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Adenoidectomy in childrenPublished by BUPA's health information team, healthinfo@bupa.com, September 2007. This factsheet is for parents of children who are having their adenoids removed. Adenoids are small lumps of tissue similar to the tonsils at the back of your child's throat, where the throat meets the back of the nose. Adenoidectomy is an operation to remove the adenoids. Your child's care will be adapted to meet their individual needs and may differ from what is described here. So it's important that you follow your doctor's advice.
What are the adenoids?Adenoids are small lumps of tissue in the back of the throat that help fight ear, nose and throat infections in younger children. It's thought that after age three they are no longer needed. Adenoids usually reach their maximum size when your child is between three to five-years-old, and then begin to shrink by age seven and can hardly be seen by the late teens.
Why have an adenoidectomy?When children have a cold or a throat infection the adenoids can become infected and swell up. They can block the nose and make it difficult for your child to breathe, especially when asleep. This can cause sleep problems, such as sleep apnoea or snoring. Swollen adenoids can also block the eustachian tube, which is a tube that connects the back of the throat to the middle part of the ear. Blockage of the eustachian tube can lead to ear infections and a build-up of sticky fluid in the ear - called glue ear. This can make it difficult for your child to hear properly and, as a result, can cause learning problems. Adenoidectomy along with a tube in your child's ear (grommets) is effective in the treatment of glue ear. Swollen adenoids are often associated with tonsillitis (infected tonsils) and may be removed as part of an operation to remove the tonsils. When both the adenoids and tonsils are taken out the procedure is called an adenotonsillectomy. DiagnosisYour doctor may examine the adenoids by looking in the back of your child's mouth using a light and mirror or a flexible telescope. X-ray images can also show enlarged adenoids. If your child suffers from sleep problems due to a blocked nose or has recurrent or persistent ear infections, your doctor may recommend that your child has an adenoidectomy. What are the alternatives to surgery?The adenoids will shrink as your child gets older, so an operation may not be necessary. An adenoidectomy removes the cause so the symptoms are relieved sooner than the child growing out of the problem. Ask your doctor if there are alternatives to surgery. Antibiotics only provide temporary relief and are not used for long-term treatment. Preparing for your child's operationAn adenoidectomy is usually done as a day-case, but sometimes your child may be kept overnight in hospital. If your child has a cold or infection in the week before the operation, please let the hospital know. The operation may need to be postponed until your child has fully recovered. The operation is always done under general anaesthetic. This means your child will be asleep during the procedure and will feel no pain. Typically, your child must not eat or drink for about six hours before a general anaesthetic. Often the operation will be planned for the morning, so that your child will only have to miss breakfast. When you and your child arrive at the hospital, a nurse will ask you questions about your child's general health. The nurse will also check that your child has not had anything to eat or drink and measure your child's heart rate and blood pressure. You must tell the nurse if your child has ever had any allergic or unusual reactions to medicines in the past. The doctor will usually visit your child before the operation. This is a good time to ask any questions. Please tell the doctor if your child has any loose teeth or any history of bleeding problems in the family. If you have parental responsibility for the child, you may be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead. About the operationThe operation takes 15 to 30 minutes. Once the anaesthetic has taken effect, the doctor will use special instruments to remove the adenoids from the back of the throat via the mouth. To stop the blood vessels in and near the adenoids from bleeding, a pack made up of gauze is applied with pressure by the doctor to the area where the adenoids are removed. When the bleeding stops the pack is removed and the operation is finished. Your child will be woken up from the anaesthetic once the bleeding has stopped. What to expect afterwardsYour child will be monitored for a short while and will need to rest on their side until the effects of the anaesthetic have passed. Your child will be groggy, and may feel or be sick. Your child may complain of a sore throat, and pain in their nose and ears. The doctor will usually prescribe painkillers for a day or two, and may send your child home with a week's course of antibiotics. Before you take your child home, you may be given an appointment for a follow-up visit. Recovering after an adenoidectomyOnce home, follow the doctor's advice about pain relief. You can usually give your child over-the-counter painkillers such as paracetamol or ibuprofen syrup (for example, Calpol or Calprofen). Follow the instructions in the patient information leaflet that comes with the medicine and ask your pharmacist for advice. Do not give aspirin to children under 16. It may be difficult, but your child must drink plenty of fluids so that they do not become dehydrated. Also get your child to eat. It's best to start with soft or liquid foods which are easier to swallow. Giving your child a dose of pain relief half an hour before meals may help make eating more comfortable. Encourage your child to brush their teeth thoroughly, as usual. Your child should rest for a few days and stay at home to avoid contact with possible infections at school. Also keep your child away from crowded and smoky places, and from people with coughs and colds. A small nosebleed is common after surgery. However sniffing or sneezing shouldn't cause any bleeding. Call your doctor if you have any concerns or if your child has any sign of bleeding in the nose or throat, develops a high temperature or complains of worsening pain. Adenoidectomy is an operation that has a good outcome, and you can expect your child to make a full and quick recovery once the initial pain has resolved. Complete recovery can take two weeks. What are the risks?Adenoidectomy is commonly performed and generally safe surgical procedure. 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-effectsThese are the unwanted, but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic. Common side-effects include:
ComplicationsThis is when problems occur during or after the operation. Most children are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding or infection. Antibiotics are usually prescribed to help prevent infection. Your child is always observed in hospital for a few hours after the operation. Bleeding after surgery is extremely rare. If there is excessive bleeding, your child may need to go back into theatre to have it stopped. Antibiotics may be prescribed to help prevent infection. There's a small chance a tooth may be chipped or knocked, your child's lips or roof of the mouth may be caught, or the joint in the jaw or the upper spine may be jarred or dislocated during the procedure. However, these complications are very rare. It's possible that there may be a long-term change in your child's voice caused by a defect in the muscle in the roof of the mouth. There's a small risk of eustachian tube injury which can cause problems such as glue ear. The exact risks will differ for every person, so we have not included statistics here. Ask your doctor to explain how these risks apply to your child. Further information
Sources
Related topicsThis information was published by BUPA's health information team and is based on reputable sources of medical evidence. It has been peer reviewed by ENT specialist Mr Michael Stearns, Mr Paul Tierney of Bristol ENT Partnership, and The Charity for Sick Children and BUPA doctors. The content is intended for general information only and does not replace the need for personal advice from a qualified health professional. Publication date: September 2007. Expected review date: July 2009.
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