Consultant ENT, Head and Neck and Thyroid Surgeon

ADENOIDECTOMY


The adenoids are a pad of lymph gland tissue at the back of the nose. They form part of a ring of glands at the back of the nose and throat (including the tonsils) that act as a filter to germs that enter in the air when you breathe in.

The adenoids are not visible with the naked eye through the nose or mouth.

If the adenoids grow too large they may block the nose and also the opening of the eustachian tube. This may prevent air getting in and out of the middle ear and therefore cause glue ear (please see ‘glue ear and grommets’ information leaflet.)

As a result of enlarged adenoids, your child may breathe excessively through their mouth, snore at night and in extreme cases have difficulty catching their breath when asleep (obstructive sleep apnoea.) In addition they may have a constantly runny nose, sometimes with continually mucky mucous.

In all these cases, the adenoids are not performing a useful function and are actually causing more harm than good. Removing them has no effect on your child’s ability to fight infection.

Adenoids do often shrink as we get older, but often cause most problems between the ages of about 4 to 8 years old. It is a therefore a reasonable option to wait and see if things resolve spontaneously if you wish.
A prolonged course of low dose antibiotics, taken in a once daily dose at night may be an option to try to help this process.
However, if your child has obstructive sleep apnoea, the adenoids and the tonsils often have to be removed together and this should be done without delay (please see ‘tonsillectomy’ information leaflet.)

BEFORE THE OPERATION

You will
need to book 1 week off school for your child.
If they or anyone in your family has bleeding problems, or if they are taking medicines that thin the blood such as aspirin or warfarin, it is vital to tell me before I consider surgery.
Your child’s operation will have to be postponed if they develop a cold or chest infection in the month prior to surgery.

THE OPERATION

Adenoidectomy is performed through the mouth with your child asleep (general anaesthetic). It takes about half an hour and usually may be performed as a day case. They will only be discharged from hospital when they are eating and drinking properly.
Adenoidectomy is safe, but there are a few small risks as in all operations under a general anaesthetic.
The risks that I specifically warn about are:-

    (please warn me and the anaesthetist if there are any loose teeth or crowns.)
      This is inevitable during the operation, but is stopped before they wake up. It can occur afterwards, either during the first 24 hours (in which case they will still be in hospital, and usually will need to return to the operating theatre to stop it) or at home up to 10 days after surgery. The latter usually occurs if they get a throat infection.

      AFTER THE OPERATION

      The operation is not usually that painful, but it is nonetheless important to use the painkillers and antibiotics that they will be prescribed to take home with you.
      The painkillers should be taken
      regularly up to the maximum prescribed dose, and the times interspersed if more than one painkiller is prescribed – do not wait for the pain to build before you use them!
      Do not take aspirin or other aspirin-like drugs, as these may cause bleeding.

      They may also feel pain in their ears – this is not due to a problem in the ears as a result of the operation, but due to the shared nerve supply between the ears and the throat causing the phenomenon of referred pain (in the same way that back pain is sometimes felt down the back of the leg in sciatica.

      As the nose was previously blocked by the adenoids, your child’s voice may sometimes sound a little different after surgery as more of their voice is now produced through their nose. This phenomenon may lead to slightly ‘nasal’ sounding speech, which usually settles quickly by itself.

      Try to get your child to drink plenty of fluids and eat their normal diet in a ‘little and often’ fashion. Avoid spicy foods, however. Ice cream and soft foods are more comfortable, but crunchier food will help keep the back of your throat cleaner. Chewing sugar-free chewing gum keeps the mouth moist and the muscles moving the jaws active, and may help recovery.
      Avoid crowds, too many people and definitely those people with coughs or colds this reduces risk they have of catching an infection.
      Some discharge from the nose and bad breath is inevitable in the first few days after the operation. If they start to feel feverish or unwell or the discharge from the nose or bad breath becomes excessive they may be developing an infection, and it is wise to get a course of antibiotics from me or your G.P as soon as possible.

      If they have any bleeding, then your child will need to be examined, and may need to come back into hospital.