Adenoidectomy
Parents who come to see me about adenoid problems are often dealing with a child who snores, breathes through their mouth, sleeps poorly, or seems to have ongoing nasal or ear problems that never fully settle. An adenoidectomy is an operation to remove the adenoids — a pad of lymphoid tissue that sits at the back of the nose, behind the soft palate. Although the adenoids form part of the immune system in early childhood, they usually become much less important as children grow and often shrink naturally with age.
Adenoid surgery can be very helpful for the right child, but as with any operation, the decision should be made carefully and on an individual basis.
What are the adenoids?
The adenoids are similar to the tonsils in that they are both made of lymphoid tissue. The difference is their location. The tonsils sit at the sides of the throat and can be seen when the mouth is open. The adenoids sit higher up, behind the nose, so they cannot usually be seen just by looking in the mouth.
Why might a child need an adenoidectomy?
The commonest reason is enlarged adenoids causing symptoms. These may include:
a blocked nose
persistent mouth breathing
snoring
restless or poor-quality sleep
obstructive sleep apnoea
recurrent ear infections
glue ear and hearing problems
a chronically stuffy or nasal-sounding voice
In some children, adenoidectomy is performed on its own. In others, it is carried out alongside grommet insertion or tonsil surgery, depending on the overall pattern of symptoms.
Why can enlarged adenoids affect hearing?
The adenoids sit close to the opening of the Eustachian tube, which is the small passage connecting the back of the nose to the middle ear. When the adenoids are enlarged, they can interfere with how the Eustachian tube works or partly block its opening. This can stop the middle ear from ventilating properly and lead to a build-up of fluid behind the eardrum, often called glue ear. When that happens, hearing can become reduced or muffled. Removing enlarged adenoids can therefore be helpful in some children, particularly when glue ear or recurrent ear problems are part of the overall picture.
What are the benefits of surgery?
For the right child, adenoidectomy can improve nasal breathing, reduce mouth breathing and snoring, and lead to better quality sleep. It can also be helpful in selected children with glue ear or repeated ear infections, particularly when combined with grommet surgery.
For some children with rhinitis or hay fever, adenoidectomy can also be a very useful treatment option to help manage symptoms. This is particularly true when enlarged adenoids are adding to ongoing nasal blockage, congestion, poor sleep, or chronic mouth breathing. By improving the airway at the back of the nose, surgery can sometimes make a real difference to day-to-day comfort and breathing.
That said, it is important to be realistic. If a child also has allergic rhinitis or hay fever, surgery may help the blockage caused by enlarged adenoids but may not remove the underlying allergy problem itself. Some children will still need medical treatment such as nasal sprays or antihistamines after surgery, and a smaller number may require further treatment or surgery later on if symptoms persist or adenoid tissue regrows.
The aim of surgery is to improve the symptoms that enlarged adenoids are causing. As with any procedure, the expected benefit depends on choosing the right operation for the right child.
How is the operation done?
An adenoidectomy is performed under a general anaesthetic. The adenoids are removed through the mouth, so there are no cuts on the outside. Different techniques can be used to remove the tissue and control bleeding during the operation.
The procedure itself is usually relatively quick, and most children go home the same day.
Will my child need their tonsils removed as well?
Not necessarily. Enlarged adenoids and enlarged tonsils are related but separate issues. Some children only need adenoid surgery. Others may benefit from both adenoid and tonsil removal if both are contributing to snoring, obstructive breathing, or repeated infections.
This decision depends on the child’s symptoms, examination findings, sleep pattern, and any associated ear or breathing problems.
Does removing the adenoids affect the immune system long term?
This is a very common concern for parents. The adenoids do form part of the immune system in early childhood, but they become much less important over time, and the wider immune system continues to function perfectly well without them.
In practical terms, there is no good evidence that children become generally less able to fight infection in day-to-day life after adenoid removal.
Why can enlarged adenoids affect hearing?
The adenoids sit close to the opening of the Eustachian tube, which is the small passage connecting the back of the nose to the middle ear. When the adenoids are enlarged, they can interfere with how the Eustachian tube works or partly block its opening. This can stop the middle ear from ventilating properly and lead to a build-up of fluid behind the eardrum, often called glue ear. When that happens, hearing can become reduced or muffled. Removing enlarged adenoids can therefore be helpful in some children, particularly when glue ear or recurrent ear problems are part of the overall picture.
What are the main risks of adenoidectomy?
Adenoidectomy is generally a shorter operation and an easier recovery than tonsillectomy, but it is still a procedure under general anaesthetic and does carry risks.
The main risks include:
bleeding
infection
temporary bad breath or unpleasant nasal discharge
pain or discomfort in the throat, nose or ears
sickness after the anaesthetic
persistence of symptoms if there are other causes of nasal blockage
regrowth of adenoid tissue in a small number of children
rare injury to the lips, teeth or jaw from the instruments used to hold the mouth open during surgery
velopharyngeal insufficiency, which is a rare problem where the soft palate does not close properly against the back of the nose after surgery; this can make the voice sound unusually nasal and, in some cases, allow air or fluids to escape through the nose. This is usually temporary, although in a small number of cases it can last longer and may need further assessment
very rarely, a lasting change in the way the voice sounds
Bleeding after adenoidectomy is much less common than after tonsillectomy, but it can happen and should always be taken seriously.
Aftercare
Most children recover quite quickly after adenoid surgery, and most go home later the same day.
Pain relief
Discomfort is usually mild to moderate, particularly when compared with tonsil surgery. Simple pain relief is often enough for a few days. Some children may complain of a sore throat, earache, or mild neck discomfort.
Eating and drinking
It is important to encourage drinking little and often after surgery, and to return to a normal diet as soon as the child feels able. Good hydration helps recovery and usually makes children feel better more quickly.
What is normal after surgery?
It is common to notice:
a blocked or stuffy nose for a short time
snuffly breathing
a mild sore throat
bad breath
yellow or unpleasant-smelling nasal discharge for up to around 2 weeks
tiredness for the first few days
These symptoms are often part of normal healing and do not necessarily mean there is a problem.
Time off nursery or school
Many children are ready to return to nursery or school within a few days, although recovery does vary. A quieter few days at home is usually sensible before returning to normal activities.
Will surgery definitely solve the problem?
Not always. Adenoidectomy can be very effective when enlarged adenoids are a major part of the problem, but some children have more than one cause for their symptoms. Ongoing hay fever, allergic rhinitis, or other causes of nasal obstruction may still need separate treatment after surgery. In some cases, despite a good initial result, further treatment or additional surgery may be needed later on.
When should I seek urgent help?
Urgent medical assessment is advisable if your child has:
any bleeding from the nose or mouth
difficulty breathing
signs of dehydration
severe pain not settling with medication
a high fever or worsening illness
repeated vomiting or unusual drowsiness after the initial recovery period
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Disclaimer
This page is intended as general information only. It does not replace a consultation, examination or individual medical advice.