Endoscopic Shaver (Microdebrider) Adenotomy: This is the "gold standard" of modern adenoid surgery. The procedure is performed under full visual control using an endoscope, which projects an image of the nasopharynx onto a monitor screen. A special instrument—a shaver (microdebrider)—is used to carefully cut and simultaneously aspirate (suction) the adenoid tissue.

Advantages of endoscopic adenotomy:

• Complete visual control: The surgeon sees the surgical field and can remove 100% of the adenoid tissue.
• Minimal risk of recurrence: Complete tissue removal minimizes the chance of adenoids regrowing.
• Safety: There is no risk of damaging surrounding important structures (openings of the Eustachian tubes, soft palate).
• Minimal blood loss: The precision and accuracy of the method ensure an almost bloodless procedure.

Cold Plasma (Coblation) Adenotomy: This technique uses cold plasma to “dissolve” and remove adenoid tissue. Like tonsillectomy, it is minimally traumatic, involves low temperature exposure (40–70°C), and causes no bleeding, ensuring rapid healing.

Classical Adenotomy (Curettage): A traditional method where adenoids are removed “blindly” using a special ring knife (Beckman adenotome). This method is increasingly rare in modern practice because it does not provide full visual control and carries a higher risk of incomplete tissue removal and recurrence.

At our clinic, we give absolute preference to endoscopic techniques (shaver and coblation) as the most precise, safe, and effective methods for your child’s health.

Advantages of Endoscopic Adenotomy:

• Complete visual control: The surgeon sees the surgical field and can remove 100% of the adenoid tissue.

• Minimal risk of recurrence: Complete tissue removal minimizes the likelihood of adenoids regrowing.

• Safety: There is no risk of damaging surrounding vital structures (openings of the Eustachian tubes, soft palate).

• Minimal blood loss: The precision and accuracy of the method ensure an almost bloodless procedure.

• Cold plasma (coblation) adenotomy: Uses cold plasma to “dissolve” and remove adenoid tissue. Similar to tonsillectomy, this method is minimally traumatic, involves low temperature exposure (40–70°C), and causes no bleeding, ensuring rapid healing.

• Classical adenotomy (curettage): A traditional method where adenoids are removed “blindly” using a special ring knife (Beckman adenotome). This method is increasingly rare in modern practice as it does not provide full visual control and carries a higher risk of incomplete tissue removal and recurrence.

At our clinic, we give absolute preference to endoscopic methods (shaver and coblation) as the most precise, safe, and effective options for your child’s health.

When adenoid removal is necessary (indications):

Persistent nasal breathing difficulty: The child constantly breathes through the mouth, and the nose is congested even when not having a cold. Snoring and obstructive sleep apnea syndrome (OSAS): Breathing stops during sleep, restless sleep. Recurrent middle ear infections: Frequent inflammation of the middle ear (more than 3-4 times a year), as enlarged adenoids block the Eustachian tubes. Exudative otitis media: Presence of fluid in the middle ear leading to hearing loss. Chronic sinusitis and rhinitis associated with impaired mucus drainage from the nose. Abnormal facial skeleton development (“adenoid face”): Elongated face, constantly open mouth, improper bite. Speech disorders (hyponasal speech). Hearing loss due to blockage of the Eustachian tubes.

When surgery should be postponed or is contraindicated: Child under 2 years old (surgery is performed only for strict indications). Acute infectious diseases (surgery is performed 2-4 weeks after recovery). Period after vaccinations (usually wait for 1 month). Severe blood disorders affecting coagulation. Exacerbation of chronic diseases. Certain palate developmental anomalies (e.g., cleft palate). Oncological diseases.

Preparation of the child for surgery includes:

• ENT surgeon consultation: Examination, nasopharyngeal endoscopy (allows precise assessment of adenoid size and condition of the Eustachian tube openings), medical history review.
• Comprehensive examination: Complete blood count (including platelets and clotting time). Coagulogram. Blood type and Rh factor. Infection tests (if required). Urinalysis.
• Specialist consultations: Pediatrician (to assess the child’s overall health and clearance for surgery). Anesthesiologist (to discuss anesthesia and evaluate risks). If necessary — consultation with a cardiologist, allergist, neurologist.
• Preoperative recommendations: The child must be completely healthy on the day of surgery. No food or drink for 6-8 hours before the procedure (the surgery is performed strictly on an empty stomach).

• Anesthesia: The operation is performed only under general endotracheal anesthesia. This is the only safe method that ensures complete painlessness, immobility of the child, control of breathing, and allows the surgeon to calmly and precisely carry out all procedures.
• Surgical stage: Access to the adenoids is through the mouth. Under endoscopic control, the surgeon uses a shaver or coblator to completely remove the adenoid tissue. If necessary, other procedures can be performed simultaneously (for example, tonsillectomy or tympanic membrane tube placement for otitis).
• Completion: After tissue removal, hemostasis control is performed. Nasal packing is usually not required. The operation typically lasts 15–30 minutes. After surgery, the child is moved to a recovery room where they wake up and are monitored together with their parents.

