In the past, a large percentage
of children have had the surgical removal of their tonsils and adenoids, early
in life. Over the years, removing the adenoids in young children has come under
severe scrutiny and the merit of such surgery has become more and more
questionable.
Medical opinions tend to change
over time and previous medical-surgical trends give way to current
medical-surgical theory and practice. Nowadays, there are very few young children who are having their tonsils and adenoids removed. Why is this so? What has
happened, historically? In order to understand this transition of thought more
fully, consider the anatomy and physiology of adenoids.
What are adenoids?
"Adenoids (or pharyngeal
tonsils, or nasopharyngeal tonsils) are a mass of lymphoid tissue situated at
the very back of the nose, in the roof of the nasopharynx, where the nose
blends with the mouth. Normally, in children, they make a soft mound in the
roof and posterior wall of the nasopharynx, just above and behind the
uvula." (1)
What is an adenoidectomy?
"Adenoidectomy is the
surgical removal of the adenoids". (2)
Why is it that children have
routinely had their adenoids removed surgically so frequently, in the past?
"Adenoidectomy has been
advocated for the treatment of middle ear effusion as an isolated procedure or
in combination with tonsillectomy, or with myringotomy and insertion of
tympanostomy tubes. This procedure is most often chosen when nasal obstruction,
nasal discharge, snoring, and mouth breathing are present." (3)
For many generations,
adenoidectomy for almost all children seemed to be the preferred method of
treatment for numerous childhood problems, including the prevention of
infection.
"Maw (1983) noted that,
historically, adenoidectomy has been recommended when the eustachian tubes are
occluded by hypertrophic adenoidal tissue, compromising middle ear ventilation
or when the adenoids appeared to be a focus of ascending eustachian tube
infection." (4)
Where the Eustachian tubes of
the ears were involved, adenoidectomy appeared to be effective, but then
further investigation made it apparent that for very young children,
adenoidectomy was not the best answer.
"For patients whose
adenoids obstruct the nasopharynx, adenoidectomy has the immediate benefit of
relief of mouth breathing and snoring. Gates, Avery, Cooper, et al. (1989)
reported a direct benefit to children 4 years or older, both in reducing
morbidity from otitis media with effusion and in reducing the number of
recurrences. On the basis of these results, adenoidectomy is a clinical option
for treatment of bilateral otitis media with effusion lasting 3 months or
longer in a child age 4 years or older. (5)
Is there another reason why the
medical opinion on the merit of removing adenoids from young children has
changed?
The focus of medicine in
general, has now shifted towards a direct emphasis on attempting to build up or
to strengthen the immune system of the human body, as opposed to surgical
intervention.
What are the current
recommendations for the adenoid removal in young children?
"Adenoidectomy is not
recommended for treatment of otitis media with effusion in a child age 1
through 3 years in the absence of specific adenoid pathology." (6)
This suggests that currently,
the practice of adenoidectomies in very young children is not advised. Are
there times when the surgical excision of the adenoids is justifiable?
"They may be removed for
several reasons, including impaired breathing through the nose and chronic
infections or earaches." (7)
While the benefits of removing
the adenoids still remains controversial to some extent, there is a rapidly
growing trend towards not removing adenoids in the majority of young children.
"Adenoidectomy is not
often performed on children aged 1-6, as adenoids help the body's immune
system. Adenoids become vestigial organs in adults. Adenoidectomy is not always
beneficial in the long-term as adenoids may return." (8)
Medical professionals are still
assessing the human immune system and its role with regard to the prevention of
infection. No one has all of the answers yet.
"The relationship between
enlarged adenoids and recurrent ear infections is controversial. We know that
chronic nasal blockage can contribute to increased rates of ear infections and
persistence of fluid in the middle ear area, but there are no definitive
studies to support the removal of adenoids in all children with recurrent ear
infections. Practically speaking, experts agree that in a child with recurrent
ear infections removal of enlarged and obstructing adenoids may help reduce the
number of ear infections." (9)
In conclusion, one must suggest
that while surgical intervention remains so controversial, if a parent or
guardian is considering the possible removal of the adenoids as a treatment
option for his or her young child, he or she should consult a family physician
first, who may recommend seeking a second opinion from a specialist.
It is generally wise to
consider the following factors before making a decision about the removal of
adenoids from young children.
Having an adenoidectomy could
adversely affect or compromise a young child's immune system. This could render
the child more prone to infections, rather than preventing or protecting the
child from possible infections, in the future. Adenoids, surgically removed in
young children, may grow back. An adenoidectomy for a young child can prove to
be unjustifiable surgery, during or after which he or she may suffer
unnecessary trauma. An adenoidectomy may not prove to be an effective cure or
even an appropriate treatment for very young children who have symptoms of
otitis media. There may be other potential medical-surgical dangers, including
cardiac arrest or hemorrhaging, that may occur during or after adenoid surgery.
Normally, parents will not
place their children in any danger or allow them to experience unnecessary
trauma. They love their children and seek to protect them from anything that
might endanger their lives; so do pediatric medical professionals.
The bottom line is that when
there is a question about medical treatment with regard to the removal of the
adenoids of a young child, it is generally advisable to rule out all other
possible treatment options first, before considering the possibility of
surgical intervention
4. Ibid.
5. Ibid.
6. Ibid.
7. Op. cit., Adenoidectomy
8. Ibid.
9.
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