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WHY WOULD ADENOIDS BE REMOVED BUT NOT THE TONSILS? DOES MY CHILD STAY OVERNIGHT
AFTER ADENOIDECTOMY? WILL MY CHILD'S VOICE CHANGE
AFTER ADENOIDECTOMY? The
surgical removal of the adenoids is called an adenoidectomy. An
adenoidectomy MAY BE associated with the surgical removal of the tonsils
(tonsillectomy) or can be performed alone. WHY WOULD ADENOIDS BE
REMOVED BUT NOT THE TONSILS? Because
the adenoids are located behind the nose in an area called the nasopharynx;
an adenoidectomy is often performed due to problems in the ears, nose and
sinuses. The indications for an adenoidectomy can be divided into two
categories: chronic infections and enlargement. A chronic adenoid
infection, called adenoiditis, can often be a subtle disease. Many
of these children have been repeatedly treated for other problems before
the adenoids were suspected. The adenoids are located next to the
Eustachian tube, which provides a drainage site for middle ear fluid.
Therefore, chronic adenoiditis may lead to recurrent ear infections due to
the spread of infection up the Eustachian tube. The infection may also
spread forward into the nose giving your child symptoms of chronic sinus
infections. The
other indication for an adenoidectomy is for adenoid enlargement. There
may be no history of any infections. These children become mouthbreathers
with snoring and nasal sounding voices as if they had a constant cold.
Often there is associated enlargement of the tonsils. This airway
obstruction can lead to changes in the growth of the facial bones and
teeth and can lead to obstructive sleep apnea, which is described in
detail in the "FAQ’s" section of this site. DOES MY CHILD STAY
OVERNIGHT AFTER ADENOIDECTOMY? A
routine adenoidectomy is performed as an outpatient surgery. In an
adenoidectomy is combined with a tonsillectomy on a patient with sleep
apnea, overnight monitoring in the hospital, possibly in the intensive
care unit, is recommended. The adenoidectomy takes approximately 30
minutes to perform and is done while your child is asleep under general
anesthesia. A special instrument holds open your child's mouth to clearly
see the back of the throat. The entire procedure is performed through the
mouth. There are no scars on the face or neck. The
technique for the adenoidectomy is as follows: 1.
General anesthesia is administered 2. An instrument is used which
opens the mouth and holds the tongue out of the way. 3.
A flexible catheter is placed through the nose into the mouth behind the
soft palate. The end of the catheter in the mouth is brought out to clamp
to the other end of the catheter under the nose. This allows exposure of
the adenoid area but allows the surgeon to use both hands to operate. A
headlight and mirror are used to identify the adenoids, and the coblator
is placed onto the adenoids, which are then removed while looking directly
at them. After
the adenoids are removed, the bleeding blood vessels are controlled with
the coblator or electrical cautery. The expected recovery time is 1-2
days. Your child may experience mild throat and neck discomfort, which
usually responds to Tylenol. Narcotic pain medication is not usually
needed. Your
child's diet may be advanced from clear liquids to solid food as
tolerated. Although your child will feel back to himself in 2 days, it is
strongly advised to limit strenuous activity (such as gym class, ballet,
T-ball, cheerleading and karate) for at least one week after surgery to
give the surgical area time for healing.
WILL MY CHILD'S VOICE
CHANGE AFTER ADENOIDECTOMY? The
major risks due to the adenoid surgery include neck pain, ear infection,
swelling which temporarily worsens nasal blockage, excessive scarring in
the back of the throat, and voice changes. There are two types of voice
changes possible. The most common one is a change in the quality of the
voice. You may notice that your child has a higher pitched voice. This is
mostly due to the sounds now being able to fill up a larger area of space. The
other voice change is much less common but is more troublesome. This voice
change is called velopharyngeal incompetence. When the adenoids are
removed, the palate may not be able to close off the area in the back of
the nose. This results in a constant connection between the nose and mouth
with excessive air leaving through the nose during speech.
These children may also have problems with liquids and food this
problem is usually temporary and resolves within weeks to months after
surgery as the soft palate muscle becomes stronger. If the velopharyngeal incompetence has not resolved three months after surgery, a speech therapy consultation may be recommended to help train your child's soft palate muscles to close the air space. If the problem has not resolved within 6-12 months after surgery and despite speech therapy, a surgical procedure may be required to partially close of the air space which the soft palate cannot reach. The information provided on
this web site is not intended to take the place of consultation with your
physician. You should always consult a physician whenever you require
diagnosis or treatment. |
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Copyright © 2008 Atlanta Children's ENT. | |
