Adenoids and adenoidectomy
Introduction
What are the adenoids?
Adenoids are small lumps of tissue that are located at the back of the throat, above the tonsils. They are part of the immune system, which helps fight infection and protects the body from bacteria and viruses.
Adenoids are only present in children. The adenoids start to grow from birth, and reach their maximum size when your child is approximately 3-5 years old. By the time your child is seven years old, the adenoids start to shrink away, and by the late teens, they are barely visible. By adulthood, the adenoids will have disappeared completely.
The adenoids shrink and eventually disappear because they are not an essential part of the body's immune system. Although they may be helpful in young children, the body has much more effective ways of coping with infections and viruses.
You will not be able to see your child's adenoids by looking in their mouth. If your GP needs to see them, they can examine the adenoids using a light and a small mirror.
Why adenoids become swollen
Adenoids may become swollen or enlarged due to:
- Infection with bacteria or a virus. Although the infection will eventually clear up, the adenoids may remain enlarged.
- Allergies. Allergens (substances that trigger an allergic reaction) can sometimes irritate the adenoids, making them swell up.
- A problem at birth. Your child may have developed enlarged adenoids in the womb, so may have had them from birth.
What is an adenoidectomy?
An adenoidectomy is a quick operation to remove the adenoids. The operation carries very few risks. Removing the adenoids will not put your child at greater risk of developing infection. The body's immune system is perfectly able to cope with bacteria and viruses without the adenoids.
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Why is it necessary?
Sometimes, a child's adenoids can become swollen, or enlarged. For most children, this will only cause mild discomfort, and will not require any specific treatment. However, for some children, swollen, or enlarged, adenoids can cause severe discomfort and start to interfere with their daily life. In these cases, a GP may suggest the child has their adenoids removed (an adenoidectomy).
Breathing problems
Swollen adenoids can make it difficult for your child to breathe through their nose. Their nasal breathing may sound noisy, or make a rattling sound.
Your child may therefore begin to breathe through their mouth instead. However, can cause cracked lips and a dry mouth, which your child may find uncomfortable.
Difficulty sleeping
Swollen, or enlarged, adenoids can also make it more difficult for your child to sleep. Because breathing through their nose is difficult, they may snore, and their disturbed breathing may make it more difficult for them to fall asleep.
In severe cases of swollen, or enlarged, adenoids, some children may also experience sleep apnoea. Sleep apnoea is a condition which causes irregular breathing at night and excessive sleepiness during the day. It occurs when the upper airway collapses at regular intervals during sleep, temporarily cutting off the air supply.
Enlarged adenoids can make the throat narrower than normal, increasing the chance of the upper airway collapsing.
Glue ear
If your child's adenoids become swollen or enlarged, your child may develop problems with their ears and hearing. This is because the adenoids can press on the entrance of the Eustachian tubes.
These Eustachian tubes connect the middle ear to the back of the nose. They help to drain away any fluid which builds up in the middle ear, as well as maintaining air pressure within the ear.
When the Eustachian tubes are blocked, fluid can build up in the middle air. Over time, the fluid can become thick and glue-like, causing sounds coming into the ear to be muffled. This condition is known as glue ear.
If your child cannot hear sounds clearly, it may affect their learning, development, and social interaction. It is therefore important that glue ear is diagnosed and treated as soon as possible. An adenoidectomy will help the Eustachian tube to function normally, which should also help to treat your child's glue ear.
Other symptoms
Enlarged adenoids can also cause other symptoms, such as a constantly runny nose, or nasal sounding speech.
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How is it performed?
An adenoidectomy is usually performed by an ear, nose and throat (ENT) surgeon. The operation is a quick procedure, and carries very few risks.
Before the operation
If your child has had a cold, or sore throat, in the week before the operation, it is important to let your ENT surgeon know. The adenoidectomy may have to be postponed for a few weeks to ensure that your child has fully recovered, and reduce their risk of developing any complications as a result of the surgery.
How long will an adenoidectomy take?
An adenoidectomy usually takes between 15-30 minutes.
Adenoidectomies are normally carried out as day cases, and your child will usually only need to stay in hospital for a few hours after the operation, before being allowed to go home. However, if your doctor feels it is necessary, or if your child has not fully recovered from the procedure, they may have to stay in hospital overnight.
How are the adenoids removed?
An adenoidectomy is carried out under general anaesthetic, so your child will be asleep during the procedure, and will not feel any pain.
A special instrument is used to prop open your child's mouth, giving the surgeon access to your child's throat. Once the surgeon has located the adenoids, they will be removed, either by being scraped away using an instrument known as a curette, or by applying heat using a diathermy instrument . A diathermia instrument produces high frequency electrical currents, which emit heat waves.
