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Adenoids and adenoidectomy

Overview

Adenoids are small lumps of tissue that are located at the back of the throat, above the tonsils. They are part of the body's 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. Once in 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.

 

What is an adenoidectomy?

 

An adenoidectomy is a short operation to remove the adenoids. Removing the adenoids will not put your child at a greater risk of developing infection. The body's immune system is more than able to cope with bacteria and viruses without the adenoids

Why it is necessary

 

 

 

Sometimes, your 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 more severe symptoms and significant discomfort. In these cases, the child's adenoids may have to be removed.

Why do adenoids become swollen or enlarged?

There are a number of factors which may cause your child's adenoids to become swollen or enlarged. These factors are outlined below.

  • Infection - your child's adenoids may become infected with either bacteria or a virus, which can cause them to become swollen. Although the infection will eventually clear up, the adenoids may remain enlarged.
  • Allergies - allergens can sometimes irritate the adenoids, making them swell up.
  • Congenital - your child may have developed enlarged adenoids while they were growing in the womb, and have had them from birth (congenital).


Breathing

Swollen adenoids can make it difficult for your child to breathe through their nose. When they do breathe through their nose, their breathing may sound noisy, or make a rattling sound.

This may make breathing through the nose difficult for your child, and they may begin to predominantly breathe through their mouth instead. However, only breathing through the mouth can cause cracked lips and a dry mouth, which your child may find uncomfortable.

Sleep

Swollen, or enlarged, adenoids can also make it more difficult for your child to sleep. Due to breathing through the nose being 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 (pharynx) 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 they can sometimes cause problems to develop with your child's ears and hearing. This is because the adenoids can press on the entrance of the Eustachian tubes. These 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, the vacuum of air which builds up draws fluid into the middle air cavity from the mucus that lines the rest of the ear. Over time, this fluid can become thick and glue-like, which may cause sounds coming into the ear to be muffled.

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.

If any of the symptoms, or problems, listed above start to significantly interfere with your child's daily life, or they are causing pain or discomfort, your GP may suggest that an adenoidectomy is the most appropriate form of treatment.

How it is 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 or complications.

 

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 and 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 heated (using an instrument called a diathermia). A diathermia produces high frequency electrical currents, which give out 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 been suffering from 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. An adenoidectomy is usually performed by an ear, nose and throat (ENT) surgeon. The operation is a quick procedure, and carries very few risks, or complications.

 

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 builds up in the middle ear.
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 that are inserted into your child's ear through a very small incision in their ear drum. They help drain away any fluid that builds up in the middle ear.

Recovery
 

Following an adenoidectomy, your child may feel groggy and lethargic, 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 be allowed 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 some painkilling medicine 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. They may also have other symptoms, such as earache, or a stiff jaw. Although your child will have been given painkilling medicine at the hospital, they may require further painkilling medicine 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 following their operation