TONNYLS AND ADENUS IN CHILDREN:
Our body has many lymph tissues for defensive purposes, especially in the parts that open to the outside. The mouth and throat are one of the most important entryways. The lymph tissues surrounding the entire throat are called Waldeyer's ring. This ring consists of palatine tonsils (tonsils) on the sides, adenoid tissue (adenoid, pharyngeal tonsil) above, tubal tonsil (Gerlach tonsil) on the upper sides, free lymphoid islands on the posterior wall of the pharynx, lateral bands on the side walls of the pharynx and tongue root tonsil (lingual tonsil) below. creates. These lymph tissues are also closely related to the nearby neck lymph nodes. For this reason, neck lymph nodes almost always swell in inflammatory diseases related to the throat.
Schematic naming of throat and lymph tissues:
The most common problems in children in daily ear, nose and throat practice are related to tonsils and adenoids. .
The lymph tissues surrounding the throat contribute to the body's defense system in many ways. However, contrary to popular belief, tonsils are not just a filter. In addition to fighting against microbes entering from outside, they have the task of identifying incoming microbes and introducing them to the general immune (defense) system (a type of intelligence). Thus, when the same microbe is encountered again, the general defense system recognizes the microbe and quickly produces protective substances (antibodies) and provides a strong defense.
In the first year of life, the baby's immune system cannot yet do its job, and defense is provided by protective substances called antibodies, which pass through breast milk. Then the child begins to create his own immune substances. Since children are generally raised in a closed and protective environment until the age of 3, tonsil problems do not occur very often. In later ages, as people go out more often and start nursery and kindergarten, they encounter many microbes, get sick more often, and their tonsil tissues begin to grow. After the age of 7-8, these problems usually decrease. Because he has met many microorganisms by this age.
Inflammatory problems related to the throat lymph nodes become more common, especially between the ages of 3-9. Frequent upper respiratory tract infections, recurrent febrile tonsillitis, inflammatory disease in the neck lymph nodes Peeing, middle ear infections, sinusitis, allergic rhinitis and related coughs, nasal congestion, mouth breathing, snoring and breathing stops during sleep (sleep apnea).
In the treatment of these disorders, medications, temporary taking of the child from the nursery home, vaccinations, and sometimes surgeries (surgery) are applied.
DOES MY CHILD HAVE ADENOL?
Of course there is. Every child has adenoids unless they are removed. The development process of the nasal tonsil is different from the lateral tonsils. While the lateral tonsils (palatine tonsils) maintain their existence throughout life, the nasal tonsils grow rapidly from the age of 1-2 until the age of 7-8, and then enter a process of shrinkage towards the age of 15-16. In other words, the sentence "your child has adenoids, they need to be removed" is not a correct way of expression. If it does not cause frequent infections, sinusitis, frequent middle ear infections, does not significantly prevent nasal breathing, and does not impair the development of facial bones and teeth, it is unnecessary to remove it. It will regress and shrink by completing its natural process.
REMOVING TONYLS AND ADENIS:
Although tonsils and adenoid tissues are an important part of the defense system, no serious immune deficiency is observed if they are removed. In other words, as is thought, microbes cannot easily pass through the throat and enter the body and lungs. Because the other lymph nodes we just mentioned continue to work. On the other hand, since these surgeries are generally performed after the age of 3-4, the body has been introduced to many microorganisms and the immune system has developed greatly during this period.
IS THE SURGERY HARMFUL?
Of course, the best surgery is the one that has not been performed. . Thus, the risks of anesthesia and surgery are avoided. However, in some cases, non-surgical methods do not work or are insufficient. In other words, if the harm of tonsils and adenoids begins to outweigh the benefits, and serious problems may arise if they are not removed, it may be necessary to decide on surgery. There are many reasons for tonsil and adenoid surgeries. In daily ENT practice, surgery is most commonly used for two reasons: frequent tonsil and adenoid infections and excessive growth of these tissues. Cause of fever 5-6 times or more, beta streptococcus microbe is frequently responsible for infections, rheumatic symptoms due to beta microbe, frequent inflammation in the ears due to frequent adenoid infections or fluid collection that does not improve, sinusitis cannot be treated, and it is not possible to eliminate infections and On the other hand, even if the child does not get sick very often, the fact that the tonsil and/or adenoid tissues are large enough to prevent eating and breathing is an absolute reason for surgery, and if necessary, it can be performed before the age of 3-4. Another problem that large adenoids can cause is the disruption of facial bone development and tooth development. For this reason, the presence of large adenoids in children with nasal obstruction should be investigated before orthodontic dental treatments. There is no known harm to these surgeries when performed for the right reason. The expected benefits are a decrease in the frequency of post-operative diseases, a decrease in secondary problems such as rheumatic diseases, ensuring the child's school attendance and social problems caused by frequent illnesses at home, and an improvement in the child's height and weight development. Of course, like every surgery, these surgeries have their own risks. These risks can be minimized with the anesthesia and surgical techniques used today. On the other hand, no doctor can promise zero percent complications. Despite all meticulous work, undesirable results may be observed. The important thing here is to have the equipment, knowledge and skills to eliminate the problems that may arise after the surgery.
