Weighing the Benefits and Risks of Adenoidectomy Surgery

An adenoidectomy is a surgery to remove your adenoids. They are a small patch of tissue that sits in the back of your throat behind your nose. This mass of tissue is part of your immune system, which helps to fight germs that cause illness.

Adenoids can become enlarged by the germs they catch. They should return to normal size when healthy but can remain swollen. This can cause problems that affect your breathing and how fluid drains from your ears. When this occurs, removing them may be advised.

Having adenoids removed can be done alone or combined with a tonsillectomy (surgery to remove your tonsils). Taking out adenoids is typically safe and comes with a low risk of side effects, though having tonsils and adenoids removed at the same time is a more complex procedure.

This article describes an adenoidectomy, the reasons it is done, the risks involved, and what to expect after it is done.

Enlarged Adenoids, Adenoidectomy, and Age of Removal

Enlarged adenoids may be present from birth or occur as a reaction to an infection. Enlarged adenoids is a common problem in children.

When adenoids swell in reaction to an infection, they typically return to normal size when the infection ends. However, they sometimes remain enlarged.

Enlarged adenoids do not always cause problems. Asymptomatic adenoids do not have to be removed. In some children, swollen adenoids can cause the following problems:

• Difficulty breathing through the nose
• Dry mouth, halitosis (bad breath), and/or cracked lips due to persistent mouth breathing
• Runny nose
• Loud breathing
• Restless sleep
• Sleep apnea (pauses in breathing during sleep)
• Snoring
• Frequent ear infections
  

Adenoid enlargement is a problem that occurs more often in children than adults. There is no standardized ideal age to remove adenoids. However, an adenoidectomy is regarded as an effective treatment for most children under age 7 whose symptoms indicate one of the following conditions:

• Nasal airway obstruction
• Ear disease
• Chronic rhinosinusitis (inflammation of the nasal passages and sinuses)

Most adenoidectomies are performed on children because adenoids become less of a problem as you age. The tissue begins to reduce in size after about age 5. In most people, adenoids practically disappear by the time they become teens.

Is There Any Reason Not to Go Through With Adenoidectomy?

While your symptoms may align with those of swollen adenoids, an adenoidectomy is not always the best solution. Before advising an adenoidectomy, your healthcare provider may monitor the swelling to determine its cause and how long it lasts.

You may not have to go through with an adenoidectomy if your swollen adenoids can be reduced with an over-the-counter or prescribed medication such as one of the following:

• Antibiotics
• Intranasal corticosteroids
• Leukotriene inhibitors such as Singular (montelukast)
• Nasal sprays

While an adenoidectomy in children is generally free of problems, the procedure carries some risks, both short-term and long-term, as follows.

Short-term risks include:

• Anesthesia complications
• Delayed healing
• Pain
• Infections
• Hemorrhage (highest risk is within the first 24 hours)
• Velopharyngeal insufficiency: Adysfunction of the structure that separates the nasal and oral cavities, resulting in poor speech, hypernasality (nasal sounds when talking), and nasal regurgitation (swallowed food or drink comes back up into your nose)
  

Long-term risks include:

• Atlantoaxial rotary subluxation : The loss of normal alignment and stability on the first (C1) and second (C2) cervical vertebrae, which causes your neck to lean to one side, with the highest risk in children with Down syndrome h
  
• Regrowth of adenoid tissue with the need to have a second adenoidectomy: Most common among children who have allergic disease or gastroesophageal reflux disease (GERD)
  

Adenoidectomy Surgery Preparation

Adenoidectomy surgery preparation helps ensure that you or your child reduces the risk of problems during and after surgery.

When surgery is scheduled, your surgeon will provide specific instructions to follow based on age and other medical conditions. Generally, adenoidectomy surgery preparation involves the following.

A week before the surgery:

• Stop using any medicines that thin the blood. Taking them can increase the risk of excessive bleeding before and after surgery. These medicines include aspirin and Advil or Motrin (ibuprofen).
• Use age-appropriate terms to talk to your child about what to expect when they go to have an adenoidectomy.

The night before the surgery, stop eating or drinking after midnight. This includes drinking water.

On the day of surgery, only use daily medicine prescribed by your surgeon.

