Adenoidectomy

Adenoidectomy or the removal of adenoid tissue is a commonly performed surgery in children. Adenoids are a part of lymphoid tissue which are situated behind the nose that means in the nasopharynx. This when enlarge gives rise to nasal obstruction, sleep disordered breathing, ear problems like pain and decreased hearing.

Indications of the surgery are mainly
•Persistent fluid in the middle ear.
•Recurrent otitis media,
•Obstructive sleep apnea.
•Also in treatment of chronic rhinosinusitis with adenoid enlargement.

Diagnosis
Before going in for surgery one has to be sure about the diagnosis of the problem and for that Doctor may ask for X-ray of nasopharynx/ soft tissue neck to demonstrate the enlargement of adenoid. If the child is co-operative the better option is to do flexible nasopharyngoscopy to see the adenoid hypertrophy.
One may need to get ears checked to rule out the presence of fluid in the ear. This may be done by examining the ears and by impedance audiometry.

Pre-operative investigations
Before every surgery certain investigation need to be done to know about the bleeding and clotting tie status, about the hemoglobin and if the biochemical parameters are within normal limits or the presence of any infection to mention a few.
One should always look for bifid uvula or cleft palate (mucosal) before doing surgery as in these patients one may do partial adenoidectomy to reduce the risk of velopharyngeal insufficiency.

Surgical techniques
There are various techniques to perform adenoidectomy. It is done as a single procedure or in combination with tonsillectomy for obstructive sleep apnea and with myringotomy while dealing with persistent otitis media with effusion.
Conventional method of doing adenoidectomy is by the curettage and with the use of endoscopes more and more surgeon ae now doing endoscopic assisted surgeries.
Endoscopic microdebrider assisted adenoidectomy: Microdebrider is a powered instrument which shaves of the tissue that gets into suction bottle. This technique is associated with less complications and leads to the complete removal of the tissue.
Endoscopic coblation assisted adenoidectomy: This is recent technique where the surgery is almost blood less and with lesser complications. Surgical time is reduced and one can achieve complete removal of the adenoid tissue. Coblation basically creates a plasma with the help of radiofrequency energy in presence of saline and this plasma leads to the tissue breakdown.

Recovery
The child is generally back to normal routine in 2-3 days but there may be some soreness in throat. But it is advisable to be in home for at least a week to avoid catching any infection in early post-operative period.
If myringotomy is also done then one should avoid water going in to the ear so, swimming is not allowed till the tympanostomy tube is in the ears.
If the adenoidectomy is combined with tonsillectomy the child may require 7-10 days for recovery and starting the proper diet. One should follow the precautions and post-operative advise properly to avoid any problems.