Adenoidectomy – Potential benefits and risks

Adenoidectomy

Summary

An adenoidectomy is the surgical removal of the adenoid glands. These are located between the nasal airway and the back of the throat (nasopharynx). Adenoidectomies are frequently performed at the same time as removal of the tonsils, a procedure known as a tonsillectomy.

Sometimes, ear tube surgery (myringotomy) will be performed in conjunction with an adenoidectomy. This is done to prevent recurring ear infections, which can be caused by allergies. 

Adenoids may become chronically infected and enlarged, leading to the following conditions:

  • Breathing problems.

  • Swallowing problems.

  • Chronic bouts of tonsillitis.

  • Obstructive sleep apnea (OSA), a disorder that causes breathing to temporarily stop during sleep.

  • Chronic ear infections.

  • Recurring ear infections (otitis media).

  • Recurring sinus infections.

  • Chronic snoring.

Physicians may recommend adenoidectomy to help alleviate these conditions. The majority of adenoidectomies are performed in children. The adenoids usually shrink by adolescence, so adults rarely undergo adenoidectomies. Occasionally the procedure is performed on adults for snoring problems.

Adenoidectomies are usually performed on an outpatient basis. After a recovery period (usually one to two weeks), patients experience benefits such as easier breathing through the nose, fewer ear infections and fewer sore throats.

About adenoidectomy

An adenoidectomy is a surgical procedure to remove the adenoids (glands located in the back of the throat). It is usually performed on children over 4 years of age, and often occurs in tandem with removal of the tonsils (tonsillectomy). Sometimes, ear tube surgery (myringotomy) is performed in conjunction with an adenoidectomy. This is done to prevent recurring ear infections, which can be caused by allergies.

In children under 4 the procedure can be useful in treating sleep apnea (a disorder that causes breathing to temporarily stop during sleep).

Also known as nasopharyngeal tonsils, adenoids are masses of tissue similar to the lymph nodes located in the neck, groin and armpits. They are located high in the throat behind the nose and the roof of the mouth (soft palate). A physician needs special instruments, such as a small mirror or a special scope, to see the adenoids, which are not visible through the mouth. The adenoids and tonsils form a ring of glandular tissue (Waldeyer’s ring) that encircles the back of the throat.

Adenoids and tonsils are part of the body’s immune system. They filter out viruses and bacteria entering the body through the nose and help produce antibodies which fight infection. As a child grows older, the role of adenoids and tonsils in fighting infection becomes less important. Children who have them removed suffer no significant loss of immunity to infection.

Sometimes, the adenoids and tonsils can become infected (adenoiditis and tonsillitis). This can lead to enlargement of the adenoid and breathing or swallowing problems, chronic tonsillitis or recurring sinus and ear infections. When this happens, the tissue may need to be removed.

Although the procedure is rarely performed in adults, it may also be recommended to treat chronic snoring in older patients.

Before the adenoidectomy

Little preparation is needed before this procedure. However, since it is primarily performed on children, they may need reassurance and support. Parents should prepare their children for the surgery by asking them about their feelings and answering questions. Children should be told to expect a sore throat after the procedure, but also be reminded that the procedure will leave them feeling healthier in the long run. Children with asthma, upper respiratory infections and other conditions should be treated for the conditions before and after the procedure.

Children should be reassured that the surgery will not change their appearance or alter their body in any noticeable way. It may be helpful for children to discuss what to expect with friends or classmates who have undergone adenoidectomies.

Prior to scheduling the surgery, the physician should be informed if the patient or someone in the patient’s family has a history of reacting to anesthesia. In addition, the patient should disclose to the physician any of the following that apply:

  • Current medication regimen
  • Sickle cell anemia
  • Bleeding disorder
  • Pregnancy
  • Concerns regarding blood transfusions
  • Steroid use in the past year

As the surgery date draws closer, patients should take several precautions. Patients should refrain from taking aspirin or medications containing aspirin for two weeks prior to surgery. Nonsteroidal anti-inflammatory drugs such as ibuprofen or naproxen should not be taken for one week prior to surgery. Physicians may also recommend that these medications be avoided for the first one to two weeks following the procedure. Acetaminophen can be used instead. Often, a physician will prescribe pain relievers for the patient. Try to have these filled before the surgery, so they will be immediately available after the surgery.

Generally, patients are encouraged not to eat or drink anything beginning at midnight the day of the surgery. This includes water, gum, toothpaste and throat lozenges. Patients may vomit when anesthesia is introduced, and any contents that are in the stomach can make this dangerous. Patients should not wear any jewelry to the hospital.

During the adenoidectomy

Upon arriving at the hospital, the patient and family may meet with members of the surgical team to discuss the procedure and the patient’s medical history. The patient is then given intravenous fluids and an anesthetic.

Once the patient is properly sedated with general anesthesia, the surgeon inserts a small instrument into the mouth to keep it open. Adenoid tissue is then removed with an instrument such as a curette or a microdebrider, or a cautery (burning instrument). Packing helps control bleeding.

