Adenoids and adenoidectomy

What are adenoids?

Adenoids are small lumps of tissue at the back of the nose, above the roof of the mouth. You can’t see a person’s adenoids by looking in their mouth.

Adenoids are part of the immune system, which helps fight infection and protects the body from bacteria and viruses.

Only children have adenoids. They start to grow from birth and are at their largest when a child is around three to five years of age.

By age seven to eight, the adenoids start to shrink and by the late teens, they’re barely visible. By adulthood, they’ll have disappeared completely.

Adenoids can be helpful in young children, but they’re not an essential part of an adult’s immune system. This is why they shrink and eventually disappear.

When adenoids need to be removed

A child’s adenoids can sometimes become swollen or enlarged. This can happen after a bacterial or viral infection, or after a substance triggers an allergic reaction.

In most cases, swollen adenoids only cause mild discomfort and treatment isn’t needed. However, for some children, it can cause severe discomfort and interfere with their daily life.

Adenoids may need to be removed if your child has:

• breathing problems – your child may have difficulty breathing through their nose and may have to breathe through their mouth instead, which can cause problems such as cracked lips and a dry mouth
• difficulty sleeping – your child may have problems sleeping and may start to snore; in severe cases, some children may develop sleep apnoea (irregular breathing during sleep and excessive sleepiness during the day)
• recurrent or persistent problems with the ears – such as middle ear infections (otitis media) or glue ear (where the middle ear becomes filled with fluid)
• recurrent or persistent sinusitis – leading to symptoms such as a constantly runny nose, facial pain and nasal-sounding speech

How an adenoidectomy is carried out

The adenoids can be removed during an adenoidectomy.

The operation is usually carried out by an ear, nose and throat (ENT) surgeon and takes around 30 minutes. Afterwards, your child will need to stay in the recovery ward for up to an hour until the anaesthetic has worn off.

Adenoidectomies are sometimes day cases if carried out in the morning, in which case your child may be able to go home on the same day. However, if the procedure is carried out in the afternoon, your child may need to stay in hospital overnight.

Before the operation

Tell your ENT surgeon if your child has had a cold or sore throat in the week before the operation.

If your child has a high temperature and cough, the operation may have to be postponed for a few weeks to ensure they’ve fully recovered and to reduce their risk of developing complications as a result of the surgery.

The procedure

An adenoidectomy is carried out under general anaesthetic, so your child will be unconscious during the procedure and won’t feel any pain.

Your child’s mouth will be propped open and after the adenoids have been located, the surgeon will remove them by scraping them away with an instrument called a curette, or by applying heat using a diathermy instrument. A diathermy instrument produces high-frequency electrical currents that burn the adenoids.

After the adenoids have been removed, the diathermy instrument may be used to stop the bleeding (cauterisation), or a pack made out of gauze may be applied to the skin in the mouth. When this is removed, the operation is complete.

Tonsils

If your child has large tonsils, or has had severe or frequent bouts of tonsillitis, removing the tonsils and adenoids at the same time may be recommended. This procedure is called an adenotonsillectomy.

Removing the adenoids and tonsils in a single procedure reduces the risk of complications. However, adenoidectomies, tonsillectomies and adenotonsillectomies are quick and straightforward procedures with few associated risks.

Read more about tonsillectomy (removal of the tonsils).

Grommets

Grommets may be inserted at the same time as an adenoidectomy if your child has had persistent glue ear which affects their hearing.

Grommets are tiny tubes that are inserted into the ear through a small incision in the eardrum. They drain fluid away from the middle ear and help maintain air pressure.

Risks

An adenoidectomy is a low-risk procedure and complications following surgery are rare. However, as with all types of surgery, there are some associated risks.

When to seek medical advice

Contact your GP immediately or go to your nearest accident and emergency (A&E) department if your child experiences the following symptoms shortly after surgery:

• bright red bleeding from their mouth (for more than two minutes)
• a fever
• intense pain that isn’t reduced by painkillers

Some of the possible problems after having an adenoidectomy are outlined below.

Minor problems after surgery

After an adenoidectomy, some children experience minor health problems. However, most of these are temporary and rarely require further treatment. They can include:

• sore throat
• earache
• stiff jaw
• blocked nose or nasal discharge
• bad breath (halitosis)
• a change in voice (your child may sound like they’re speaking through their nose)

Most of these symptoms will pass within one to two weeks, and shouldn’t last longer than four weeks. Contact your GP if your child is still experiencing side effects after this time.

Infection

All surgery carries the risk of infection. The tissue in the area where the adenoids were removed may become infected with bacteria.

Therefore, after the procedure, your child may be prescribed antibiotics to help prevent infection.

Allergy to the anaesthetic

With any surgery where an anaesthetic is required, there’s a risk of the person having an allergic reaction to the anaesthetic.

If your child’s general health is good, their risk of having a serious allergic reaction (anaphylaxis) to the anaesthetic is extremely small (1 in 20,000).

Around 1 in 10 children may experience some temporary symptoms, such as a headache, sickness or dizziness.

Bleeding

In rare cases, excessive bleeding can occur after the adenoids have been removed. This is known as a haemorrhage.

Further surgery will be needed for cauterisation (where heat is applied to stop the bleeding) or to insert a dressing.

Less than 1 in 100 children need emergency treatment to stop a haemorrhage. However, if it occurs, a haemorrhage needs to be dealt with quickly to prevent excessive blood loss.

Recovery

It’s normal 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 after having an anaesthetic. After the operation, they’ll be observed for several hours to make sure they’re recovering normally. Once the doctor is satisfied, you’ll be able to take your child home.

Pain relief

Your child may still have a sore throat, earache or stiff jaw after returning home, and they may need painkillers in the days after the operation.

Over-the-counter painkillers, such as paracetamol, are usually suitable. Younger children may find it easier to take liquid or soluble paracetamol, particularly if they have a sore throat.

Always make sure you follow the dosage instructions on the packet, and never give aspirin to a child who’s under the age of 16.

Eating and drinking

Your child should be able to drink liquids two to three hours after having an adenoidectomy. They can begin eating several hours after that.

To start with, eating normally may be difficult because of the sore throat. Encourage your child to eat soft or liquid foods, such as soups or yoghurts, which are easier to swallow.

Giving your child a dose of painkillers about an hour or so before they eat may make swallowing food easier.

It’s also important for them to drink plenty of fluids to avoid dehydration.

Returning to school

Your child will need to rest for several days after an adenoidectomy and should be kept off school for a week. This is to reduce their risk of getting an infection.

The skin and tissue where the adenoids used to be will take a while to heal. It’s important to try to prevent the wound becoming infected because an infection could cause complications.

Keep your child away from people with coughs or colds, and from smoky environments. They should also avoid swimming for three weeks after the operation.

Resources : NHS UK

This information provides a general overview and may not apply to everyone. Talk to your family doctor to find out if this information applies to you and to get more information on this subject.