Poliklinika Sinteza

Adenotomy – Surgery of the third tonsil

The adenoid, also known as the third tonsil (gland), is lymphatic tissue located at the back of the nose. It grows from the back wall of the nasal pharynx, behind the nasal passages and nasal cavity.

The role of the third tonsil is to protect against infections by stimulating an immune response. If they grow too much, they can reduce or completely block airflow through the nose, cause infections of the nose, throat, sinuses, and ears, and lead to many complications.

The causes of the enlargement of the third tonsil are unknown. There is evidence linking it to diet, hormonal changes, and hereditary factors. Enlarged third tonsils are mainly associated with childhood, while in adults, this lymphatic tissue rarely causes problems as it spontaneously atrophies.

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Acute adenoid infections are very common in young children, from 2 to 7 years of age. They usually pass quickly and without complications, but in certain patients, they can lead to more serious complications, especially after purulent bacterial infections.

Young children, due to the immaturity of their immune system, are particularly prone to frequent infections, leading to physiological enlargement of the adenoids. Due to the small size of the nasal pharynx in young children, this enlargement causes breathing difficulties through the nose, constant nasal congestion, nasal discharge, snoring, open mouth breathing, sleep disturbances, and cough. It can lead to delays in the child’s physical development, with a typical facial expression: open mouth, sleepy look, nasal discharge, and/or pale skin.

Enlarged tonsils and adenoids lead to dysfunction of the Eustachian tube, which connects the nose and the middle ear, reducing air pressure in the middle ear and causing fluid accumulation. This creates a favorable ground for bacterial growth and leads to ear infections (purulent or serous otitis), causing the child to hear poorly. Besides hearing impairment in children, enlarged adenoids promote bacterial growth in the nasal cavity, leading to frequent nasal and bronchial infections.

Treatment of acute nasal pharynx and adenoid infections primarily involves nasal cleaning, nasal drops and sprays, inhalations, anti-inflammatory drugs (paracetamol, pelargonium extracts), topical steroid sprays, and antibiotics if a bacterial infection is suspected. It is very beneficial to teach the child to blow their nose well as early as possible.

If frequent episodes of inflammation continue despite the mentioned therapy, or if parents notice that the child hears poorly, an otorhinolaryngological examination is necessary to determine if the third tonsil is enlarged and if surgery – adenotomy – is needed. This is extremely important to prevent ear complications with hearing impairment and speech development issues.

Preparation

The examination is performed through the nose with a thin and soft fiber endoscope, which children tolerate without major problems. If hearing loss is suspected, middle ear pressure measurement (tympanometry) and hearing testing (audiometry) for older children are required.

These tests will show the extent of hearing damage and ultimately help decide on adenotomy and possible placement of ventilation tubes in the eardrum.

After the otorhinolaryngologist indicates the procedure, the child is referred to their pediatrician who will do a complete blood count, blood clotting test, and confirm that the child can undergo general anesthesia.

Procedure

Third tonsil surgery or adenotomy is a routine procedure performed under short general anesthesia, and it is done through the child’s mouth. Usually, one procedure is sufficient; however, sometimes adenoids grow back and the surgery has to be repeated after a few years.

Rarely performed on children under 2 years old, most commonly between the ages of 3 and 7. Since enlarged adenoids tend to shrink later, surgery is rarely needed in adults. Caution is required for children with blood clotting disorders (hemophilia, deficiency of certain clotting factors), cleft palate, and muscular dystrophy.

Paracentesis and Middle Ear Drainage

During an adenoidectomy, a doctor may also perform a paracentesis (making an opening in the eardrum) or place ventilation tubes.

Enlarged adenoids often correlate with ear infections and hearing loss due to fluid accumulation behind the eardrum, thus allowing pressure equalization and improving hearing. The tubes usually stay in the ear for up to 6 months before they are removed or fall out on their own.

Recovery

After waking from anesthesia, the child is monitored for 3-4 hours and can go home the same day if there is no significant bleeding. Children generally recover quickly from the procedure, typically experiencing short-term moderate pain and discomfort They are usually absent from daycare or school for 2-3 days. After surgery, the child may temporarily develop a nasal-sounding voice, which resolves spontaneously within 2-3 weeks.

Precautions

Complications are generally very rare, with bleeding being the most common. It usually stops on its own, and rarely requires returning to the operating room. Ventilation tubes remain in the eardrum for several months until inflammation subsides and middle ear pressures normalize. They are removed under short anesthesia or fall out spontaneously.

Why Choose Sinteza for Tonsil Surgery?

There are multiple reasons for choosing tonsil surgery at Sinteza. Primarily, the experience and knowledge of Professor Gjurić and his team in making the correct surgical indication. Over the years, doctors’ opinions have varied from frequent tonsil surgeries to unnecessary restraint from performing them.

Correct surgical indication considers all possible elements and benefits for the child. The time from indicating the need for surgery to the actual procedure is very short, and we do our best to accommodate family needs. Additionally, the individual approach to the child and family, and the possibility for the parent to stay with their child the entire time, minimizes the discomfort for both the child and the parent caused by staying in a medical facility.

We pay special attention to minimizing the inevitable pain for the child. During the surgery, we use modern technology, including lasers, R – Frequency, and endoscopy, alongside the most advanced anesthesia, ensuring a quick and uncomplicated recovery. The dedication of the entire team of nurses and doctors guarantees patient satisfaction.

If your child needs a tonsillectomy, find more information by clicking on the link.

Cost of Adenoidectomy

For more information on the cost of the procedure, check the current price list of the Sinteza Polyclinic. Contact us by phone at +385 1 5005 970 or via email at info@sinteza.hr for more information. For direct appointment reservations, click on the link.

FAQ

1. What should you eat after adenoidectomy?

It is advised to give the child softer foods for a few days and to avoid overly salty and acidic foods, as they can increase discomfort and pain. A normal diet can be resumed after 7 days.

2. Bleeding after adenoidectomy – what is normal and what is not?

In the first 24 hours, traces of blood may appear, and often after a few days, when the usual layers that form during wound healing come off. If the bleeding is heavier, it is necessary to contact a doctor.

3. What are the possible complications?

Temporary complications that may also occur include elevated body temperature, bad breath, and temporary speech difficulties (nasal tone).

4. Is it allowed to perform adenoidectomy before the recommended age of 3 years?

If the symptoms are severe and pose a risk to the child’s health and development, the procedure may sometimes be performed earlier.

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Prof. dr. sc. Mislav Gjurić, dr. med.

Specijalist otorinolaringologije, subspec. plastične kirurgije glave i vrata

Saznaj više o mislav-gjuric

Juraj Lukinović, dr. med.

Specijalist otorinolaringologije, subspec. plastične kirurgije glave i vrata

Saznaj više o juraj-lukinovic

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