Adenoids in children: to remove or not to remove?
TGIF dear readers! Another week has flown by, and we are already into a NEW YEAR!
May 2022 bring us all to a safer and more peaceful world 🌎 as we hope to exit from the COVID pandemic to an endemic mode of living with the SARS COV 2 virus 🦠
This week, we are looking into a common ENT condition in children: ADENOIDS
Q: What are Adenoids?
Adenoids are a cluster of soft lymphoid tissue that sits at the very back of the nasal passage.
Like tonsils, adenoids help keep the body healthy by trapping harmful bacteria and viruses that we breathe in or swallow. This is also called "Waldeyer's Ring"part of our body's natural immune defence mechanisms. They can also process antigens of pathogens and microbes entering the nasal airway and help to stimulate antibody production to combat such infections.
Adenoids (AD-eh-noyds) do important work as infection fighters for babies and young children. But they become less and less important as a child gets older and the body develops other ways to fight germs. In kids, adenoids usually begin to shrink after about 5 years of age and often practically disappear by their teen years.
Q: Why do they cause problems?
Adenoids generally only give problems when they enlarge and cause obstruction to the airway. The adenoids can typically enlarge due to allergy, inflammation or infection (adenoiditis). In the USA, the Adenoids are sometimes termed the "sewer" of the nose, as many bacteria may infect and colonise the tissues here.
Endoscopic view of enlarged adenoids at the back of the nose (nasopharynx) showing near complete obstruction of the airway, this leads to other issues eg OSA, difficulty swallowing and a nasal voice
Such children with enlarged adenoids might:
have trouble breathing through the nose
breathe through the mouth (which can lead to dry lips and mouth)
talk as if the nostrils are pinched
have noisy breathing ("Darth Vader" breathing)
have bad breath
stop breathing for a few seconds during sleep (obstructive sleep apnea), which can lead to disturbed sleep. This in turn can cause learning, behavioural, growth, and heart problems, and sometimes even bedwetting.
have frequent or chronic (long-lasting) nose or sinus infections
have ear infections, middle ear fluid (Otitis Media with effusion), and hearing loss
Q. What should be done?
First, see your Paediatrician or Family Doctor. if they are concerned, they will then likely refer you to see us in ENT.
The ENT doctor will ask about and then check your child's ears, nose, and throat, and feel the neck along the jaw. To get a really close look, the doctor might order X-rays or look into the nasal passage with a tiny telescope (naso-endoscopy)
For a suspected infection, the doctor may prescribe different types of medicine, like pills or liquids. Nasal steroids (a liquid that is sprayed into the nose) might be prescribed to help reduce swelling in the adenoids, and nasal passages
If the problem persists, then the ENT doctor may recommend an ADENOIDECTOMY
An adenoidectomy (ad-eh-noy-DEK-teh-me) is the surgical removal of the adenoids. It's one of the most common surgical procedures done on children, along with the removal of tonsils.
If swollen adenoids bother your child and do not respond to medical treatment, a health care provider may recommend an adenoidectomy.
These days, many of us ENT specialists use atraumatic powered instruments paired with endoscopes for direct visualisation and accurate clearance of the naso-pharynx. In my practice, I prefer to use COBLATION wands.
Endoscopic view of the posterior end of the nose (nasopharynx) showing the COBLATOR EVAC plasma wand reaching and clearing the obstructing adenoids at the back of the nose (nasopharynx) clearing the airway effectively with minimal blood loss.
Coblation can also be used to perform Adenoidectomy. The device used in this procedure is the EVac Xtra, EVac T&A Plasma Wand, or the PROcise EZ Plasma Wand. Coblation Adenoidectomy offers the following advantages:
Minimal intra-operative blood loss
Precision of tissue removal
Less heat / thermal damage to surrounding tissue
Less postoperative neck pain
Less incidence of dehydration
Endoscopic view of the posterior end of the nose (nasopharynx) which shows post-Coblation reduction of the Adenoid pad 3 days post op with some typically "white" slough which is then cleaned off with irrigation. The airway is thereby opened up by > 80 percent, and good airway is re-established through the nose once again.
In conclusion, Adenoids form part of our protective defence Waldeyer's Ring of lymphoid tissue in the upper aero-digestive tract; however, if they enlarge excessively, they can obstruct the airway, and also the drainage of the Eustachian Tube orifices at the back of the nose (nasopharynx). This leads to other medical issues eg Obstructive Sleep Apnoea (OSA), Otitis Media with effusion (OM e) etc.
We now have safe & effective tools to help deal with these issues for your child.
Do consult your Family Doctor or Paediatrician if you have any concerns, and they can refer you on to see an ENT Specialist for definitive treatment.
Have a restful weekend ahead. TGIF folks!
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