Adenoid removal
Adenoidectomy; Removal of adenoid glands
Adenoid removal is surgery to take out the adenoid glands. The adenoid glands sit behind your nose above the roof of your mouth in the nasopharynx. Air passes over these glands when you take a breath.
The adenoids are often taken out at the same time as the tonsils (tonsillectomy).
Adenoid removal is also called adenoidectomy. The procedure is most often done in children.
Adenoids are masses of tissue located high on the posterior wall of the pharynx. They are made up of lymphatic tissue, which trap and destroy pathogens in the air that enter the nasopharynx.
The adenoids (lymphatic tissue in the back of the throat), along with the tonsils, comprise the Waldeyer ring.
Description
Your child will be given general anesthesia before surgery. This means your child will be asleep and unable to feel pain.
During surgery:
- The surgeon places a small tool into your child's mouth to keep it open.
- The surgeon removes the adenoid glands using a spoon-shaped tool (curette). Or, another tool that helps cut away soft tissue is used.
- Some surgeons use electricity to heat the tissue, remove it, and stop bleeding. This is called electrocautery. Another method uses radiofrequency (RF) energy to do the same thing. This is called coblation. A cutting tool called a microdebrider can also be used to remove the adenoid tissue.
- Absorbent material called packing material may also be used to control bleeding.
Your child will stay in the recovery room after surgery. You will be allowed to take your child home when your child is awake and can breathe easily, cough, and swallow. In most cases, this will be a few hours after surgery.
Maybe your child snores a lot. Maybe your child gets a lot of ear infections or has a lot of sore throats. Maybe your child needs to have his tonsils removed. If so, chances are your child also needs the adenoids removed. Let's talk about adenoid removal, or adenoidectomy. So, why do the adenoids need to be removed? The adenoids are glands, located between the airway your child breathes into through their nose, and the back of your child's throat. Like your child's tonsils, the adenoids can often become swollen. When this happens, your child's airway can become blocked, and he may have trouble breathing through his nose. Your child may even stop breathing at times during sleep. Typically, your child's doctor will use a special mirror to see if the adenoids are swollen. Your child may also need an X-ray. Often a child's swollen adenoids have been a problem for a while. The doctor may have tried to treat the chronic swelling with prescription medications, and if they are still causing problems, perhaps now it's time to remove them. So, let's go over what happens during an adenoidectomy. Your child will be given general anesthesia. He'll be unconscious and unable to feel pain. The surgeon will prop your child's mouth open with a small instrument, then remove the adenoid glands, and probably remove the tonsils as well. Your child will probably go home the same day as surgery. Complete recovery takes about one to two weeks. There might be some bleeding in your child's throat or mouth, so you'll want to encourage him to spit the blood out instead of swallowing it. Have him gently gargle often with baking soda mixed with water. Soft foods and cool drinks will make his throat feel better too. Adenoidectomy is one of the most common reasons children have surgery. But surgery doesn't have to be all bad. Your child can look forward to a steady diet of pudding, ice cream, and other soft and fun foods, until he feels better. And hopefully your child can look forward to fewer sore throats, ear infections, and more normal breathing, in the future.
Why the Procedure Is Performed
A health care provider may recommend this procedure if:
- Enlarged adenoids are blocking your child's airway. Symptoms in your child can include heavy snoring, problems breathing through the nose, and episodes of not breathing during sleep.
- Your child has chronic ear infections that occur often, continue despite use of antibiotics, cause hearing loss, or cause your child to miss a lot of school days.
Adenoidectomy may also be recommended if your child has tonsillitis that keeps coming back.
The adenoids normally shrink as children grow older. Adults rarely need to have them removed.
Risks
Risks of any anesthesia are:
- Reactions to medicines
- Breathing problems
Risks of any surgery are:
- Bleeding
- Infection
Before the Procedure
Your provider will tell you how to prepare your child for this procedure.
A week before the surgery, do not give your child any medicine that thins the blood unless your doctor says to do so. Such medicines include aspirin and ibuprofen (Advil, Motrin).
The night before the surgery, your child should have nothing to eat or drink after midnight. This includes water.
You will be told what medicines your child should take on the day of surgery. Have your child take the medicine with a sip of water.
