Adenoidectomy and Ear Tubes

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It is common for children to have adenoid removed and ear tubes inserted in one operation.

What are adenoids?

• The adenoid is a single mass of tissue located way in the back of the nose where the nose joins the throat.
• Although most people say “adenoids” as if there is more than one, we really have just one adenoid.
• The adenoid is part of our immune system. Our immune system helps us fight germs that cause illness. The adenoid however, is only a very small part of our immune system. Children who have their adenoid (and even the tonsils) removed do not, on average have more illnesses than children who “keep” their adenoid. In fact, some children will get fewer illnesses, like recurrent nasal infections, after their adenoid is taken out.

Why does my child need their adenoid removed?

There are a number of reasons that your provider may recommend removal of your child’s adenoid including:

1. To help your child breathe and sleep better if the adenoid is found to be large. If the child’s adenoid becomes too large, it can partially block a child’s breathing during sleep and this can cause snoring, restless sleep and overall sleep disturbance.
2. For frequent ear infections or chronic middle ear fluid. The adenoid is located next to the opening of the Eustachian tube in the back of the nose. A large adenoid or constantly infected adenoid can lead to poor Eustachian tube dysfunction. When the adenoid is removed, ear infections and fluid are less likely to occur.
3. A less common reason is for recurrent nasal infections. Some children have recurrent nasal infections with thick, green or yellow drainage. Sometimes this drainage gets better with antibiotics, but often returns when the antibiotics are stopped; this is a sign of chronic adenoid infection. Removing the adenoid can help this problem, but will not prevent the common cold or illnesses that cause nasal drainage.

How is the adenoid removed?

• Removal of the adenoid is a surgical procedure. This procedure is commonly referred to as “Adenoidectomy.” It is done by an ears, nose, and throat surgeon in the operating room under general anesthesia. The procedure itself usually takes 20-30 minutes.
• Although the adenoid is in the back of the throat, it is removed through the mouth and there are no visible scars after surgery.
• Unlike the tonsils, the surgeon cannot completely remove all adenoid tissue in the back of the throat/nose. It is possible for the adenoid to “grow back” and cause symptoms again. However, it is rare for a child to need the adenoid removed a second time.

What are ear tubes?

• Ear tubes are small plastic or metal tubes that are surgically inserted into the eardrum (also called the tympanic membrane.)

Why does my child need ear tubes?

• Ear tubes are recommended for children who either get lots of ear infections or have fluid behind the eardrum that doesn’t go away. Both of these problems are most common between the ages of 6 months and 3 years, although older children sometimes have these problems too.
• During an ear infection, fluid builds up behind the eardrum in a place called the middle ear space. Normally, when the ear infection has run its course the fluid drains out of the middle ear into the back of the nose through the body’s natural drainage tube called the Eustachian Tube.
• Sometimes the fluid doesn’t go away because the Eustachian Tube remains swollen and can’t open. Fluid trapped behind the eardrum causes a hearing loss because it prevents the eardrum from vibrating normally.
• Ear tubes also allow air to get into the middle ear. Just like the big bubbles in the water tank on top of a water cooler, air needs to get into the middle ear in order for the fluid to drain out. Over time, this “ventilation” helps to decrease swelling in the Eustachian Tube and allows it to function normally again. This is why ear tubes are sometimes called ventilation tubes or pressure equalizing tubes (PE tubes for short.)

How are ear tubes put in?

• Ear tubes are put in by an ears, nose, and throat surgeon. Using a microscope, a small incision is made in the eardrum. The tube is then placed through this hole.
• Since the tubes are very small, this is a delicate operation. Because children cannot hold still for this procedure it is performed in the operating room under general anesthesia. The procedure itself generally takes 5-10 minutes.

Ear drainage after ear tubes

Ear infections are still possible with ear tubes and you will notice drainage coming from the ears. If drainage is noted in one or both of your child’s ears, your ENT provider will give you a prescription for antibiotic ear drops.

• If ear drainage is noted, you can start the antibiotic ear drops at home and let the ENT team know that you have started ear drops via MyChildrens Portal or telephone the ENT clinic at 612-874-1292 on the next business day (Monday through Friday 8 a.m. to 4:30 p.m.)
• Please also contact the ENT clinic during normal business hours if the ear drainage is still present after a full 7 days of ear drops OR for back to back episodes of ear drainage

What can I expect after surgery?

• Children usually go home the same day after surgery, but in some cases your surgeon may require keeping your child in the hospital overnight.
• Once your child is ready to be discharged home, they will be instructed to:
  • Use acetaminophen and ibuprofen as needed for pain management.
  • Your child can eat their normal diet as tolerated
  • Encourage your child to drink plenty of fluids. This keeps the throat moist and helps with discomfort as well as helps to prevent dehydration.
  • Your child may return to regular activities after surgery.
  • Your child may return to school/daycare when they are feeling well and not requiring regular pain medications. Most children return to school/daycare within 1-3 days.

What are common symptoms after surgery?

• An upset stomach and possible vomiting in the first 24 hours after surgery
• Increased nasal congestion, snoring, runny nose, bad breath and neck soreness due to swelling after surgery. These symptoms will go away during the first 3 weeks after surgery.
• There may be watery, mucus-like, or bloody drainage from either ear for 2 or 3 days. Your doctor will give you a prescription for ear drops to use after surgery to help control the drainage and prevent the ear tubes from clogging.
• Ear pain (this is referred pain from the back of the throat) following adenoid removal or due to pressure changes in the ear and/or hearing louder sounds than he or she is used to following ear tube placement.
• Fevers up to 102.0 F are considered normal after surgery. Call your provider for fevers over 102.0 F that do not come down with acetaminophen (Tylenol) and/or Ibuprofen 
• Voice may sound different and this generally improves over 6-8 weeks
• Streaks of blood seen if your child sneezes or blows the nose are common during the first few hours and should be no cause for alarm
• Severe bleeding is rare after adenoidectomy. If your child coughs up, throws up, or spits out bright red blood or blood clots, bring him/her into the emergency room immediately.
• If you are concerned about dehydration (sunken eyes, dry and sticky lips, no urine for over 8 hours, and no tears) call the ENT clinic.

Questions?

The information provided in this brochure is not specific to your child. This information is provided as a service to our patients. The information is for educational and informational purposes only and should NOT be used as a substitute for the advice of your child’s physician. If you have any questions, please call Children’s ENT & Facial Plastic Surgery at 612-874-1292.

Reviewed 10/2022

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