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 (also sometimes called the pharyngeal tonsil) is part of our immune system. Our immune system helps us fight germs that cause illness. You can think of the adenoid as a germ processing center. It helps our bodies learn to recognize different kinds of germs so that we can fight them better.
Will my child’s immune system be weaker if the adenoid is removed?
The adenoid is only a very small part of our immune system. It turns out that our immune system has many different ways of learning to recognize germs. Children who have their adenoid (and even the tonsils) removed do not, on average, have any 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 do some children need to have their adenoid removed?
There are actually quite a number of reasons that your doctor may recommend removal of your child’s adenoid.
Today, the most common reason that children have their adenoid removed is to help them breathe and sleep better. In some children, the adenoid becomes too big. This may happen for a variety of reasons, but we usually don’t know why it happens to a particular child. If the adenoid becomes too large it can partially block a child’s breathing during sleep. In severe cases, the adenoid can completely block the back of the nose! This will usually result in loud snoring and sometimes causes a child’s sleep to be very restless or fragmented resulting in poor concentration during the daytime, behavior changes, and sometime persistent bedwetting. This is known as sleep apnea. Removing the adenoid (and sometimes the tonsils too) makes this breathing much better. Sometimes just the adenoid needs to be removed and sometimes both the tonsils and adenoids need to come out to solve this problem.
Another common reason that children have their adenoid removed is because of frequent ear infections. The adenoid is located next to the opening of the Eustachian tube [yoo-STAY-shun] in the back of the nose. Normal Eustachian tube function is responsible for keeping our ears healthy. When the tube is blocked or inflamed, middle ear infections or middle ear fluid can result. A large or constantly infected adenoid can lead to poor Eustachian tube function. When this kind of adenoid is removed, ear infections and fluid are less likely to occur.
A less common reason to remove the adenoid is for recurrent nasal infections. Some children have recurrent nasal infections characterized by thick, green or yellow drainage that is present more or less all the time. Sometimes this drainage will improve with antibiotics, but often returns when the antibiotics are stopped. Left untreated for a long period of time this can even lead to chronic inflammation of the sinuses. Removal of the adenoid will often help manage this problem, although it will not prevent the common cold or every illness that causes nasal drainage.
How is the adenoid removed?
Removal of the adenoid (adenoidectomy) is a surgical procedure. It is performed by an ears, nose, and throat surgeon in the operating room under general anesthesia. In this day and age, general anesthesia is very safe and your child will be carefully monitored during the procedure. Although the adenoid is in the back of the nose, it is removed through the mouth and there are no visible scars following surgery. Unlike the tonsils, your surgeon cannot completely remove all adenoid tissue in the back of the nose (although today’s instruments allow us to do a pretty good job). It is therefore possible for the adenoid to “grow back” and cause symptoms again. However, it is quite rare for a child to need to have the adenoid removed a second time.
Are there any instructions I need to follow before surgery?
Your child must have a physical examination by his or her pediatrician or family doctor before surgery to make sure he or she is in good health. Although this exam can be done anytime within 30 days before surgery, we recommend having this exam as close to the day of surgery as possible. The doctor you see needs to complete the History and Physical form provided by our office. You must bring the completed form with you the day of surgery.
You should not give your child any pain or fever medication except Tylenol® (acetaminophen) for at least 3 days before surgery. Medicines like Children’s Motrin® and ibuprofen should be avoided before surgery, but ibuprofen may be used for pain control after surgery.
For your child’s safety, it is very important that he or she have an empty stomach when anesthesia is given. Please follow our preoperative Eating and Drinking Guidelines. If you do not follow these guidelines, your child’s surgery will be cancelled.
What can I expect after surgery?
The procedure itself usually takes 20 to 30 minutes. Your doctor will talk to you as soon as the surgery is over.
Your child will wake up in the recovery room after surgery. This may take 45 minutes to an hour. When your child is awake, he or she will be taken to the Short Stay post operative area to complete the recovery. You can be with your child once he or she has been transferred to this area.
Children usually go home the same day after surgery, but in some cases your doctor may recommend keeping your child in the hospital overnight (e.g., your child is under age 4 and had his or her tonsils removed). If your child does stay overnight, one parent is required to stay overnight too.
An upset stomach and vomiting (throwing up) are common for the first 24 hours after surgery.
If just the adenoid is removed (not the tonsils too) your child’s throat will be mildly sore for a day or two after surgery. Most children are able to eat and drink normally within a few hours after surgery, even if their throat hurts a little. It is very important that your child drink plenty of fluids after surgery. If your child complains of neck pain, throat pain, or difficulty swallowing you can give your child plain Tylenol® (acetaminophen) or Children’s Motrin® (ibuprofen). Prescription pain medications are not necessary.
Antibiotics are no longer routinely prescribed following adenoid surgery.
Your child may have a fever for 3-4 days after surgery. This is normal and is not cause for alarm.
Neck soreness, bad breath, and snoring are also common after surgery. These symptoms will also go away during the first 3 weeks after surgery.
How should I take care of my child after surgery?
It is important to encourage your child to drink plenty of liquids. Keeping the throat moist decreases discomfort and prevents dehydration (a dangerous condition in which the body does not have enough water). There are no specific dietary restrictions after adenoidectomy. In other words, your child can eat whatever you would normally feed him or her.
In most cases, your child may return to his or her regular activities within 1 or 2 days after surgery. There is no need to restrict normal activity after your child feels back to normal. Vigorous exercise (such as swimming and running) should be avoided for 1 week after surgery.
What else do I need to know?
Upset stomach and vomiting are common during the first 24 to 48 hours after surgery. If vomiting continues for more than 1 or 2 days after surgery, call our office.
Signs of dehydration include sunken eyes, dry and sticky lips, no urine for over 8 hours, and no tears. If your child has these signs you should call our office.
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 you should bring him or her to the emergency room at Children’s Hospital immediately. Although rare, this type of bleeding can occur up to 2 weeks after surgery.