What are adenoids?
The adenoid is a collection of lymphoid tissue that is found in the nasopharynx, where the nose blends into the throat. It is often enlarged in children but tends to regress in size at around 8-9 years.
When they are large or infected they can cause the following symptoms:
- Obstructive sleep apnoea
- Nasal blockage and mouth breathing
- Purulent nasal discharge alongside frequent and prolonged colds
- They are also thought to have a role in glue ear. When adenoidectomy is combined with grommet insertion, there is a slightly reduced risk of recurrence of glue ear than if grommets are inserted alone.
Assessment of size
Children with a large adenoid often have an atypical facial appearance, known as 'adenoidal facies'. It is helpful to have clarification that they are in fact enlarged.
This can be done by simply examining the nose with an otoscope - sometimes it may be necessary to apply some topical decongestant to shrink down the nasal mucosa. However, examination with a flexible fibre-optic endoscope is the most definitive means of confirming their size. Lateral neck X-rays can also be used, but are not always accurate.
Surgery to remove the adenoids will help relieve nasal obstruction, but is not always effective at reducing nasal discharge.
How do you remove the adenoid?
The operation is performed through the mouth. A gag is used to open the mouth and a suction diathermy device is used to 'vaporise' the adenoid tissue under direct vision. This is a relatively new technique and has the advantage of being a 'bloodless' procedure with minimum pain following the surgery.
There is an older technique involving the use of a curette but this has generally been superseded by the suction diathermy technique.
What should I expect after the operation?
Adenoidectomy can usually be performed as a day surgery. However, patients who have been experiencing obstructive sleep apnoea will require an overnight stay in hospital for observation.
Patients may experience some of the following:
- some slight bloodstained discharge from the nose which usually settles after a few hours
- an unpleasant smell that is noticeable after a few days and usually disappears after a week
- nasal obstruction as a result of swelling - this may not clear immediately but usually improves after a few days following surgery
Are there any complications?
These are unusual.
The most common are persistence of the offensive smell and prolonged nasal congestion. Nasal escape is very unusual and may occur in children with a sub-mucous palatal cleft.
How long before my child can return to school?
Children may return to school 2-3 days after the operation.