Almond and polyp surgery in children – dr

Numerous parents ask themselves the question: Does my child need an tonsil or polyp operation? We spoke to the well-known Viennese ENT specialist Dr. about the possible background of problems in the nasopharynx. Reinhard Kürsten. Dr. Kürsten, what are polyps or almonds??

Dr. Kürsten: adenoids, A popular term for adenoids or tonsil tonsils is an almond tissue that lies in the space behind the nose. The actual ones are to be distinguished from this almonds – So the tonsils that are located on both sides in the throat. Which processes take place in the room behind the nose?

Dr. Kürsten: The air inhaled through the two nostrils initially flows into the nasopharynx behind. From there, two small "tubes" branch off to the left and right towards the ears, called "tubes" or "Eustachian tubes". These ensure ventilation of the middle ear. You can feel this when you swallow or yawn and your ear opens and closes at the same time. As far as the ear is concerned, the same air pressure must exist in the middle ear as in the outside air so that the eardrum – the boundary between the middle and outer ear – can vibrate freely. If the necessary pressure equalization does not take place or is insufficient, hearing problems arise. How does this relate to polyps in children??

Dr. Kürsten: In children it is often the case that the nasal / pharynx of polyps is more or less closed and thus the ventilation of the middle ear through the tubes is prevented. This creates a negative pressure in the middle ear, as if you were driving down a mountain with the gondola. If this negative pressure persists for a long time, the lining of the mucous membrane in the middle ear begins to produce a liquid, the middle ear fills with this liquid and the children have poor hearing. A problem that has to be taken seriously, because good hearing is extremely important for language development. Which organic functions can still be affected by polyps?

Dr. Kürsten: The second problem in connection with polyps: They hinder nasal breathing, the children get bad air through the nose, have a "sniff all year round", and breathe mainly through the mouth, which is also not healthy. If the polyps become inflamed, mucus runs down the throat, which can lead to coughing. At what age are children mainly affected?

Dr. Kürsten: The problem affects children – with deviations – mostly in kindergarten age, i.e. between three and six years. This is the age at which children typically experience multiple infections a year. Subsequently, the question is often raised whether a polyp or tonsil operation makes sense. First of all for polyp removal. What do you usually advise?

Dr. Kürsten: The typical case – a child has difficulty breathing for a long time after an infection – is usually not yet a sufficient reason for an operation. You wait a few months at first, and if the problem continues, you can think of surgery. And this only if there is expect leaves the removal of the polyps that problem can eliminate. Removal of the adenoids is really indicated if the child’s speech development is at risk, i.e. if the ventilation disorder of the ears leads to the fact that there is fluid in the middle ear for a long time or if otitis media frequently occurs. Polyps can grow back – this could start the problem again. This speaks against the distance?

Dr. Kürsten: This does not speak against the removal, because even if there is a risk that a problem will arise again, I have to find a solution for the acute case. You don’t refuse the hairdresser because you already know that your hair will grow back. The use of tympanic tubes as an alternative is often considered to remedy ear problems. How do you feel about it?

Dr. Kürsten: Timpani tubes are small tubes that are used to ventilate the middle ear into the eardrum. I am very reserved here. Because when the tympanic tube is inserted, it must be strictly ensured that no water can get into the ears – almost impossible for children. Furthermore, it happens – albeit very rarely – that when the tube falls out again, the gap no longer completely closes. I therefore only recommend tympanic tubes if ear problems remain despite polyp surgery and, if necessary, suctioning off fluid through a small eardrum perforation. Now for the removal of the tonsils: In which cases is this considered?

Dr. Kürsten: Today the removal of the tonsils is performed less frequently than before, under six years only in exceptional cases. In my view, the fact that a child is often ailing is by no means a reason for having tonsils removed. Surgery is only really indicated if the child suffers from real angina several times two years in a row – the ENT society says five times – or if the size of the tonsils makes it difficult to breathe. If only the size is the problem, in most cases a so-called tonsillotomy, i.e. a reduction in the size of the tonsils, is sufficient. in principle applies to me: it is always the smallest possible intervention to be carried out.

In summary, one can say: The reasons why an operation of polyps or tonsils are absolutely necessary are a significant and long-term impairment of breathing as well as ear problems, which harbor the risk of delayed speech development. What to look out for if conservative therapy is used instead of surgery?

Dr. Kürsten: In the case of infections in the pharynx, a swab smear should be used to determine whether the disease is due to a virus or bacteria. Antibiotics only work against bacteria and should therefore not be prescribed “automatically” and possibly unnecessarily. A runny nose is always caused by viruses, and even with otitis media it is often found (under medical supervision) without antibiotics.


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Christina Cherry
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