How Long Does Adenoidectomy Take?

An adenoidectomy usually lasts between 20 and 30 minutes. After surgery, your child remains in the recovery room until they are awake and can breathe easily, cough, and swallow. Most children can go home an hour or two after their surgery concludes.

Post-Op Adenoidectomy Supplies

Your child will likely go home around two hours after their surgery ends. The timing for their release from the hospital or surgical center depends on how quickly they recuperate from anesthesia.

Review the post-op instructions from your healthcare provider about a week before the surgery so you know what to expect. Pain relief and hydration are important aspects of post-op care. You can help your child manage post-op pain and promote healing with the following post-op adenoidectomy supplies:

• Motrin (ibuprofen) and Tylenol (acetaminophen) for a sore throat or neck pain as directed by your healthcare provider
• Water, milk, and non-citrus fruit juices (avoid red-colored beverages, which can make it hard to monitor post-op bleeding)
  
• Thick beverages like milkshakes and smoothies
• Frozen foods like popsicles, ice cream, water ice, and frozen yogurt
• Soft foods like custard, pudding, Jell-O, yogurt, scrambled eggs, mashed potatoes, oatmeal, and applesauce
• Humidifier to moisten the air in your child's room

Adenoidectomy Recovery Timeline

While everyone recovers at their body's own rate, most children have a complete recovery from adenoidectomy in about two weeks. Pain and discomfort are most intense in the day or two immediately after surgery, then begin to improve.

A typical adenoidectomy recovery timeline may include the following:

Immediately after surgery and lasting up to 24 hours after surgery:

• Nausea
• Vomiting
• Light bleeding from the nose

Immediately after surgery and lasting up to seven to 10 days after surgery:

• Pain in the neck, ear, and/or throat that can be controlled with medication
• A small amount of drainage from the nose
• Stuffy nose and snoring
• Swollen tongue
• Low-grade fever of 100 degrees F to 101 degrees F
• Formation of scabs in your child's throat at about five to seven days post-surgery, then scabs fall off at about seven to 10 days after surgery

Immediately after surgery and lasting up to a month after surgery:

• Neck pain or throat pain that can be controlled with medication
• Bad breath
• Changes in your child's voice or snoring
• Changes in your child's normal speech pattern
  

Adenoidectomy Healing Complications

An adenoidectomy is considered a relatively safe surgery with a low rate of complications. Compared to an adenotonsillectomy (removal of adenoids and tonsils at the same time) complications of an adenoidectomy alone are infrequent.

However, every surgery carries the risk of healing complications. The following healing complications can occur after an adenoidectomy:

• Infection
• Bleeding
• Dehydration
• Breathing problems

Follow these guidelines to determine how to handle changes in your child's recovery that may indicate a healing complication:

Get immediate medical care if your child has the following reactions:

• Blood dripping out of the nose or coating their tongue for more than 10 minutes
• Bleeding from the mouth and/or nose after the first day post-op
• Vomit with blood or a substance that resembles coffee grounds
• Loss of consciousness
• Difficulty breathing
  

Contact your healthcare provider if your child has the following reactions:

• Fever of 101 degrees F or higher
• Vomiting after the first day post-surgery or after taking medicine
• Neck pain or neck stiffness that doesn't go away with pain medicine
• Difficulty turning the neck
• Refusal to drink
• Signs of dehydration (dry mouth, sunken eyes, no tears when crying, reduction in urine)

Adenoidectomy Follow-Up

Your healthcare provider will give you instructions on the requirements for your child's adenoidectomy follow-up care. This may involve an office visit a few weeks after surgery. It is important to attend any follow-up appointments even if your child seems to have healed without problems.

Summary

An adenoidectomy is usually done when adenoids become swollen and cause health problems. Taking them out can often provide relief from symptoms like nasal obstruction, sleep apnea, and chronic ear infections.

This treatment is most often done in children under age 7. Swollen adenoids become less of a problem with age. These glands shrink and almost vanish by the time most people become teens.

An adenoidectomy is viewed as safe, with a good prognosis for most children. It can often allow children to breathe better through their noses and get sounder sleep. They are also likely to have fewer sore throats and ear infections.