Adenoidectomy

What are adenoids?

At the back of the nose in children are small swellings called adenoids.

They are absent at birth and grow in the first year or two of life. They regress naturally at a variable age usually between 7 and 9. Occasionally they persist into the teens but they have disappeared by the time we reach adulthood.

What do they adenoids do?

Adenoids are made of lymphoid tissue, just like the tonsils and appendix. There is lymphoid tissue in many parts of the body. Lymphoid tissue contains cells from the immune system. Removing a small amount of lymphoid tissue however does not prevent your body from fighting germs.

Why do we remove adenoids?

Adenoids can cause a number of different problems.

1. Blocked nose – large adenoids can cause a blocked nose, this is usually associated with snoring and a tendency to breathe through the mouth. In severe cases the breathing can be affected. Children may struggle to breath at night or have pauses in their breathing. This is a condition known as obstructive sleep apnoea.

2. Runny nose- adenoids can harbour bacteria, this may result in prolonged runny noses.

3. Ear problems- the adenoids sit at the entrance to the Eustachian tube. This tube is important for ventilation of the ear. We still do not fully understand what causes glue ear but there is increasing evidence that if we remove the adenoids this helps ventilate the ear and makes glue ear less likely to return.

What are the alternatives?

Runny or blocked noses may improve with antibiotics or occasionally with steroid treatment into the nose. Unfortunately the problems frequently recur when the medication is stopped.

If the problems are not too bad then it is often better to simply wait for the adenoids to regress naturally.

If there are significant breathing or hearing problems however it may not be advisable to simply wait and removal of the adenoids may be recommended.

What are the risks?

A general anaesthetic is required. Your child will be fully assessed by a paediatric anaesthetist before the operation who will answer your questions with regard to this.

Very rarely children experience some bleeding after adenoidectomy. This is usually minor. If your child has some bleeding you should contact a doctor. If your child has persistent bleeding you should take them to the nearest accident and emergency department. The nurses at the ward where your child is admitted can give you advice.

The Day of the Operation

Eating and drinking

Your child will have to have nothing to eat and drink for a few hours before the operation. You will be given instructions with regard to this.

Before the Operation

You and your child will see the anaesthetist and the surgeon. The surgeon will explain the procedure once again and ask you to sign a consent form.

What happens during the Operation?

The operation involves a short general anaesthetic. While your child is asleep the adenoids are removed through the mouth. There is usually only a little bleeding and this is controlled.

What happens after the operation?

Pain Medication

Removing the adenoids alone is generally not very painful and simple painkillers such as paracetamol (calpol) are usually sufficient. If the tonsils are removed as well then extra painkillers are required.

Going Home

If your child is having just adenoids removed (or adenoids and grommets) they will go home around three or four hours after the operation. The paediatric nurses will help decide exactly when your child has recovered enough to go home. If they are having their tonsils removed as well then they will stay overnight.

When can my child go back to school or nursery?

After removal of the adenoids children should keep away from school for one week, if the tonsils are removed as well then they should keep away for two weeks. This is simply to try and reduce the chance of them picking up an infection from another child which will make them feel more uncomfortable. They can mix with family and close friends.

Follow up appointments

Your child will be seen about two weeks after the operation.

Michael Saunders FRCS 2012

With thanks to Mr Ben Hartley FRCS