When your child is having surgery it feels like a big deal. I know that as a Dad. But I'm also a pediatrician. I'm Dr. Alan Greene and I want to talk to you about how to prepare for tonsillectomy and adenoidectomy. Perhaps the first thing is preparing yourself because if you're feeling confident and good about the surgery, then everything will go much easier for you and for your child. And that means getting your questions answered beforehand. And in particular, the question I hear the most from parents is concern about the anesthesia. And that comes often from anesthesia risks that happened back when we were children. Anesthesia was much more dangerous than it is today. The problem was there weren't ways to monitor whether kids were getting enough oxygen to the brain or not. But since those monitors were developed about 20 years or so ago now, anesthesia has become incredibly safe - in fact, often safer than driving to the hospital. Now there other things that are important to do to prepare. First is to remember to take notice if your doctor has ordered any lab tests before the surgery. Perhaps blood tests, perhaps urine tests, maybe nothing was needed. But if it was, you want to make sure you've gotten it done before you end up going to the hospital. The second thing are instructions should've been given to you about when is the last time your child could eat or drink before heading to the hospital. Often it'll be midnight the night before, but whatever you were told be sure to take note of that and really don't cheat on this one. Nothing after what they say. And that leads to point number 3. Whatever medications that your child is taking, prescribed medicines, over-the-counter medicines, need to be taken into account. So, make sure you discuss with your physician, your anesthesiologist or the surgeon beforehand whatever medicines your child is taking and whether they should be taken or skipped after that deadline for food and drink. Next thing that's important, number 4, is to help your child select a favorite toy or stuffed animal, action figure to bring with them to the hospital. This little dog here or something that's comforting for them to have with them along the way. And it's a great idea before the whole thing depending on the age and temperament of your child to act out the whole scenario using their favorite toy. So, for instance, this little dog is not feeling well, hasn't been feeling well for awhile, has to take lots of medications, but the doctors are going to be able to fix it. Can't eat or drink anything after midnight - every step of it you go through. They're a little bit scared and they find out everything is fine and it worked out great and they get some ice cream afterwards and the problem is all gone. But to work it through with them so they get the story and it also helps you feel more prepared. I also suggest giving children something specific and fun to look forward to shortly after the surgery. It might be something as simple as a trip to the movies together or a trip to get ice cream but something that they can focus on. Take the focus a little bit off the surgery itself. Not a bad thing for you too. Then a couple of practical things. I do suggest that before going in you take off any jewelry that the child has, you bathe them, you get rid of even earrings that may stay in all the time or hair clips that may, you don't really want those at the hospital. And it's good to choose comfortable clothes when you go to the hospital, things that are easy on, easy off. It's not a fashion show. Although you may want some pictures of this cause it is a kind of historic moment. And lastly, if your child does develop any kind of fever or rash or cold beforehand, make sure to give them a call and let the folks know what's going on cause it may mean the surgery should be postponed. But the good news is that this kind of minor surgery today in children is extraordinarily safe and when it's done for the right child at the right time really helps move them ahead, move the family ahead. Most parents are really glad afterwards that the surgery has been done.
After the Procedure
Your child will go home on the same day as surgery. Complete recovery takes about 1 to 2 weeks.
Follow instructions on how to care for your child at home.
Now that your child's had a tonsillectomy or adenoidectomy what do you do when you go home? I'm Dr. Alan Greene and I want to give you some tips for going home with a child who's just had surgery. First thing to expect is your child's not going to be feeling great for a week or two, especially that first week they may still have pretty significant throat pain and may feel lower energy. So plan a pretty easy week or maybe 2 weeks after the surgery. When it comes to diet one of the most important things is getting plenty to drink. So you want lots of popsicles, fluids, juices, but avoid real citrusy or acidic juices. This isn't the time for lemonade. You also want foods that are soft going down and not crunchy or spicy. So things like jello can be good, ice cream. I still remember sherbet after my tonsillectomy when I was 4-years-old, it was wonderful. Pasta can be good, mashed potatoes, you want to avoid though toast. Toast is great after a tummy ache perhaps, but it can be really scratchy on the raw throat after a tonsillectomy. Also want to avoid really spicy foods. Now your doctor may have prescribed some medication, perhaps some for pain and perhaps some antibiotics and those should be taken regularly as prescribed. And you want to make sure and call your physician if the pain is severe and is not relieved by the pain medications that were given to you. Or if there is bright red bleeding. A little oozing afterwards is normal, but if there's a lot of bleeding it should be looked into. Or if there's real difficulty swallowing even those mashed foods or any difficulty breathing would be reasons to get back in touch with the doctor.
Outlook (Prognosis)
After this procedure, most children:
- Breathe better through the nose
- Have fewer and milder sore throats
- Have fewer ear infections
In rare cases, adenoid tissue may grow back. This does not cause problems most of the time. However, it can be removed again if necessary.
References
Schilder AGM, Rosenfeld RM, Venekamp RP. Acute otitis media and otitis media with effusion. In: Flint PW, Francis HW, Haughey BH, et al, eds. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Philadelphia, PA: Elsevier; 2021:chap 199.
Told TN. Tonsillectomy and adenoidectomy. In: Fowler GC, ed. Pfenninger and Fowler's Procedures for Primary Care. 4th ed. Philadelphia, PA: Elsevier; 2020:chap 66.
Wetmore RF. Tonsils and adenoids. In: Kliegman RM, St. Geme JW, Blum NJ, Shah SS, Tasker RC, Wilson KM, eds. Nelson Textbook of Pediatrics. 21st ed. Philadelphia, PA: Elsevier; 2020:chap 411.
Version Info
Last reviewed on: 11/29/2022
Reviewed by: Josef Shargorodsky, MD, MPH, Johns Hopkins University School of Medicine, Baltimore, MD. Also reviewed by David C. Dugdale, MD, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.
