Paediatric ENT

Adenoidectomy

The adenoids are lymph glands or filters for infection and are located at the back of the nose and level with the ears. They lie up and behind the uvula, which is the fleshy extension of the palate as seen when the mouth is open. There are over 120 lymph glands in the human head and neck.

Adenoidectomy is offered to children with the following problems:

• Children with chronic nasal obstruction and nasal discharge, which has caused chronic sinusitis. Failure to remove the adenoids in this situation can lead to permanent changes in growth in areas such as the high arched palate. This in turn causes crowding of the dentition in the upper jaw which will necessitate orthodontics at a later stage.
• Children with chronic disease of the Eustachian tubes. These are the tubes that connect the nose and the middle ear. Most children who experience problems in their Eustachian tubes will recover with medical treatment or perhaps surgery to insert one set of grommets. However, children with chronic Eustachian tube disease who require a second set of grommets are often advised to have an adenoidectomy This removes the infected adenoidal lymph node at the back of the nose.

Adenoidectomy may be needed in adults if there is a suspicion of cancer of the nasopharynx. These types of cancers are more common in south East Asia.

The Surgery

The surgical procedure takes approximately 25 minutes. The surgery is performed via the mouth. The adenoid tissue is removed either with special instrument or cautery.

The nose may ooze a little blood stained mucous for a few hours but patients are normally discharged after an observation period of 4 hours. Patients are advised to rest for at least 2 days.

Post operative Care

It is essential that no Nurofen or Aspirin medication is taken for two weeks before or after surgery as these medicines will promote bleeding. Any surgery carries risks. The risk of bleeding is rare in most cases. Dr Shahidi will discuss with you prior to the operation the risks of surgery.

Glue Ear

After each episode of ear infection fluid accumulates in the middle ear. In 90% of children this fluid will clear within two to three months. If the fluid persists it is known as “glue ear”, the name reflects the thick and sticky nature of the fluid. This condition occurs if the Eustachian tubes (tubes that connect the nose to the ear) do not function properly, particularly in small children. The Eustachian tubes are designed to drain and aerate the middle ear through the nose. The peak incidence of glue ear is between the ages of three and six years old though it can occur as early as the first year of life.

Why is Glue Ear harmful?

The presence of fluid can cause problems such as a 10-40 decibel loss of hearing leading to poor speech development, inattention and inappropriate behaviour, imbalance in toddlers and poor progress at school. The thick sticky fluid has been shown in many cases to contain germs and predisposes the child to recurring attacks of middle ear infection and pain.

Grommets

To bypass the problems of the poorly functioning Eustachian tube, a grommet (tiny tube) is placed in the eardrum after the thick gluey fluid has been removed. Most parents notice an immediate improvement in their children.

Using a microscope, the procedure takes approximately ten minutes though it may take ten to fifteen minutes for your child to go to sleep and to wake up as this procedure is done under general anaesthesia. Your child will only be in hospital for a few hours but must fast for six hours prior to the anaesthesia.

The grommets are expected to last for 8 months. If there is infection it may be extruded earlier. Occasionally the grommet is retained more than expected and will require a second anaesthetic for removal. Any surgery carries risks, Dr Shahidi will discuss with you prior to surgery what those may be.

Most grommets give no trouble and children are unaware of them but must be taught to keep their ears dry.