• First hours and day: The child stays in the hospital (usually one day is enough). There may be a slight increase in temperature, discomfort in the throat or nose, and nasal congestion. Drinking water is allowed, followed by cool, soft foods.
• Diet: A gentle diet (soft, not hot, non-irritating foods) is recommended for 3–5 days.
• Physical activity: It is recommended to limit physical exertion, active play, attending kindergarten/school, swimming, and sauna visits for 7–14 days.
• Breathing recovery: Nasal breathing and sleep improve almost immediately after surgery, but due to postoperative swelling, the final effect develops over several weeks.
• Other symptoms: In the first days, bad breath and nasal voice may occur—these are temporary phenomena related to the healing process.

• Specialization in Pediatric ENT Surgery: Our surgeons and anesthesiologists have extensive experience working specifically with young patients, understanding all the nuances of pediatric anatomy and psychology.

• Only Endoscopic Methods: We use a shaver and coblator under full video control, which guarantees complete removal of adenoids and minimizes the risk of recurrence.
• Safe Anesthesia for Children: We use modern, safe anesthesia drugs and continuously monitor all vital functions of the child during surgery.
• Friendly Atmosphere: We do everything possible to make the clinic stay as comfortable and stress-free as possible for the child and their parents.
• Comprehensive Approach: If necessary, during adenotomy we can perform additional procedures (for example, ear examination under a microscope, tympanic membrane shunting), addressing multiple issues during a single anesthesia session.

1. Will the adenoids grow back after removal? When using modern endoscopic methods (shaver, coblation), where the surgeon removes all adenoid tissue under full visual control, the risk of true recurrence (regrowth) is extremely low. With the older “blind” method, incomplete removal was more common, leading to recurrences.

2. How painful is the operation for the child? Recovery after adenotomy is significantly less painful than after tonsil removal. The child may experience mild discomfort in the throat or nose for 1–3 days, which can be easily relieved with children’s pain relievers (such as syrup-based paracetamol or ibuprofen).

3. How quickly will nasal breathing improve and snoring stop? Many parents notice that their child starts breathing through the nose and stops snoring as early as the first night after surgery. However, due to slight postoperative swelling of the nasal mucosa, temporary nasal congestion may occur. Stable improvement usually happens within 1–2 weeks.

4. Will the child’s immunity weaken after adenoid removal? No. By the time surgery is considered, hypertrophied adenoids are more of a chronic infection source causing health problems than a protective organ. The immune system has many other components (palatine tonsils, lymph nodes, etc.) that fully compensate for the removed pharyngeal tonsil. Usually, children get sick less often after the surgery.

5. When can the child return to kindergarten or school? We generally recommend keeping the child at home for 7–10 days after surgery to limit physical activity and reduce exposure to infections during healing.

The days when tonsil removal was associated with severe pain and lengthy recovery are behind us. In our clinic, we use the most modern and gentle techniques:

• Cold Plasma Tonsillectomy (Coblation): This is the “gold standard” of modern ENT surgery. The procedure is performed using a special coblation device that generates a cloud of cold plasma at temperatures between 40-70°C. The plasma allows for highly precise and virtually bloodless “dissolution” and removal of tonsil tissue while simultaneously coagulating (sealing) blood vessels.

Advantages of coblation:

• Minimal pain: Postoperative discomfort is significantly less compared to traditional methods.
• No bleeding: Cold plasma instantly seals blood vessels.
• Minimal damage to healthy tissue: The low temperature prevents burning of surrounding muscles and mucosa.
• Faster healing: Recovery is quicker and more comfortable.
• Radiofrequency Ablation: A technique similar to coblation that uses radio wave energy for precise tissue removal.
• Laser Tonsillectomy: Uses a laser beam to excise tonsils. It ensures a bloodless procedure but may cause more pronounced thermal injury to surrounding tissues compared to coblation.
• Classical (Extracapsular) Tonsillectomy: Removal of tonsils using a scalpel and surgical instruments. This traditional method is increasingly being replaced by gentler technologies in modern practice.

In our clinic, we prefer cold plasma tonsillectomy (coblation) as the safest, most effective, and most comfortable method for our patients.

Indications for Tonsillectomy:

• Chronic Decompensated Tonsillitis:
• Frequent tonsillitis episodes (more than 3-4 episodes per year for the last 2 years, or more than 5-6 episodes in one year).
• Ineffectiveness of conservative treatment (tonsillar lacunae irrigation, antibiotic courses).
• Presence of persistent purulent-caseous plugs in the tonsillar crypts and bad breath.
• Complications of Chronic Tonsillitis (Tonsillogenic Intoxication):
• Persistent low-grade fever, weakness, fatigue, joint pain, complications affecting the heart
• (myocarditis), kidneys (glomerulonephritis), joints (rheumatism) – so-called metatonsillar diseases.
• Peritonsillar Abscess: A purulent complication of tonsillitis (especially recurrent episodes).
• Obstructive Sleep Apnea Syndrome (OSAS) and Snoring: Caused by significantly enlarged (hypertrophic) tonsils obstructing the airway.
• Significant Tonsil Enlargement: Interfering with normal swallowing.
• Suspicion of Malignant Tumor in the Tonsil.

