This article is on adenoidectomy. It is intended to help inform patients, relatives of patients and health professionals. The information in the grey boxes is more technical and intended more for Health professionals that are reading this article.

 

AdenoidectomyDefinition/What is adenoidectomy?

– Adenoids are small glands located in the back of the nose (please see page Adenoids, adenoiditis, and large adenoids for more detail)
– Adenoidectomy, or adenoid surgery, is the surgical procedure for removal of these glands
– Adenoid surgery (along with tonsil surgery) are among some of the most commonly performed operations

 

What are the indications?

Surgery may be recommended by a surgeon if the problem has not got better after a period of observation or with medications (where possible). There are a number of reasons why adenoid surgery may be recommended including:

– Some ear problems as adenoids may prevent the tube that connects the ear to the back of the nose (Eustachian tube) from working properly. This could cause ear infections or hearing loss.
– Large adenoids can block the back of the nose so that you can only breath through your mouth
– Large adenoids could cause significant snoring at night. Some children may even stop breathing for few seconds in their sleep (Obstructive sleep apnoea)
– In adults this operation may rarely be carried out if there are any suspicions for cancer in this area

 

What happens before surgery?

Only after meeting a surgeon and deciding to proceed with surgery would you be contacted to come in for surgery. What happens before surgery may vary from hospital to hospital. Often you or your child is asked not to eat or drink for a period (usually no more than 6 hours) prior to the surgery.

The anesthetist usually meets you prior to your surgery, often on the day of surgery. There may be a need for a blood test prior to proceeding with surgery.

 

What happens during surgery and how long does it take?

Once you or your child is asleep, adenoids are removed through the mouth or sometimes through the nose. There will be no cuts or stitches on the outside. Adenoids can be removed in a number of ways and a common method is through electrical cautery. Once adenoids are removed and the surgeon has stopped any bleeding, you or your child will go the recovery area to be watched carefully as they wake up from the anesthesia.

The duration of surgery depends if adenoid surgery is done on its own or combined with other procedures (e.g. tonsillectomy or grommets). The operation on its own can take up to 20 minutes. However, there are other steps such as pre-operative check, anesthesia time and recovery therefore the entire process may take several hours.

 

What are the risks?

Your ENT surgeon will explain all the risks of the surgery and also answer any questions prior to surgery. While adenoid surgery is very safe, every operation has small risks. Bleeding after the operation is the main risk (usually within the first 24 hours) which can occur between 1 in 100 or 1 in 200 patients.1

Nasal speech, where air escapes through the nose during speech, can rarely occur. In severe cases fluid can escape through the nose when drinking. This is referred to as “velopharyngeal insufficiency”. This is a rare complication (1 in 1200 to 1 in 1500 procedures), and if it occurs it usually resolves within a few weeks.2,3

Some people may experience pain, including ear pain which can usually be managed with simple pain relief. Many people will have bad breath (halitosis) which can last up to two weeks.

During surgery there is a small chance of injury to surrounding structures such as a chipped tooth or a small cut to the lip or mouth. Please let the surgeon know if there are any teeth problems. These usually don’t require any additional treatment.

 

Are there alternative options?

This depends on why the surgery may be recommended. Generally speaking, adenoids get smaller as we grow older. Surgery removes adenoids and therefore make these problems better sooner but it has small risk.

In some circumstances, medications such as steroid nasal spray or antibiotics may help. You should discuss the alternative options with your surgeon before you decide to proceed with surgery.

 

How long is the recovery?

Usually after adenoidectomy you are discharged on the day of surgery, provided you or your child is awake and comfortable enough to go home. Bleeding can be serious and therefore, while rare, if there are any evidence of bleeding please seek medical attention promptly.

In case of adenoid surgery alone recovery is usually quick, usually less than a week. During this time you or your child may feel tired for the first few days after the operation which is normal.

Initially your child’s or your nose may feel blocked, but should come right over a week or so. Pain should be managed though simple pain relief such as paracetamol or ibuprofen. Do not use Aspirin for pain relief in this setting as it can cause bleeding. There are no dietary restrictions after the operation and you are encouraged to eat normal food.

There is a small risk that adenoids may grow back with time.

 

Further reading:

https://emedicine.medscape.com/article/872216-overview

 

References:

1. Tomkinson A, Harrison W, Owens D, Fishpool S, Temple M. Postoperative hemorrhage following adenoidectomy. Laryngoscope. 2012;122(6):1246-53.
2. Stewart KJ, Ahmad T, Razzell RE, Watson AC. Altered speech following adenoidectomy: a 20 year experience. Br J Plast Surg. 2002;55(6):469-73.
3. Khami M, Tan S, Glicksman JT, Husein M. Incidence and Risk Factors of Velopharyngeal Insufficiency Postadenotonsillectomy. Otolaryngol Head Neck Surg. 2015 Dec;153(6):1051-5.

 

Author + Affiliation:
Dr Omid Ahmadi – ENT registrar Waikato Hospital

Date of Publication +/- Review:
Date of Publication: May 2021
Date of Review:

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