Adenoidectomy

What are adenoids?

 Adenoids are a collection of lymphoid tissue (like   found in the nasopharynx, at the back of  the nose.  They are often enlarged in children but tend to regress in size at around 8-9 years.

When they are large or infected they can cause the following symptoms:

  • Snoring
  • Obstructive sleep apnoea
  • Nasal blockage and mouth breathing
  • Purulent nasal discharge with frequent and prolonged colds
  • They are also thought to have a role in glue ear. When  an adenoidectomy is combined with grommet insertion, there is a slightly reduced risk of recurrence of glue ear once the grommets come out than if grommets are inserted alone. 

How can we tell if they are enlarged

Children with large adenoids often have a typical facial appearance, known as 'adenoidal facies'  It is best to have clarification that they are in fact enlarged for putting a child through a general anaesthetic.

Examination with a flexible fibre-optic endoscope is the most accurate means of confirming their size. Tiny Paediatric endoscopes (2.4mm in diameter) can be used in the outpatient setting and are mostly well tolerated by children (fiberoptic endoscopy). 

Lateral neck X-rays can also be used, but are not always accurate.

Is surgery to remove the adenoids effective?

Surgery to remove the adenoids will help relieve nasal obstruction, but is not always effective in treating  nasal discharge.

How do you remove the adenoids?

The operation is performed  under general anaesthetic through the mouth.

A gag is used to open the mouth and a suction diathermy  or coblation device is used to 'vaporise' the adenoid tissue under direct vision. This technique has superceded the old fashioned curettage procedure and has the advantage of being a relatively  'bloodless' procedure with minimal  pain following the surgery. 

 

Older adenoidectomy operation using a curette

Older adenoidectomy operation using a curette

 

What should I expect after the operation?

Adenoidectomy can usually be performed as a day procedure. However, patients who have been experiencing obstructive sleep apnoea may require an overnight stay in hospital for observation.

It is a relatively painless procedure with children returning to normal activity within a couple of days

Patients may experience some of the following:

  • some  bloodstained or mucoid discharge from the nose which usually settles after a few days
  • 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?

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. 

Best to avoid swimming for 10 days

Can the adenoids grow back

Yes this happens in about 5% of patients and is more likely to happen the younger the child 

Red flag symptoms

Should your child develop a stiff  or painful neck or difficulty in swallowing then you should contact us without delay. Very rarely there can be inflammation of the ligaments in front of the spine after the surgery.