Adenoids and adenoidectomy
Adenoids and adenoidectomy
An adenoidectomy is a quick operation to remove the adenoids – small lumps of tissue at the back of the nose, behind the palate.
What are adenoids?
Adenoids are part of the immune system, which helps fight infection and protects the body from bacteria and viruses.
Adenoids are only present in children. They start to grow from birth and are biggest when your child is approximately three to five years old.
But by age seven to eight they start to shrink and by the late teens, are barely visible. By adulthood, the adenoids will have disappeared completely.
The adenoids disappear because – although they may be helpful in young children – they're not an essential part of an adult's immune system.
You will not be able to see your child's adenoids by looking in their mouth.
When do adenoids need removing?
It may be necessary to remove the adenoids if they become swollen or enlarged due to:
infection with bacteria or a virus (adenoiditis) – although the infection will eventually clear up, the adenoids may remain enlarged
allergies – allergens (substances that trigger an allergic reaction) can sometimes irritate the adenoids, making them swell up
Adenoids can also be removed to treat recurrent ear infections or glue ear.
What is an adenoidectomy?
An adenoidectomy is a quick operation to remove the adenoids. It takes about 30 minutes to perform and is carried out in hospital by an ear, nose and throat (ENT) surgeon.
In most cases your child can go home on the same day once the effects of the anaesthetic have worn off.
Are there any risks?
The operation carries very few risks. Removing the adenoids will not put your child at greater risk of developing infection. The body's immune system is perfectly able to cope with bacteria and viruses without the adenoids.
However, as with all surgery, there is a small risk of complications such as infection, bleeding, nasal discharge, or an allergic reaction to the anaesthetic.
There may also be some temporary minor health problems such as a sore throat, earache or a blocked nose for a few weeks.
Why adenoids need to be removed
Sometimes a child's adenoids can become swollen or enlarged. For most children, this will only cause mild discomfort and will not require any specific treatment.
But, for some children, swollen or enlarged adenoids can cause severe discomfort and start to interfere with their daily life.
For example, a GP may suggest the child has their adenoids removed (an adenoidectomy) if they're experiencing:
breathing problems – such as shortness of breath or constantly breathing through their mouth
difficulty sleeping – particularly if breathing problems lead to heavy snoring and sleep apnoea
recurrent or persistent problems with the ears – such as glue ear or middle ear infections (otitis media)
recurrent or chronic sinusitis – leading to symptoms such as a constantly runny nose, facial pain and nasal-sounding speech
These symptoms are discussed in more detail below.
Swollen adenoids can make it difficult for your child to breathe through their nose. Their nasal breathing may sound noisy or make a rattling sound causing them to breathe through their mouth instead.
However, this can cause cracked lips and a dry mouth, which your child may find uncomfortable. Occasionally, your child may have difficulty eating as they need to breathe through their mouth at the same time.
Swollen or enlarged adenoids can also make it harder for your child to sleep, and as breathing through their nose is difficult, they may snore.
In severe cases of swollen or enlarged adenoids, some children may also experience sleep apnoea.
Sleep apnoea is a condition that causes irregular breathing and holding your breath during sleep at night and excessive sleepiness during the day. It occurs when the upper airway obstructs during sleep, temporarily cutting off the air supply.
Enlarged adenoids can make the throat narrower than normal, increasing the chance of the upper airway obstructing.
Swollen or enlarged adenoids can also lead to problems with the ears and hearing. This is because the adenoids can press on the entrance of the Eustachian tubes. Bacteria on the adenoids can also spread up the Eustachian tubes, causing middle ear problems.
The Eustachian tubes connect the middle ear to the back of the nose and help drain away any fluid that builds up in the middle ear, as well as maintaining air pressure within the ear.
When the Eustachian tubes are blocked, fluid can build up in the middle ear, leading to glue ear or a middle ear infection.
If your child cannot hear clearly, it may affect learning, development and social interaction so it is important that ear conditions are diagnosed and treated.
If your child's ear condition is still causing hearing loss after three months, an adenoidectomy may be considered to help the Eustachian tube function normally.
Ear and sinus infections
If the adenoids are infected (adenoiditis), this can lead to other infections in connected areas, such as the middle ear or sinuses.
How an adenoidectomy is performed
An adenoidectomy (surgery to remove the adenoids) is usually performed by an ear, nose and throat (ENT) surgeon. The operation is quick and carries few risks.
Before the operation
If your child has had a cold or sore throat in the week before the operation, it is important to let your ENT surgeon know.
If the infection is associated with a high temperature and a cough, the adenoidectomy may have to be postponed for a few weeks to ensure your child has fully recovered and to reduce their risk of developing any complications as a result of the surgery.
How long will an adenoidectomy take?
An adenoidectomy usually takes around 30 minutes but your child will need to stay up to an hour in the recovery ward.
