How long does the surgery take?
The surgery time for adenoids alone is about 20 minutes (meaning from the start of excision to the completion of hemostasis), and if combined with tonsillectomy, the time is about twice as long (30-40 minutes in total). But the child is in the operating room for much longer than that (about 150 minutes in total) because there is also pre-surgery preparation, anesthesia and post-surgery anesthesia recovery time. For the parents, it can feel like longer than a year.
12.How long does the hospital stay take?
It usually takes anywhere from 3-7 days, mainly for pre-operative checkups and waiting, and you can usually be discharged the next day after surgery.
13.How long do I have to rest after being discharged from the hospital?
Generally, you can go to school normally, and there is no special recommendation to rest at home. For children who have had tonsillectomy at the same time, if the school cannot provide semi-solid food at noon, you can consider resting at home for a few more days until you can eat solid food.
14.What should I eat after the surgery?
For adenoid surgery alone, you can eat semi-solid food that night and regular food the next day. If combined with tonsillectomy, you can eat semi-solid food on the night of surgery, and generally you have to eat for about a week, and you can basically resume normal diet after 3 weeks. In case of plasma surgery, it is generally recommended to eat for two weeks. It is important to encourage your child to eat as early as possible so that more movement of the pharyngeal muscles can make the pain go away sooner and reduce the possibility of foreign body sensation in the pharynx later. It is not necessary and not allowed to eat the so-called big tonic food, which will increase the possibility of bleeding.
15.Can I eat ice cream?
Yes, you can. Eating ice cream can reduce pain and will also reduce the chance of bleeding. But it is not necessary to eat, do not eat bad stomach.
16.Is there anything I can’t eat?
Except for the aforementioned tonic things, solid food, and overly spicy and stimulating food, all other things can be eaten.
17.Is there any food that can promote wound healing?
There is no such thing. Ordinary food is fine.
18.When do I need to review after the surgery?
One week and two weeks after discharge, if there is no special need, there is no need to review. If there is a need, the doctor will explain the time to review again (usually two months after the surgery).
19.Can laser remove tonsils and adenoids?
A: Laser is unable to remove tonsils and adenoids, but laser can assist in making a small incision when removing tonsils, and adenoids cannot be removed by laser.