The adenoids are part of a ring of lymph gland tissue at the back of the nose and throat. They sit at the back of the nose and, along with the tonsils at the back of the mouth, act as a filter to germs that enter in the air when you breathe in. The adenoids are not visible with the naked eye through the nose or mouth.
Adenoids usually shrink as we get older, but may cause problems in children — or in adults if they persist and/or grow too large. In this situation they may block the nose, and because of where they sit they may also obstruct the opening of the Eustachian tube. This may prevent air getting in and out of the middle ear and so cause symptoms of Eustachian tube dysfunction or glue ear (please see our Balloon Eustachian Tuboplasty and Glue Ear and Grommets leaflets).
As a result of enlarged adenoids, you or your child may breathe excessively through the mouth, snore at night, and in extreme cases have difficulty catching breath when asleep (obstructive sleep apnoea). There may also be a constantly runny nose, sometimes with continually mucky mucous.
In all these cases, the adenoids are no longer performing a useful function and are actually causing more harm than good. Reassuringly, removing them has been shown to have no effect on the ability to fight infection in this scenario.
In children, problems with the adenoids most often occur between the ages of about 4 and 8 years old. It is therefore a reasonable option to wait and see if things resolve spontaneously, if you wish. However, if your child has symptoms of obstructive sleep apnoea, the adenoids and the tonsils often have to be removed together, and this should be done without delay (please see our Tonsillectomy leaflet).
Before the operation
You will need to book one week off school or work for you or your child. If you, they, or anyone in your family has bleeding problems, or if you or they are taking medicines that thin the blood such as aspirin or warfarin, it is vital to tell your surgeon before the day of surgery. The operation will have to be postponed if you or they develop a cold or chest infection in the 14 days prior to surgery.
The operation
Adenoidectomy takes about 30 minutes and is performed through the mouth or the nose with you or your child asleep (general anaesthetic), as a day case — you or they are discharged home the same day. Patients will only be discharged from hospital when they are eating and drinking properly.
Adenoidectomy is safe, but there are a few small risks, as in all operations under a general anaesthetic. The risks we specifically warn about are:
- Damage to the teeth and lips, if the operation is carried out through the open mouth (please warn your surgeon and the anaesthetist if there are any loose teeth or crowns).
- Bleeding. This is very rare, as we employ the latest techniques using diathermy or coblation, and minimal bleeding occurs during surgery as the adenoid tissue is cauterised as it is removed. It can very unusually occur afterwards — either during the first 4 to 6 hours (in which case patients will still be in hospital, and usually need to return to theatre to stop it) or at home up to 10 days after surgery. The latter usually occurs if an infection happens, and is usually readily controlled with antibiotics.
After the operation
The operation is not usually that painful, but it is nonetheless important to use the painkillers and antibiotics prescribed to take home on discharge. Painkillers should be taken regularly up to the maximum prescribed dose, with the times interspersed if more than one is prescribed — do not wait for the pain to build before using them. Do not take aspirin or other aspirin-like drugs, as these may cause bleeding.
There may be some pain in the ears. This is not due to a problem in the ears as a result of the operation, but due to the shared nerve supply between the ears and the throat, causing the phenomenon of referred pain (in the same way that back pain is sometimes felt down the back of the leg in sciatica).
As the nose was previously blocked by the adenoids, the voice may sometimes sound a little different after surgery, as more of it is now produced through the nose. This may lead to slightly ‘nasal’-sounding speech (termed rhinolalia aperta), which usually settles quickly by itself.
It is important to drink plenty of fluids and eat as normal a diet as possible, in a ‘little and often’ fashion — avoid spicy foods, however. Ice cream and soft foods are more comfortable, but crunchier food will help keep the back of the throat cleaner. Chewing sugar-free gum keeps the mouth moist and the jaw muscles active, and may help recovery.
Avoid crowds, too many people, and definitely anyone with coughs or colds — the less risk of catching an infection, the better. Some discharge from the nose and bad breath is inevitable in the first few days, but should be kept under control by the antibiotics prescribed on discharge. If you or they start to feel feverish or unwell, or the discharge or bad breath becomes excessive, an infection may be developing, and it is wise to get a further or different course of antibiotics from your surgeon or GP as soon as possible.
If there is any bleeding, you or your child will need to be examined and may need to come back into hospital. Please call us via our secretary on 01622 232880 during office hours, and we will call you back as soon as possible. Out of hours, please call your GP emergency service or go to your local Accident & Emergency department as soon as possible.