Adenoidectomies are normally carried out as day cases and your child will usually only need to stay in hospital for a few hours after the operation before being allowed home.
However, if your doctor feels it is necessary, or if your child has not fully recovered, they may need to stay in hospital overnight.
How are the adenoids removed?
An adenoidectomy is carried out under general anaesthetic, so your child will be asleep during the procedure and will not feel any pain.
Your child's mouth will be propped open and once the adenoids have been located, the surgeon will remove them either by scraping them away using an instrument known as a curette, or by applying heat using a diathermy instrument. A diathermy instrument produces high-frequency electrical currents that burn the adenoids.
After your child's adenoids have been removed, the diathermy instrument may be used to stop the bleeding or a pack made out of gauze is applied to the skin to stop any bleeding. When this is removed, the operation is complete.
If your child has large tonsils or has had severe or frequent bouts of tonsillitis (when the tonsils become infected with a virus or bacteria), it might be recommended that the tonsils are removed at the same time as the adenoids. This means your child will only need to have one procedure, reducing the risk of complications.
An adenotonsillectomy is when the tonsils are removed at the same time as the adenoids. The operation is a quick procedure and carries very few risks.
If your child has had persistent glue ear which affects their hearing, grommets may be inserted. An adenoidectomy may be performed at the same time.
Grommets are tiny ventilation tubes inserted into your child's ear through a small cut in their eardrum. They help drain away any fluid that builds up in the middle ear.
Risks of an adenoidectomy
An adenoidectomy is a low-risk procedure that rarely causes complications. It is a relatively common operation that is quick and easy to carry out.
When to contact your GP
Contact your GP immediately or go to your nearest accident and emergency (A&E) department if your child experiences the following symptoms shortly after their surgery:
bright red bleeding from their mouth (for more than two minutes)
intense pain that is not reduced by painkillers – do not give aspirin to children under 16
Some of the possible problems are outlined below.
Minor problems after surgery
Following an adenoidectomy, some children will experience minor health problems. However, most of these are temporary and rarely require further treatment. They can include:
blocked nose or nasal discharge
halitosis (bad breath)
change in voice (your child may sound like they are speaking through their nose)
Most of these symptoms will pass within one to two weeks. They should not last longer than four weeks. If your child is still experiencing side effects after this time, contact your GP for advice.
All surgery carries the risk of infection. The tissue in the area where the adenoids were removed may become infected with bacteria.
Following an adenoidectomy, your child may be prescribed antibioticsto help prevent an infection occurring.
Allergy to the anaesthetic
With any surgery that requires an anaesthetic, there is a risk of the patient experiencing an allergic reaction to the anaesthetic.
If your child has good general health, their chance of experiencing aserious allergic reaction to the anaesthetic is extremely small (one in 20,000).
Around one in 10 children may experience some temporary symptoms, such as a headache, sickness or dizziness.
In a tiny number of cases, bleeding after the adenoids have been removed will be excessive (known as a haemorrhage), requiring additional treatment. This requires further surgery for cauterisation or to insert a dressing.
Less than one in 100 children will require emergency treatment to stop a haemorrhage. However, if it occurs, a haemorrhage has to be dealt with quickly to prevent your child losing too much blood.
Recovering from an adenoidectomy
It's perfectly normal for children to have a sore throat after an adenoidectomy. Your child will usually be given painkillers while in hospital to help ease discomfort.
Your child may also feel groggy and sleepy as a result of the general anaesthetic. They will normally need several hours in a hospital ward after the operation to make sure they are recovering normally. Once the doctor is satisfied, you'll be able to take your child home.
Once your child has returned home, they may still have a sore throat, earache or a stiff jaw and they may need painkillers in the days after the operation.
Over-the-counter painkillers, such as paracetamol, will normally be suitable. Younger children may find it easier to take liquid or soluble paracetamol, particularly if they have a sore throat.
Make sure you always follow the dosage instructions on the packet. You should never give aspirin to a child who is under the age of 16.
Eating and drinking
Your child will normally be able to start drinking liquids two to three hours after the operation. They can begin eating several hours after that.
Because an adenoidectomy can leave your child with a sore throat, they may struggle to eat their normal diet. Encourage them to eat soft or liquid foods, such as soups or yoghurts, that are easier to swallow.
You may want to try giving your child a dose of painkillers about an hour or so before they eat, as this may make it easier for them to eat and swallow their food.
It is also important that your child drinks plenty of fluids, so they do not become dehydrated.
When can my child return to school?
Following an adenoidectomy, your child will need to rest for several days and will normally not be able to return to school for a week. It is important to keep your child off school to limit their contact with any viruses or infections.
The skin and tissue where the adenoids used to be will take a while to heal. So it is important to try to prevent the wound becoming infected, because an infection could lead to complications.
Try to keep your child away from smoky environments and from people with coughs or colds. It is also advisable for your child not to go swimming for three weeks after their operation.