After your child's adenoids have been removed, the diathermia may be used to seal the broken blood vessels and help stop the bleeding. A pack made out of gauze (thin, loosely woven cloth used for dressings) will then be applied to the skin, to make sure that the bleeding stops. Once the bleeding has stopped, the pack is removed and the operation is complete.
Tonsils
If your child has had severe or frequent bouts of tonsillitis (when the tonsils become infected with a virus, or bacteria) your child's ENT surgeon may recommend removing their tonsils at the same time as removing their adenoids. This means that your child will only have to undergo one procedure, reducing the risk of complications.
When the tonsils are removed at the same time as the adenoids, it is known as an adenotonsillectomy. The operation is a quick procedure and carries very few risks.
Grommets
If your child has had glue ear, as a result of their enlarged adenoids, a grommet insertion may also be carried out at the same time as an adenoidectomy.
Grommets are very small ventilation tubes which are inserted into your child's ear through a very small incision in their ear drum. They help drain away any fluid that build up in the middle ear.
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Risks
An adenoidectomy is a low-risk procedure, which rarely causes any complications. It is a relatively common operation, which is quick and easy to carry out. The possible problems are outlined below:-
Minor problems after surgery
Following an adenoidectomy, some children will experience minor health problems. However, most of these are only temporary, and rarely require further treatment. They can include:
- sore throat,
- earache,
- stiff jaw,
- blocked nose,
- bad breath (halitosis),
- change in voice (your child may sound like they are speaking through their nose).
Most of these symptoms will pass within 1-2 weeks. They should not last longer than four weeks. If your child is still experiencing side effects after this time, contact your GP for advice.
Allergy to the anaesthetic
With any surgery that requires an anaesthetic there is a risk of the patient experiencing an allergic reaction to the anaesthetic medication.
However, if your child has good general health, the chances of them experiencing a serious allergic reaction to the anaesthetic is extremely small (1 in 20,000).
Approximately 1 in 100 children are mildly allergic to anaesthetic, and 1 in 10 may experience some temporary symptoms such as a headache, sickness, or dizziness.
Bleeding
In a very small number of cases, the ENT surgeon may struggle to stop the bleeding after the adenoids have been removed. This kind of heavy bleeding is known as a haemorrhage. Less than 1 in 100 children will require emergency treatment to stop a haemorrhage. However, if it occurs, a haemorrhage has to be dealt with quickly in order to prevent your child from losing too much blood.
Infection
All surgery carries the risk of infection. The tissue in the area where the adenoids were removed from may become infected with bacteria. Following an adenoidectomy, your child may be prescribed antibiotics in order to help prevent an infection occurring.
When to contact your GP
You should contact your GP immediately if your child experiences the following symptoms shortly after their surgery:
- bright red bleeding from the mouth (for more than two minutes),
- a fever, or
- intense pain, that is not reduced by painkilling medicine.
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Recovery
Following an adenoidectomy, your child may feel groggy and sleepy, as a result of the anaesthetic. They will normally need to spend several hours in a hospital ward after the operation to ensure that they are recovering normally. Once the doctor is satisfied, your child will beable to go home.
Most children will find that their throat feels very sore following the procedure. This is perfectly normal. Your child will normally be given painkillers while they are in hospital to help ease any discomfort.
Pain relief
Once your child has returned home, they may still have a sore throat earache or stiff jaw. Although your child will have been given painkillers at the hospital, they may need more painkillers in the days after the operation.
Over-the-counter (OTC) painkillers, such as paracetamol, will normally be suitable. Younger children may find it easier to take liquid, or soluble, paracetamol, particularly if they have a sore throat. Make sure you always follow the dosage instructions on the packet. You should never give aspirin to a child who is under the age of 16.
Eating and drinking
Your child will normally be able to start drinking liquids 2-3 hours after the operation, and they can then begin eating several hours after that.
Because an adenoidectomy can leave your child with a sore throat, they may struggle to eat their normal diet. You should therefore encourage your child to eat soft, or liquid, foods, such as soups, or yoghurts, which are easier to swallow.
You may want to try giving your child a dose of painkilling medicine about an hour or so before they are going to be eating, as this may help to make it easier for them to eat and swallow their food.
It is also very important that your child drinks plenty of fluids, so that they do not become dehydrated.
When can my child return to school?
After your child has had an adenoidectomy, they will need to rest for several days, and will normally not be able to return to school for at least a week. It is important to keep your child off school in order to limit their contact with any viruses, or infections.
The skin and tissue where your child's adenoids used to be will take a while to heal. It is therefore important to try to prevent the wound from becoming infected because if it does it could lead to complications.
Try to keep your child away from smoky environments and from people with coughs, or colds. It is also advisable for your child not to go swimming during the first three weeks after their operation.
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