Tonsil surgery - third tonsil - adenotomy

Acute inflammations of adenoids are very common in younger children, aged 2 - 7 years of life. Most often, they pass quickly and without complications, however, in certain patients, more serious complications can arise, especially after purulent bacterial inflammations. Due to the immaturity of the defense system, smaller children are especially prone to frequent infections, which leads to a physiological enlargement of the adenoids. Due to the small dimensions of the nasopharynx in young children, this enlargement causes nasal breathing problems, constant stuffy nose, nasal discharge, snoring, open mouth breathing, sleep disturbances and cough. There may be a delay in the child's physical development, along with a typical facial expression: open mouth, sleepy appearance, nasal discharge and/or pallor of the facial skin. Enlarged tonsils and adenoids lead to dysfunction of the Eustachian tube, which connects the nose and the middle ear, and to a decrease in air pressure in the middle ear and an effusion of fluid in it. This creates a suitable ground for the development of bacteria and causes ear inflammation (purulent inflammation or so-called serous otitis), so the child's hearing is impaired. In addition to hearing damage in children, enlarged adenoids favor the development of bacteria in the nasal cavity, and thus frequent inflammation of the nose and bronchi.

The examination is performed through the nose with a thin and soft fiberendoscope, which children tolerate without major problems. When there is suspicion of impaired hearing, it is necessary to measure the pressure in the middle ear (tympanometry) and, in older children, to record hearing (audiometry). These tests will show to what extent the hearing is damaged and ultimately definitely help in the decision about adenotomy and the possible placement of ventilation tubes in the eardrum. After the otorhinolaryngologist has set the indication for the procedure, we refer the child to his pediatrician, who will do a complete blood count, a blood clotting test and confirm that the child can undergo general anesthesia.

Surgery of the third tonsil or adenotomy is a routine procedure that is performed under a short general anesthesia, and is performed through the child's mouth. Most often, one operation is sufficient, however, sometimes the adenoids grow again, so the operation must be repeated after a few years. It is extremely rarely performed in children under 2 years of age, most often between the ages of three and seven, and since the enlarged adenoids shrink later in adults, surgery is rarely necessary. If an ear infection is also present, the operation will continue with an incision on the eardrum (paracentesis) and if thick, gelatinous contents are found in the middle ear, the surgeon will place ventilation tubes in the eardrum.

After waking up from anesthesia, the child is under medical supervision for 3-4 hours, and if there is no noticeable bleeding, a child can go to home care the same day. Children recover very quickly from the procedure. They usually experience short-term moderate pain and discomfort.

Caution is required in children with blood clotting diseases (hemophilia, lack of some clotting factors), cleft palate and muscular dystrophy.