Adenoidectomy

What Are Adenoids?

The Adenoids are a collection of immune tissue, similar to ‘the tonsils’, and are located at the back of the nose and above the roof of the mouth. As air is breathed in, it passes over the adenoids on its way into the lungs. Adenoids are a component of the immune system. They provide protection from bacteria and viruses. These glands are found in children but steadily shrink as children age. By age 5, they are often already diminishing in size. By a child’s teen years, the adenoids may almost completely disappear.

Problems with adenoids are sometimes accompanied by issues with the tonsils. If the tonsils are also persistently infected, inflamed or enlarged, the surgeon may recommend their removal as well.

Why choose adenoid removal surgery?

While most children will have no problems with their adenoids, some will experience chronic inflammation and possibly infection. The causes for persistent adenoid enlargement and inflammation can vary but may include allergies and infections. It’s also possible for children to be born with adenoids that are abnormally large.

When adenoids are persistently enlarged, they can obstruct a child’s airway. They can lead to difficulty breathing, snoring, sleep apnoea, glue ear and ear infections and other symptoms. Adenoid removal surgery offers a way to address these symptoms and improve the quality of life for the patient.

It is important to note that the removal of the adenoids has not been shown to inhibit a child’s ability to fight off infections. Adenoid removal surgery is quite common and there is a general consensus in the medical community that their removal does not adversely affect the immune system in a significant way. The same is true for the removal of the tonsils.

What kinds of problems can an adenoidectomy treat?

• Obstructed breathing - e.g. Nasal obstruction, mouth breathing
• Sleep apnea
• Snoring
• Ear infections / Glue Ear
• Sinus infections

Adenoid removal surgery can offer multiple benefits for children who are struggling with symptoms related to adenoid enlargement. Some of these benefits include:

• Freedom from constant ear infections or persistent middle ear effusions. Some children with persistently infected adenoids suffer from ear infections or ear effusions that do not respond to antibiotics. It can lead to an ongoing cycle of ear infection and ineffective antibiotic treatments. Even if the ear infection resolves, another may occur. This is a painful cycle for both children and parents. It can lead to many difficulties, including problems hearing, problems sleeping, adverse reactions to repeated antibiotic treatments, and more. The removal of the adenoids can stop this cycle.
• Restful sleep. Sleep is just as important for children as it is for adults. They need regular, restful sleep to recover from their daily exertions and wake refreshed and energized. Failure to get restful sleep can lead to learning difficulties, behavioral challenges and other issues. If enlarged adenoids are causing sleep apnea in a child, the removal of those adenoids can eliminate the obstruction to the airways and cause a return to a regular, healthy sleep cycle.
• Improved learning outcomes. Even if a child loves learning, they are going to struggle to absorb and retain new information if they are in pain from ear infections or failing to get a good night’s sleep. Adenoid removal surgery can relieve these symptoms so that a child can achieve their full learning potential.

What are the risks of adenoid removal surgery?

Significant surgeries always carry risks, including bleeding, adverse reactions to anesthesia and infection. Other risks specific to adenoid removal surgery include:

• Failure to resolve ear infections, breathing problems or nasal drainage. It is possible that an adenoidectomy could fail to resolve the issues it was intended to solve. The child could recover from surgery and still suffer from the original problem. For example, due to the nature of adenoid tissue, and the way it is removed, there is a small chance that it can regrow and cause recurrent symptoms in the months to years after adenoid removal surgery. The problem may be less significant, the same as before or even exacerbated.
• Permanent changes to the voice. Because the surgery focuses on the airways and the area around the mouth, it is possible that the child could have an altered vocal quality after recovering from surgery, though generally, alterations in voice are minor, and for the better.
• Excessive bleeding. Although it is quite rare, it is possible that the removal of the adenoids could lead to excessive bleeding. If this does happen, the medical team can address it quickly and effectively. It is also possible that excessive bleeding could occur after the patient has returned home, although this is also rare. If it does occur, you should seek medical assistance immediately.

Is it easy to perform an adenoidectomy?

An adenoidectomy involves the upper airways, so caution and attention to detail are extremely important. These are some of the key considerations your surgeon will need to make when performing the surgery:

• Varying anatomy. The human body can be surprisingly varied in the way it develops, which means that the surgeon needs to know how to adapt during surgery. They will need to carefully examine the child’s anatomy before and during surgery to identify the best approach to adenoid removal. The positioning of both ‘hard’ tissues, like the jaw, teeth and nasal septum, and the soft tissues, like the palate, eustachian tubes, tongue and tonsils, all need to be taken into consideration while performing an adenoidectomy.
• Tonsil removal. The tonsils are another immune tissue that helps to protect against viruses and bacteria. Tonsils can also become infected and swollen, sometimes at the same time as the adenoids. While not every patient requires tonsil removal along with adenoid removal, many do, especially paediatric patients. The surgeon may need to remove the tonsils along with the adenoids. Removing the tonsils in addition to the adenoids can be done during the same anaesthetic surgical procedure, and with the same or similar surgical techniques.
• General anesthesia is required. An adenoidectomy is a surgery that requires general anesthesia. General anesthesia involves putting the patient under so that they are unconscious through the procedure, and the anaesthetist is supporting the patient’s breathing. It carries its own risks and requires careful monitoring by the anaesthetist, to be done properly. The need for general anesthesia means that the surgery will require more resources than a surgery performed under local anaesthesia.

Can you go home soon after an adenoidectomy?

Most patients can go home the same day as the adenoid removal surgery. There will be a monitoring period following the surgery where the child will remain under observation. Once the doctor verifies that the child is recovering from the anesthesia well and that there are no complications from the surgery, the child can usually go home. However, it is possible that the child will be required to stay overnight for observation.

How long does it take to recover?

An adenoidectomy is usually not a complicated or overly invasive surgical procedure, which means that the recovery time is often short. For most patients, there will be some mild pain in the hours and days following the procedure. Nasal obstruction will persist (if this was a symptom before the operation), for a few days to a couple weeks after the operation, before healing is complete and the nasal pathways clear. Usually, the patient can return to their normal activities within a week and the problems the adenoids were causing will be resolved.

The surgeon may prescribe some pain medication or recommend over the counter medications to help alleviate discomfort. There may also be symptoms like sore throat, noisy breathing, bad breath and runny nose. These symptoms should resolve within a few days after the procedure.

Generally your child can resume a normal diet immediately after adenoidectomy. . It is important that they drink plenty of fluids to prevent dehydration. If for some reason your child does not drink enough fluids, offering icy-poles can be helpful. Any discomfort or pain should resolve in less than a week in most cases, and should be easily controlled with simple pain relief such as paracetamol

Recovery times are extended somewhat to up to two weeks if the tonsils are also removed with the adenoids. Both procedures can be performed during the same surgery and will generally heal in a similar fashion.