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TONSILS AND ADENOID
TONSILS AND ADENOID
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Tonsils are two lymph nodes located at the back of the mouth, being one on each side of the tongue base. Due to its location, it might cause snoring by narrowing the diameter of throat when it is enlarged and even with further enlargement it might lead to difficulty breathing during sleep. Especially in children, tonsils and adenoid are the most significant causes for obstruction of trachea which is already narrow structural-wise. Muscles, which relax during sleep, cause to block the trachea which is already narrow. This situation, which shows itself with snoring, uneasy sleep and night sweats in children, might cause a set-back in their development and growing up as well as personality swings like aggressiveness, crankiness and also learning disability. These undesirable circumstances occur as a result of obstruction of airflow through blocked windpipe and the short delay in oxygen delivery to tissues and brain, due to decrease in oxygen diffusion to blood from the lungs. In children, the most commonly used treatment of difficulty breathing during sleep in the world is tonsillectomy and adenoidectomy (removal of tonsils and adenoids).Success rate of this surgery is remarkably high. In children, it is common to observe positive improvements like relief in breathing and positive changes in personalities, development and growing up, right away. With this surgery, windpipe is considerably dialated but because of being a painful operation it becomes pretty uncomfortable for children and parents. As a result of the pain, children’s food intake diminishes and they would need their parents’ care for a long time. Furthermore, in adults, tonsillectomy is a highly commonly applied procedure for the treatment of frequent tonsillitis, beta germline existence, bad breath and sleep apnea. Undesirable consequences like post-operative pain, risk of bleeding and undergoing general anesthesia have been a reason for implementation of less risky methods by the help of technological improvements. There are options for tonsillectomy and adenoidectomy.

Classical Method: This surgical method, which is done with sharp instruments like scalpel and forceps and mechanical apparatus to separate tonsils from the muscle layer underneath, has been in use for over a century. Its advantage is being known and used for the longest time and full removal of the tonsils. Whereas the disadvantages can be specified as occasional bleeding and frequent pain during eating. It is used for the treatment of chronic tonsillitis as well as intermittent shortness of breath at sleep and snoring.

Electrocautery Method: In this method, instead of sharp instruments, electric current is used. With this method, tonsils are completely removed. Bleeding is encountered less and recovery is faster. Yet, post-operative pain while swallowing is possible. It is used for the treatment of chronic tonsillitis as well as breathing stoppage at sleep and snoring.

Coblator Method: Coblator is a device that can vaporize (ablate/melt/remove) the tissues via radiofrequency energy. With this device, a sizeable part of the tonsils are removed. The advantages are, almost no bleeding or pain, but fast recovery. It can particularly be used to shrink the tonsils which are large enough to clog and to remove majority of unhealthy tissues, as well as for the treatment of chronic tonsillitis. Also, removal of the odor creating tissue in complaints of bad breath related to tonsils, is one of the other application reasons. It is a frequently used method in modern ENT but due to the requirement of general anesthesia, it is not preffered by the patients who have anesthesia fobia. Recovery takes 2 days and compared to classical method it is slow.

Somnus radiofrequency method: Radiofrequency method eliminates the disadvantages of classic surgeries. While providing windpipe dialation, it does that in a painless manner. A needle, which is connected to a radiofrequency generating Somnus device, is stuck into the tonsils. By the help of this needle, radiofrequency energy shrinks the tonsils thus they get smaller in size. Researches indicate that a 70 to 80% widening (dialation) is achieved in windpipe. In adults and older children, this method is being applied without general anesthesia. There isn’t any post-operative pain. This makes going back to eating habits much easier and prevents crankiness in children and the family. In order to shrink the enlarged tonsils rather than just removing them is a preferred method to achive a suitable treatment towards frequent throat pain and bad breath. There is almost no pain after the procedure. Patients return bak to their routine the very same day.

Adenoid shaving method: For many years, to remove the tonsils, gropingly shaving by the help of finger tips, was a common method. But today, we use endoscopic viewing by utilizing a shaver instrument for adenoid surgeries. The clear visual provided by an endoscope lets us remove accurate and adequate part of adenoid. As opposed to the gropingly method, the procedure is carried out more delicately and the surrounding tissues are not damaged. Since there is no residual left behind with this method, recurrence is out of the question. There is no pain since the surrounding tissues are not harmed and recovery is very fast.

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