Should the tonsils be removed completely or can a part of them be left?
(You can find the detailed explanation in the "surgeries" section)
TONNYLS AND ADENIS IN ADULTS:
Since the adenoid tissue generally shrinks with adolescence, adenoids that are large enough to require surgery are rarely encountered in adulthood. In an adult who complains of nasal congestion, an endoscopy should be performed to examine the nasal area after a normal nasal examination. When adenoids are seen here, tumors in the nasal area should always be suspected, and if necessary, a biopsy should be performed before surgery.
Adult or The most common tonsil disease in women is chronic and recurrent infections. Frequent tonsillitis with high fever, tonsil abscess, persistent sore throat, which is especially evident in the morning and can also be seen after consuming cold food, accompanied by weakness, fatigue, bad breath due to foul-smelling white (cheesy) accumulations called magma in the tonsils, and throat pain. Stinging and foreign body sensation are important symptoms. In addition to these, tonsils that are large enough to cause snoring and sleep apnea and suspicious tonsil enlargements due to various oncological (cancer type) diseases are tonsil problems specific to the adult age period.
HOW ARE TONYC AND ADENUS SURGERY PERFORMED?
Nowadays, tonsil and/or adenoid surgeries are performed under general anesthesia, that is, completely anesthetized.
Adenoid surgery is usually performed through the mouth and sometimes through the nose. The aim is to remove the tissue that blocks air passage from the nose to the nasal passages. Since there is no clear border separating the adenoid from the surrounding tissues, it may not always be possible to completely remove all tissue. For this reason, although rare, it is possible for adenoid enlargement to recur. This process takes about 15 – 20 minutes. There is no severe pain after the surgery, and there is no restriction on eating and drinking. Children who have surgery in the morning can usually be sent home in the evening if there is no problem. Healing is completed in 2-3 weeks. It is recommended that the child not be sent to school for about 1 week after the surgery.
Tonsil surgeries are performed in the same way for children and adults. On both sides, the tonsils are surrounded by a sheath called "capsule", which separates the tonsils from the pit in which they sit. The basic principle is to remove the tonsils completely, along with the capsule, without leaving any residue. Rarely, due to some structural features (such as arteries passing under/near the tonsils), it may not be completely removed. On the other hand, in some cases, partial removal of the tonsils is also a desired method. Especially in children who do not get sick frequently but have extremely large tonsils, removing the excess parts of the tonsils protruding into the throat is a method used to ensure that the remaining tissue continues to function. In addition to the surgical method called cold dissection, it can also be performed with the help of new devices (Thermal Welding, Coblator, etc.) that minimize bleeding without causing excessive burn damage to the tissue. Laser surgery is not preferred because it causes excessive burn damage and pain after surgery. Again, radiofrequency, one of the current techniques, can sometimes be used to reduce the size of the tonsil without removing any part of it. After the tonsil is removed, the surgery is completed by burning the areas that may bleed with a cautery device or by closing them with stitches if necessary. The surgery may take up to 20-40 minutes. Postoperative pain is more pronounced than after adenoid surgery. Since the surgery area is in the complete swallowing and food transition zone, a liquid and soft diet is recommended for 2-3 weeks, and some foods are avoided. After tonsillectomy, the patient usually stays in the hospital for one night and is sent home the next day if no problems are observed. Home rest for about a week is required.
The pain after tonsil removal is mild in the first days and lasts for 5-6 days. It increases significantly in days, then starts to decrease and ends in 10-15 days. Pain is more severe after adult surgeries, and pediatric patients generally recover more easily. Disruption of eating and drinking habits due to pain and not being able to take enough food and fluids negatively affect healing and the pain lasts longer. Therefore, nutrition after tonsillectomy is very important. A white layer resembling inflammation forms in the areas where the tonsils are removed. This layer will decrease as healing is completed and finally the wound areas will be covered with a mucosa cover similar to the one inside the cheek. Infection and bleeding may occur, although rarely, after adenoid and tonsil surgeries. Infection is treated with medication on an outpatient basis or in a hospital setting. Bleeding sometimes occurs in the form of a few drops mixed with saliva and passes spontaneously. However, rarely, persistent and excessive bleeding may occur. In this case, bleeding control should be achieved by intervention as soon as possible. The risk of bleeding after surgery is highest in the first 24 hours. However, it can occur at any stage of healing, especially on the 10th - 14th day, when the scabs on the tonsils are removed.
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