The upper respiratory tract is in constant contact with microorganisms during breathing. There are many lymphoid formations under the mucous membrane in the nasal region called the nasopharynx, which fight the microbes coming from the nose. The nasopharynx is the chamber where the nasal passages open at the back. passive smoking; In other words, as a result of parents’ smoking, allergies, and especially exposure to repeated exposure to microorganisms (frequent upper respiratory tract infections), these lymphoid formations enlarge and form the adenoid. The adenoid reaches its maximum size around 4-7 years of age and usually does not grow after this age. As the child’s head grows with age, it remains relatively small in later life. In particular, the frequency of adenoids increases in the preschool period as the children who go to kindergarten constantly infect each other.
How does it cause problems?
Nasal meat creates problems for two main reasons:
First; when it gets too big, it mechanically closes the nasal passage and prevents the respiratory air from reaching the lungs, it can cause serious problems up to the pause of breathing during sleep, called obstructive sleep apnea.
Secondly; Regardless of its occlusive feature, when the adenoid is invaded by microbes, it prepares an environment for their growth like a garbage dump. This situation causes recurrent infections in the upper and lower respiratory tracts, since the anatomical part where the adenoid is located is a complete junction. As a result of the long duration of the problem, a typical facial expression called “adenoid face”, characterized by a long and thin facial structure, high palate, forward growth of the upper jaw, constantly open mouth, bad teeth and sunken under eyes, emerges in children.
In children after the two main reasons listed above; obstructive sleep apnea, upper respiratory tract resistance syndrome, snoring, nasal congestion and mouth breathing, swallowing and speech disorder, decreased taste and smell, fluid collection in the middle ear, otitis media, decreased hearing, abnormal facial and tooth development, growth and development problems such as retardation, urination at night, sinusitis, tonsillitis, pharyngitis, vocal cord inflammation (laryngitis), lung inflammations (bronchitis, pneumonia), pulmonary hypertension, cor pulmonale, restlessness-irritability, distraction and a decrease in academic success.
How is it diagnosed?
Diagnosis is made by the abnormal appearance of the nasal tissue or radiographic imaging as a result of nasal endoscopic examination of pediatric patients who apply to the clinic with the above-mentioned problems. In the past, the presence of adenoid was investigated by performing a maneuver called finger-touch. Finger examination is a traumatic and painful procedure for the child and should not be performed. As is known, radiographic imaging has a radiation disadvantage for the child. For this reason, we do not have a film taken as long as the child adapts to the endoscopic examination. The advantage of looking with endoscope is that it allows observing the quality of the tissue and making the differential diagnosis from tumors, cysts and similar lesions.
When should the surgery be done?
Surgery can be performed at any age when the correct indication is given. It is reported in the world literature that this surgery is performed from the age of six months. My youngest cases were two toddler boys aged 9 and 11 months. The largest adenoids I have seen in my professional practice were present in these patients, and I observed both of them as seriously healthy two years later. In the past, it was used as a criterion after the age of 3, since the complications of anesthesia were more feared. Today, safer surgery can be performed in children with more modern medical devices and new generation anesthesia drugs.
What are the risks of the surgery?
Although very rare, complications related to anesthesia may occur. Bleeding and nasal adhesions may occur very rarely after surgery. Since the working area is close to the mouth of the Eustachian tube connecting the middle ear cavity to the nasal cavity, if this is damaged, aeration problems may occur in the middle ear.
What awaits the patient after surgery?
Adenoid surgery is the most common surgical procedure in childhood, almost all over the world. The operation itself is 10-15 minutes and takes an average of 30-45 minutes, including the time to sleep and wake up in the operating room. After the 5-hour period after waking up from anesthesia, the patients are discharged after the child has eaten, they continue their normal lives on the day of surgery and can eat everything on the same day, provided that it is not too hot and solid. Children may feel pain in their throat rather than their nasal passages for 2 days due to the endotracheal intubation tube used during anesthesia rather than the surgical wound. Due to the nature of the operation being an open wound, it would be appropriate for children not to go to school for at least a week or ten days due to the risk of infection.
After the correct diagnosis, performing adenoid surgery in a suitable center without delay is extremely important for the healthy development of the child.
prof. Dr. Mustafa KAZKAYASI