Adenoidectomy

Adenoidectomy – Surgery to Remove the Adenoids

Adenoidectomy is a surgical procedure in which enlarged adenoid tissue, or the pharyngeal tonsil, is removed. The adenoids are located behind the nose, in the upper part of the nasopharynx, and cannot be seen simply by looking into the mouth. Enlarged adenoids most commonly cause problems in children. They can make it difficult to breathe through the nose, cause mouth breathing, snoring and sleep-disordered breathing, and may also contribute to impaired middle ear ventilation and hearing problems. Adenoids are more prominent during childhood and usually gradually decrease in size with age.

How is an adenoidectomy performed?

The operation is performed under general anaesthesia. The adenoid tissue is removed through the mouth, so no external incisions are required on the face or neck. During the procedure, the ENT specialist removes adenoid tissue that obstructs the nasopharynx or contributes to other symptoms associated with enlarged adenoids. Duration of the procedure: usually approximately 20–30 minutes. However, the total time spent at the medical facility is longer because preparation for anaesthesia and postoperative observation are required.

Indications for adenoidectomy

An ENT specialist may recommend adenoidectomy if enlarged or chronically inflamed adenoids cause significant health problems. The most common indications include:

  • persistent difficulty breathing through the nose;

  • constant mouth breathing;

  • pronounced snoring;

  • sleep-disordered breathing or obstructive sleep apnoea;

  • chronic or recurrent inflammation of the nasopharynx;

  • chronic rhinosinusitis in selected cases;

  • recurrent middle ear problems;

  • accumulation of fluid in the middle ear, or otitis media with effusion, and associated hearing impairment;

  • situations in which adenoidectomy is performed together with tympanostomy or another ENT operation.

Adenoidectomy is often performed in children with nasal breathing difficulties and sleep-disordered breathing. In selected cases, it may be combined with other ENT procedures.

What symptoms may indicate enlarged adenoids?

A consultation with a paediatric ENT specialist is recommended if a child persistently experiences:

  • nasal blockage without significant nasal discharge;

  • regular mouth breathing;

  • snoring;

  • restless sleep;

  • pauses in breathing during sleep;

  • frequent ear infections;

  • reduced hearing;

  • persistent or recurrent runny nose;

  • a voice that sounds as though it is coming through the nose.

Snoring alone does not necessarily mean that surgery is required. The decision to perform adenoidectomy is made by the ENT specialist after assessing the child’s symptoms, examination findings and the degree of adenoid enlargement.

Preparing for surgery

Before adenoidectomy, the following are required:

  • a consultation with an otorhinolaryngologist (ENT specialist);

  • assessment of the patient’s general health;

  • endoscopic examination of the nose and nasopharynx, if required;

  • if hearing impairment or impaired middle ear ventilation is suspected – tympanometry, audiometry or other hearing tests;

  • preoperative investigations required before surgery and general anaesthesia, as instructed by the doctor and anaesthetist.

The treating doctor will provide the patient or the child’s parents with detailed instructions regarding the required laboratory tests, medication use, eating and drinking before surgery.

Adenoidectomy and tonsillotomy

Adenoidectomy is the removal of the adenoids, or pharyngeal tonsil.
Tonsillotomy is a partial reduction of the palatine tonsils. It is more commonly performed in children when the palatine tonsils are significantly enlarged and, together with enlarged adenoids, interfere with breathing, cause snoring or contribute to sleep-disordered breathing. If both enlarged adenoids and palatine tonsils are causing the problem, the ENT specialist may recommend performing both procedures during the same operation. During tonsillectomy, by contrast, the palatine tonsils are removed completely. The most appropriate type of surgery is determined by the ENT specialist, taking into account the patient’s age, symptoms, the size of the adenoids and tonsils, hearing status and other health problems.

Adenoidectomy and ear problems

Enlarged adenoids are located close to the openings of the Eustachian tubes in the nasopharynx. They can interfere with middle ear ventilation and contribute to fluid accumulation in the middle ear.

In children, this may present as:

  • frequent middle ear infections;

  • a feeling of blocked ears;

  • reduced hearing;

  • frequently asking others to repeat themselves;

  • listening to the television or other devices at a higher volume;

  • difficulties with speech and language development if hearing impairment persists for a long time.

In selected cases, adenoidectomy is performed together with the insertion of ventilation tubes, or grommets, into the eardrum. The need for adenoidectomy in these situations is assessed individually.

After adenoidectomy

After the operation, the patient is monitored at the medical facility. Whether the patient can go home on the same day or requires longer observation depends on their age, general health, the extent of the procedure and the doctor’s recommendations. During the first few days after surgery, the following may occur:

  • discomfort or mild throat pain;

  • a blocked nose;

  • temporary changes in the voice;

  • unpleasant breath;

  • a slight increase in body temperature;

  • a small amount of blood-stained nasal discharge.

It is important to drink enough fluids and follow the doctor’s instructions regarding diet, physical activity and medicines. Recovery after adenoidectomy is generally faster than after tonsillectomy, and many children gradually return to their usual daily routine within approximately one to two weeks. The specific recovery regimen is determined by the treating doctor.

When is urgent medical attention required after surgery?

Bleeding after adenoidectomy is uncommon, but it is one of the most important potential complications. If fresh, bright red blood appears from the nose or mouth, repeated vomiting of blood occurs, or the child’s general condition deteriorates rapidly, urgent medical attention should be sought immediately.