What are the adenoids?
Adenoids are small glands in the throat found at the back of the nose. They are part of the lymphatic system, which means their job is to help fight infection. After about the age of three they gradually reduce in size.
Your body can still fight infections even without your adenoids. However if the adenoids are doing more harm than good, then it may be better to have them removed.
Do I have to have my adenoids removed?
If the adenoids are significantly enlarged, they may cause a blocked nose and mouth breathing during the day and snoring at night. Sometimes children may have pauses in their breathing for a few seconds at a time, which can be quite frightening to witness.
The adenoids may also cause ear problems by blocking the tube, which connects the nose to your ears. In children with glue ear, removing the adenoids (adenoidectomy) at the same time as putting grommets in the ears reduces the chance of the glue ear coming back at a later date.
What are the alternatives to having an adenoidectomy?
As you grow older, the natural history is for the adenoids to gradually get smaller. It is therefore possible that your nose and ear problems may improve with the passage of time. Surgery will make these problems get better more quickly than just watching and waiting, but adenoidectomy does carry with it a small risk, which needs to be considered as well. Your surgeon will be able to advise you as to whether it is better to undergo an adenoidectomy or to wait and see.
Many children with a blocked nose have rhinitis, which is inflammation of the lining of the nose often caused by allergy, in addition to any enlargement of their adenoids. Use of a steroid nasal spray will help to reduce congestion in the nose and to some extent the adenoids, and may therefore be worthwhile trying before adenoid surgery to see how much benefit your child gets.
Antibiotics are rarely if ever helpful and only produce temporary relief in the presence of an upper respiratory tract infection and/or sinusitis. They also have some side effects and may promote bacteria that are resistant to antibiotics.
You may change your mind about the operation at any time. Even if you initially agree to the surgery, you are at liberty to discuss your options at any stage with your surgeon particularly if your child’s symptoms change or if you wish to try an alternative treatment. If you would like to have a second opinion about the treatment, your specialist will not be offended and will be happy to arrange this for you either directly or via your GP.
Other operations sometimes performed at the same time as adenoidectomy
If the adenoids are being removed because of ear problems, it is likely that grommets will also be inserted.
If there is a history of recurrent severe sore throats or episodes of stopping breathing at night, we may also take the tonsils out (tonsillectomy) at the same time particularly if they are enlarged.
In either of these situations described above, your surgeon will discuss these options with you prior to the adenoidectomy.
Different techniques used in adenoidectomy:
- Monopolar diathermy: this involves electrical heat generation that dissects tissues and seals off the blood vessels at the same time.
- Cold steel: this involves using instruments only to remove the adenoids. It is rarely used nowadays owing to the increased risk of bleeding during and shortly after the surgery.
- Coblation: this involves the use of a radiofrequency device that coagulates tissues at a lower temperature than traditional diathermy
Before the adenoidectomy:
It would be advisable to arrange one week off work or school if adenoidectomy alone is planned, or two weeks if the adenoids and tonsils are being removed. This is because there is a risk of acquiring an infection in the immediate postoperative phase. Please also let us know if you have a chest infection, ‘flu or cold within the week immediately before the admission date – you may require a course of antibiotics although it may still be necessary to postpone the operation if the infection has not cleared in time.
It is also important to tell us if you have had any unusual bleeding or bruising problems, or if this type of problem runs in the family.
Adenoidectomy – the operation:
The operation will be carried out with your child asleep under a general anaesthetic. The adenoids are usually removed through his or her mouth using either traditional steel instruments or diathermy (heat generated through an electrical current), and then any bleeding is stopped before your child is woken up. The operation usually lasts no more than 10 minutes.
After the adenoidectomy – what to expect:
It is quite normal for most children to feel a little sick after having the adenoids out. Anti-sickness medicine often needs to be given for this, but it usually settles quickly.
There may be a sore throat, which is usually not too severe although it may last for several days and typically gets worse before it gets better. It is important to take the prescribed painkillers as needed. Aspirin is not safe for children and should never be given to children under 16.
Your child may have an earache. This is normal – it happens because the same nerves connect your throat and ears. It does not mean that you have an ear problem.
A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks.
The child’s nose is also likely to become more blocked immediately after the surgery. This can last a week or two but usually clears quite quickly after this.
When can I go home after having my adenoids out?
In the vast majority of hospitals, adenoid surgery is performed as a day case, which means that you will be able to take your child home on the same day as the operation. Some surgeons may prefer to keep children in hospital for one night, particularly if the operation is done in the afternoon. Regardless of the preference of your surgeon or hospital, we will only let you go home once you are recovered from the immediate effects of the operation, when you are eating and drinking and feel well enough.
Most children need about a week off nursery or school if adenoidectomy alone is performed, or two weeks if the tonsils are also removed. It is advisable to remain indoors for the first few days, keeping away from crowded and smoky places and keeping your distance from people with coughs and colds. You may feel tired. After the first few days it is OK to gradually increase your activity and get back to normal according to how you feel.
Things that can go wrong after adenoidectomy:
Adenoid surgery is extremely safe, but every operation has its own risks that can occasionally occur.
The most frequently encountered problem is bleeding. This can occur at any time from immediately after the operation up until two weeks later, but is extremely uncommon after adenoidectomy. In most instances of bleeding, treatment is initially medical with antibiotics as the majority of bleeds occur following a postoperative infection. A second operation may rarely be required to stop the bleeding.
During the operation, there is a very small chance that a tooth may be chipped or knocked out, especially if it is loose, capped or crowned. Please let us know if you have any teeth like this. Damage or minor cuts to the lips and/or gums can also occur.
It is expected that the snoring and/or episodes of stopping breathing will be very much improved following the operation but it is unlikely that these will vanish completely. A small amount of audible noise whilst sleeping is not uncommon. Most parents in fact report that their child is so quiet after the surgery that they are just as worried as they were before the surgery when their child was noisy!
In rare cases, the surgery can lead to liquid or food coming out of the nose. This can occur due to a pre-existing weakness of the soft palate or an increased difficulty in the soft palate closing against the back of the nose. In most cases a pre-existing problem with the soft palate can be detected before the surgery, which can then allow modifications to be made during the adenoidectomy surgery (such as a limited or conservative reduction in adenoid tissue).
Bleeding after an adenoidectomy:
If you notice any bleeding from your throat or nose, you must seek medical advice. If it is only a drop or two, call your GP or the ward of the hospital where you were treated. However, for anything more severe or if in any doubt, it is advisable to go to your nearest hospital casualty department.