Adenoidectomy

The adenoids are very similar to tonsils, but are located at the back of the nose.  If adenoids are enlarged they can block the nose and force children to breath through their mouth, sometimes contributing to obstructive sleep apnoea.  Adenoids can also cause a persistent runny nose (discharge), and reduce the function of the ears by making glue ear (middle ear effusion) more common.  

The adenoids are usually small at birth, but may grow significantly in the first few years of life.  Given time the adenoids in most children will gradually reduce in size again as they grow towards 8-10 years of age.  Adenoids (and tonsils) have a small contribution to the immune system when very young, but there is no good evidence that infections are more common after removal.  

Sometimes it is appropriate to remove the adenoids, with the most common reasons being to treat obstructive sleep apnoea, unblock the nasal airway, improve a persistent runny nose, or improve function of the ears and hearing.  Often an adenoidectomy is performed at the same time as a tonsillectomy or placing grommets in the ears.

Nasal symptoms may also commonly be due to a degree of swelling of the lining of the nose (rhinitis), in which case it may be appropriate to use a mild steroid nasal spray and/or antihistamine before considering surgery.  Longer term antibiotics can be helpful in reducing thick nasal discharge, but often the symptoms return once antibiotics are stopped. 

An adenoidectomy is performed with the child asleep under general anaesthetic, and typically the surgery takes around 10-15 minutes.  The two most common methods I use to remove adenoids are Coblation or suction diathermy.  Both of these are performed through the mouth under direct vision, so the adenoids are taken away very precisely.  Both of these techniques help seal any blood vessels during the procedure, so bleeding is very rarely a problem.  It is possible that adenoids can grow back, although this is uncommon. 

 

If children are well they often go home a few hours after surgery, and are usually ready to go back to nursery or school in 3-4 days.  Pain is usually mild but I send children home with pain medication, as well as antibiotics to reduce the nasal discharge which is common in the first few days.

 

Other Small Risks

Low risk of troublesome bleeding post-operatively, around 1 in 3000 children

Occasionally a loose tooth is removed while the child is under anaesthetic to prevent it passing into the stomach or lungs, but damage to teeth/lips/gums is rare

Very rarely a change in function of the palate muscles, causing a nasal voice, or liquids leaking into the nose when drinking. This would usually settle with speech therapy

If adenoids are very large, there may rarely be some change in voice once this bulky tissue is removed, as the vibrations in the throat change slightly

Post-Operative Advice

Use calpol and neurofen as needed, although pain is normally minor

A bad smell from the nose/mouth is common for a few days. This is improved by taking antibiotics post-operatively for 5 days

I encourage the children to eat a normal diet from day 1, with no dietary restrictions

Small streaks of blood when blowing the nose is common