There are no external incisions in an adenoidectomy. The entire procedure usually takes less than 45 minutes. Children with loose baby teeth may have them removed during the procedure if necessary.Patients also may undergo a tonsillectomy at the same time as the adenoidectomy procedure. In this procedure, the tonsils are cut away much like the adenoids are in the adenoidectomy. If chronic ear infections are a problem, the patient may also have tubes installed in the ears during a procedure known as myringotomy.

After the adenoidectomy

Adenoidectomy is performed on an outpatient basis and generally does not require a hospital stay. Most children are released within several hours after the surgery. Occasionally, an overnight hospital stay may be required if there is excessive bleeding or the child is unable to drink liquids. Children with seizure disorders or certain chronic diseases may also require an overnight stay.  

Complete recovery from surgery generally takes one to two weeks. During that time, the patient may experience the following:

  • Stuffiness
  • Sore throat, especially when eating
  • Nasal drainage
  • Nasal congestion
  • Ear pain during swallowing
  • Jaw spasms
  • Bad breath
  • Snoring
  • Sleepiness
  • Headache
  • Nausea
  • Vomiting

These symptoms may linger for weeks or months after the surgery. Throughout the recovery process, patients should drink plenty of fluids to keep the throat moist and prevent body dehydration. At minimum, a patient should drink enough fluid to cause them to urinate every eight hours. After surgery children should be encouraged to sneeze with an open mouth to prevent pressure buildup.

For the first 24 hours following surgery, patients should consume only cool, clear liquids such as apple juice, water, gelatin and flavored ice.  Broth can also be consumed as long as it is not too hot and it does not contain noodles.  Red foods and liquids should be avoided, because they may be mistaken for blood if a patient’s upset stomach causes them to vomit. Patients should avoid using straws.

On the second day, patients may consume dairy products and soft foods such as ice cream, milk shakes, smooth yogurt, pudding, mashed potatoes and scrambled eggs.

A soft diet is advisable for one to two weeks after the surgery. Foods with rough edges should be avoided, including chips, crackers, hard candies, pretzels, popcorn and pizza crusts. Spicy foods or those hot in temperature should also be avoided.

Patients should rest for the first few days following surgery and slowly increase activity as they feel up to it. Exercise, heavy or rough play and swimming are prohibited for three weeks, and diving should be restricted for two months. Because of the potential risks, patients should not travel for three weeks following surgery.

Children often experience a slight change in the tone of their voice following surgery. This is normal and usually temporary.

Potential benefits and risks of adenoidectomy

The benefits of an adenoidectomy should become apparent soon after the procedure. Most children will breathe easier through the nose following the surgery. They will also experience fewer ear infections and sore throats. Although the adenoids and tonsils are part of the immune system, children who have them removed suffer no loss of resistance to illness.

Risks associated with adenoidectomies are mostly those connected to any type of general surgery. They include:

  • Bleeding
  • Infection
  • Reactions to anesthesia, including breathing problems

Other risks of the procedure are rare. These include:

  • Velopharyngeal insufficiency. This occurs when the soft palate muscle at the back of the mouth does not close properly.
  • Torticollis (twisted neck). Rarely patients may experience a stiff neck or neck spasm after the procedure.
  • Atlantoaxial subluxation. An infection or inflammation of the postnasal space may require consultation with a neurosurgeon.
  • Mandible (jaw bone) fracture.
  • Injury to the eustachian tube (auditory tube in the middle ear).

A physician should be notified if the following symptoms appear after surgery:

  • Sudden increase in nosebleeds that is not relieved by pressure, ice and head elevation.
  • Bleeding from the mouth.
  • Persistent fever greater than 101.5 degrees Fahrenheit (38 degrees Celsius).
  • Persistent sharp pain or headache that does not respond to pain relievers.
  • Increased swelling or redness of the nose or eyes.
  • Persistent nausea and vomiting.

Emergency medical attention should be sought for patients experiencing the following after surgery:

  • Vomiting of blood
  • Shortness of breath or difficulty breathing

Because the adenoids are located above and behind the soft palate, they can be difficult to see clearly. This difficulty is compounded by the fact that an adenoidectomy often causes a great deal of bleeding in the area. For this reason, tissue is sometimes left behind during the surgery. In rare cases, remaining adenoid tissue can later grow.

In most cases, this regrowth does not cause problems. However, in rare situations, a second adenoidectomy may have to be performed.

Questions for your doctor

Preparing questions in advance can help parents to have more meaningful discussions with their child’s physicians. Parents may wish to ask their child’s doctor the following questions regarding adenoidectomy:

  1. Why are you recommending that my child undergo an adenoidectomy?
  2. Can you explain the procedure to me in detail?
  3. What risks will my child face if he/she undergoes an adenoidectomy?
  4. Are there any alternatives available to my child?
  5. Will my child have to stay in the hospital following the procedure?
  6. What are the chances that the procedure will be successful for my child?
  7. What is the next step for my child if the procedure is unsuccessful?
  8. Are there any special steps my child needs to take on the day of the procedure?
  9. How should I expect my child to feel in the days following the surgery?
  10. How long will it take my child to fully recover from the adenoidectomy?
  11. What is the best way to prepare my child for the procedure?
  12. How soon after the procedure can I feed my child? What foods should I feed my child?
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