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Adenoid removal (adenoidectomy) in children

An adenoidectomy is an operation to remove the adenoids. Adenoids are small lumps of tissue, similar to the tonsils, at the back of the throat, where the throat meets the back of the nose.

About adenoidectomy

Adenoids are small lumps of tissue in the back of the throat that help fight ear, nose and throat infections in younger children. Adenoids usually reach their maximum size when your child is between three and five years, then begin to shrink by age seven and can hardly be seen by the late teens. The location of the adenoids An adenoidectomy can remove the adenoids if they are causing health problems for your child. For example, if your child has recurrent colds or throat infections, his or her adenoids can become infected and swell up. They can block the nose and make it difficult for your child to breathe, especially when asleep. Swollen adenoids can also block the eustachian tube that connects the back of the throat to the middle part of the ear. If the eustachian tube is blocked, it can lead to an ear infection and a build-up of sticky fluid in the ear - this is called glue ear. This can make it difficult for your child to hear properly and as a result can cause learning problems. If your child suffers from sleep problems due to a blocked nose or has recurrent or persistent ear infections, your GP may recommend that your child sees a specialist ear, nose and throat (ENT) surgeon to discuss an adenoidectomy. Swollen adenoids are often associated with infected tonsils (tonsillitis) and may be removed as part of an operation to remove these. When adenoids and tonsils are taken out together, the procedure is called an adenotonsillectomy.

What are the alternatives?

The adenoids will shrink as your child gets older, so an operation may not be necessary. You can choose to wait and see. A steroid nasal spray may help to reduce congestion in your child`s nose and adenoids so this is another option to try before surgery. Antibiotics can treat infections and provide temporary relief but they aren`t used for long-term treatment.

Preparing for your child`s operation

Your child will probably be able to go home on the same day that they have the adenoidectomy, but sometimes he or she may be kept overnight in hospital. If your child has a cold or infection in the week before the operation, it`s important to let the hospital know. The operation may need to be postponed until your child has fully recovered. The operation is done under general anaesthesia. This means your child will be asleep during the operation. You will be asked to follow fasting instructions. Typically your child must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand. The surgeon and anaesthetist will visit your child before the operation. This is a good time to ask any questions. It`s important to tell the surgeon and anaesthetist if your child has any allergies, loose teeth or if there is a history of any bleeding problems in the family. Your surgeon or another healthcare professional will usually ask you to sign a consent form on behalf of your child. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

What happens during adenoidectomy

The operation takes about 15 minutes. Once the anaesthetic has taken effect, your child`s surgeon will remove the adenoids. He or she will either scrape them away with an instrument known as a curette, or will use heat waves to remove them in a technique called diathermy. The surgeon may then press a gauze pack on to the area to stop the blood vessels in and near the adenoids from bleeding. Alternatively - or as well as - diathermy will be used to stop the bleeding. Once the bleeding has stopped, the pack will be removed and your child will be woken up.

What to expect afterwards

Your child will be monitored for a short while and will need to rest on his or her side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel sick or vomit. Your child will have a sore throat, earache and a stiff jaw. Your child`s surgeon will usually prescribe painkillers for a day or two, and may send your child home with a week`s course of antibiotics. Before you go home, you may be given an appointment for a follow-up visit.

Recovering from adenoidectomy

Once home, follow your surgeon`s advice about pain relief. You can usually give your child over-the-counter painkillers such as paracetamol or ibuprofen syrup but don`t give your child aspirin as this can make the wound bleed. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice. It`s important for your child to drink plenty of fluids so that he or she doesn`t become dehydrated. Also encourage your child to eat - it`s best to start with soft or liquid foods that are easier to swallow. Giving your child painkillers half an hour before meals may make him or her more comfortable when eating. Encourage your child to brush his or her teeth thoroughly as usual. Your child will need to rest at home for a few days and stay off school for about a week to prevent picking up any infections that may delay healing. Also keep your child away from crowded and smoky places, and from people with coughs and colds. If your child has any sign of bleeding in his or her nose or throat, seek medical help immediately. Your child should make a full recovery in one to two weeks.

What are the risks?

Adenoidectomy is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects

Common side-effects include:
  1. a sore throat, earache and a stiff jaw for a couple of days
  2. a blocked nose - this usually clears within a week or so
  3. a change in your child`s voice - he or she may sound as if they are talking through the nose and this can last a few weeks

Complications

Complications are when problems occur during or after the operation. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Bleeding after surgery is extremely rare but if your child does have excessive bleeding, he or she may need to go back into theatre for a second operation to stop it. There`s a small chance a tooth may be chipped or knocked out during the operation, or your child`s lips or roof of the mouth may be caught by the instruments. The exact risks are specific to your child and differ for every person, so we haven`t included statistics here. Ask your surgeon to explain how these risks apply to your child.