Adenoidectomy

An adenoidectomy is a surgical procedure to remove the adenoids — a small pad of lymphatic tissue (part of the immune system) that sits at the back of the nose, above the roof of the mouth.

In children, the adenoids normally help fight infection. Sometimes they become permanently enlarged or chronically infected. When this happens, they block the airway behind the nose, making it hard to breathe through the nose, disrupting sleep, and allowing fluid to build up in the middle ear. Removing the adenoids relieves these blockages. The body's immune system continues to work normally without them, because other lymphatic tissue takes over.

An adenoidectomy is recommended when enlarged or infected adenoids are causing significant health problems that have not improved with other treatments such as antibiotics or nasal sprays.

• Chronic nasal obstruction — persistent blockage that forces the child to breathe through the mouth
• Obstructive sleep apnea (OSA) — repeated pauses in breathing during sleep caused by the enlarged adenoids blocking the airway
• Recurrent or chronic adenoiditis (repeated infections of the adenoid tissue) that do not respond to antibiotic treatment
• Glue ear (otitis media with effusion — sticky fluid behind the eardrum) that keeps coming back, often done together with the insertion of grommets (tiny drainage tubes placed in the eardrum)
• Recurrent middle ear infections linked to adenoid enlargement
• Nasal speech or a persistently 'blocked' voice quality affecting communication

An adenoidectomy may not be suitable in certain situations. The ear, nose and throat (ENT) specialist will carefully assess each patient before recommending surgery.

• A known cleft palate (a gap in the roof of the mouth) or certain abnormalities of the palate, because removing the adenoids can affect speech
• Very recent acute infection — surgery is usually postponed until the infection has cleared
• Bleeding disorders (conditions that prevent normal blood clotting) that are not well controlled
• General medical conditions that make a general anaesthetic (medication that puts the patient fully to sleep) unsafe

Adenoidectomy is a common and generally safe operation in children, but like all surgery it carries some risks that are worth understanding.

• Bleeding — a small amount of bleeding during or shortly after surgery is normal; heavy or delayed bleeding is uncommon but may require a return to the operating room
• Infection — the throat or surgical site can become infected after the procedure
• Reactions to general anaesthesia — nausea, vomiting, and grogginess are common after waking up; serious anaesthetic reactions are rare
• Temporary changes in the voice or speech — the voice may sound more nasal for a few weeks while the throat heals
• Velopharyngeal insufficiency (VPI) — a rare complication where air escapes through the nose during speech, making the voice persistently nasal; more likely if there is an underlying palate abnormality
• Regrowth of adenoid tissue — in a small number of cases, some adenoid tissue grows back, particularly in younger children, and symptoms may return
• Breathing or airway concerns during recovery from anaesthesia, especially in children who already have severe sleep apnea

Preparing a child well for adenoidectomy helps the procedure go smoothly and reduces the risk of complications. The surgical team will give specific instructions, but the following outlines what is typically expected.

Fasting (not eating or drinking) before the operation is essential because a general anaesthetic is used. In most hospitals, children are asked to stop all food and milk for several hours before the scheduled time, and to stop drinking clear fluids for a shorter period before the procedure. The exact fasting times will be given by the hospital team — it is important to follow them carefully.

Certain medications may need to be paused before surgery. Blood thinners are usually stopped in advance because they increase the risk of bleeding. The doctor or anaesthetist (the specialist who manages the anaesthetic) will review all medications the child is currently taking and advise on which to continue and which to pause. Parents should bring a full list of any medicines, vitamins, or herbal supplements the child takes.

If the child has an active cold, fever, or chest infection close to the operation date, the surgical team should be informed immediately, as the procedure may need to be postponed.

Before the operation, the team will usually carry out the following assessments:

• A physical examination of the nose, throat, and ears
• A review of any previous ear, nose, and throat investigations, such as hearing tests or nasendoscopy (a thin flexible camera passed through the nose to look at the adenoids)
• Blood tests to check general health and confirm normal blood clotting
• An anaesthetic assessment to identify any risks related to sedation

On the day of surgery, the procedure typically follows these steps:

• 1. The child is admitted and checked in by the nursing team.
• 2. The anaesthetist meets the child and family, explains the anaesthetic process, and usually gives the anaesthetic through a mask or an intravenous (IV) line — a thin tube placed in a vein.
• 3. Once the child is fully asleep, the surgeon passes small instruments through the mouth — no cuts are made on the skin.
• 4. The adenoid tissue is removed from the back of the nasal passage using one of several techniques, such as curette scraping, suction diathermy (using gentle heat to remove tissue and seal blood vessels at the same time), or other methods depending on the surgeon's preference and the child's anatomy.
• 5. The surgical site is checked to make sure bleeding has stopped.
• 6. The child is moved to the recovery area and woken from the anaesthetic under close monitoring.

Adenoidectomy is usually performed as a day-case procedure, meaning the child goes home the same day once the team is satisfied that they are eating, drinking, and breathing comfortably. Some children — particularly those with severe sleep apnea — may be kept overnight for monitoring. Recovery at home is generally straightforward, but it takes time for the throat to heal fully.

• Pain and discomfort: A sore throat and some ear pain (referred pain — discomfort felt in the ear even though the ear itself is not injured) are normal for up to one to two weeks. The surgical team will advise on appropriate pain relief suitable for the child's age.
• Eating and drinking: Cold or lukewarm soft foods and plenty of fluids are usually recommended in the first days. The child can usually return to a normal diet as comfort allows.
• Breathing and snoring: Many families notice an improvement in breathing through the nose within the first week. Snoring and mouth breathing often reduce quickly.
• Voice changes: The voice may sound more nasal for a few weeks as the throat and palate (roof of the mouth) adjust. This usually resolves on its own.
• Activity restrictions: In most cases, children are advised to rest for several days and to stay away from nursery, school, or crowded places for about one to two weeks to reduce the risk of catching an infection.
• Strenuous exercise: Contact sports and vigorous physical activity are usually avoided for a period advised by the surgeon.
• Wound care: There is no external wound to care for. A thin layer of white or yellowish coating at the back of the throat is normal healing tissue and will disappear on its own.
• When to seek urgent help: If the child has heavy or bright-red bleeding from the mouth or nose, a high fever, difficulty swallowing fluids, or signs of breathing difficulty, the family should seek medical attention immediately.
• Follow-up appointment: The ENT specialist will usually arrange a review appointment to check healing, hearing, and whether any further treatment — such as grommets — is needed.