When the Surgery Should Be Postponed or Is Contraindicated:

• Acute infectious diseases (surgery is performed 2-4 weeks after recovery).
• Exacerbation of chronic diseases.
• Severe blood disorders affecting coagulation (e.g., hemophilia).
• Severe decompensated cardiovascular, renal, or respiratory failure.
• Active tuberculosis.
• Certain vascular anomalies of the pharynx.
• Pregnancy (surgery postponed until postpartum period).

• Comprehensive Examination:

• Complete blood count (including platelets and coagulation time).
• Blood biochemistry (including C-reactive protein, ASLO, rheumatoid factor).
• Coagulogram.
• Infection screening tests (HIV, hepatitis, syphilis).
• Blood group and Rh factor.
• Urinalysis.
• ECG.

Consultations:

• Therapist (or pediatrician for children) and anesthesiologist consultations for surgical clearance.
• Sometimes – dental consultation for oral cavity sanitation.

Preoperative Recommendations:

• Discontinue medications affecting blood coagulation 1-2 weeks before surgery (in agreement with your doctor).
• On the day of surgery, do not eat or drink for 6-8 hours prior to the procedure (strictly fasting).

Tonsillectomy is always performed in a hospital setting.

1. Anesthesia: The procedure is carried out under general endotracheal anesthesia. This is the gold standard, ensuring complete safety, painlessness, patient breathing control, and comfortable conditions for the surgeon.
2. Surgical Stage: Access to the tonsils is through the open mouth. Using the chosen instrument (for example, a coblator), the surgeon carefully separates and removes the tonsil tissue along with its capsule. Thanks to modern techniques, bleeding is minimal or absent.
3. Completion: After tonsil removal, thorough hemostasis (bleeding control) is performed. The duration of the operation usually ranges from 20 to 45 minutes. After the procedure, the patient is transferred to a ward where they are monitored by medical staff.

Recovery After Tonsillectomy Requires Following Certain Guidelines, Especially Regarding Diet:

• First day: The patient stays in the hospital. The main symptom is a sore throat, which may radiate to the ears. Painkillers are prescribed. In the first hours, it is recommended to swallow saliva and drink cool water.
• Diet: For 10–14 days, a strict diet must be followed. Food should be cool, liquid or pureed, not acidic, salty, or spicy. Ideal options include yogurt, kefir, broths, purees, and ice cream.
• Physical activity: Physical exertion, sports, sauna, bathhouse visits, and hot baths should be avoided for 2–3 weeks.
• Healing: A fibrinous coating (white-yellow in color) forms at the site of the removed tonsils — this is a normal healing process and should not be confused with pus. It gradually disappears by days 7–10.
• Return to normal routine: Children can return to school or kindergarten after 10–14 days. Adults usually return to work within the same timeframe, provided their job does not involve physical strain.
• Hospital stay: Typically lasts 1–3 days.

Advantages of Tonsillectomy at Our Clinic:

• Leading ENT surgeons: Procedures are performed by experienced specialists proficient in modern techniques, including coblation.
• Focus on minimal pain: Using cold plasma surgery allows us to significantly reduce pain and make the postoperative period as comfortable as possible.
• Safety for children and adults: We use only modern, safe anesthesia under the supervision of experienced anesthesiologists. All equipment and protocols comply with strict international standards.
• Comfortable inpatient care: We provide attentive care and monitoring during the postoperative period in comfortable conditions.
• Radical solution to the problem: We perform complete tonsil removal, ensuring freedom from chronic tonsillitis and its complications.

1. How severe is the throat pain after tonsil removal? Throat pain after tonsillectomy is the main symptom. Its intensity varies individually, but with modern methods like coblation, it is significantly less. The pain is well controlled with regular use of doctor-prescribed painkillers and following a diet of cool food and drinks.

2. Will my child get sick more often after tonsil removal? This is a common myth. By the time tonsillectomy is indicated, the tonsils no longer serve their protective function and instead act as a chronic source of infection, weakening immunity. After removal, the immune system is not impaired (other lymphoid tissues in the throat compensate), and in fact, children generally get sick less often as the body is freed from a constant bacterial source.

3. At what age is it best to remove the tonsils? The surgery is done based on medical indications, not age. Most often, the need arises in children older than 3–4 years and in adults.

4. What is the most dangerous period after the operation? The period from day 5 to day 10 after surgery requires the most attention because the fibrinous coating starts to detach. There is a small theoretical risk of bleeding during this time. That’s why it is important to strictly follow the diet and gentle regimen during the first two weeks.

5. How long will I stay in the hospital? Hospitalization usually lasts from 1 to 3 days. This is necessary to monitor the patient’s condition and prevent early postoperative complications.