Adenoidectomy

What conditions does Adenoidectomy treat? 

Adenoids can become enlarged and partially block the airway, causing a range of problems. An adenoidectomy may be recommended if your child has: 

• Persistent difficulty breathing through the nose, leading to mouth breathing or snoring 
• Sleep apnoea, where breathing briefly stops and starts during sleep, which can leave your child tired and irritable during the day 
• Glue ear, a build-up of fluid in the middle ear that causes hearing difficulties 
• Frequent ear infections 
• Recurring sinus congestion or nasal discharge that does not improve 
• Blocked eustachian tubes, the tubes that connect the middle ear to the back of the throat, causing pain and reduced hearing.

Adenoidectomy is most often performed on children between the ages of 1 and 7. After age 7, adenoids typically start to shrink on their own. The procedure can be carried out in older children and adults, though this is much less common. 

What are the benefits? 

Removing enlarged adenoids relieves the obstruction causing your child's symptoms and can improve their sleep, breathing, and ear health significantly. There is no reliable evidence that adenoid removal weakens the immune system. Adenoids are thought to help fight infection primarily in the first three years of life; after that, the body can manage without them. 

For children with glue ear, taking out the adenoids at the same time as inserting grommets (small tubes placed in the eardrum to drain fluid) appears to reduce the chances of the glue ear returning. 

Are there different approaches, and what can it be combined with? 

The surgeon removes the adenoids through the mouth or through the nose. There are no cuts or stitches on the outside of the skin. 

Removal techniques include a curette (a small scraping tool) or electrical instruments such as a heated wire or a coblation device, which use heat or radio frequency energy to remove the tissue. 

An adenoidectomy is sometimes performed at the same time as a tonsillectomy (removal of the tonsils) if your child also has frequent tonsillitis or significant difficulty breathing at night. It may also be combined with the insertion of grommets to treat glue ear at the same appointment. 

Are there alternatives to surgery? 

Your surgeon may suggest waiting, as adenoids often shrink naturally as a child grows. A steroid nasal spray can help reduce a blocked nose and may be worth trying before deciding on surgery.

Antibiotics are generally not recommended for adenoid problems, as they usually provide only short-term relief and there are concerns about antibiotic resistance. There is no evidence that treatments such as homeopathy or cranial osteopathy are effective for adenoid problems. 

Before the operation 

Tell your child's surgeon if your child develops a cold, sore throat, or any respiratory infection in the week before the operation. It will be safer to postpone by a few weeks until they have fully recovered. 

It is important to let the surgical team know if your child, or anyone in the family, has a history of unusual bleeding or bruising. This is needed for safe planning of the procedure. 

Also tell the team about: 

• Any loose, capped, or crowned teeth your child has, as there is a small risk of dental damage during surgery 
• Any known weakness in the roof of your child's mouth, as this affects how the operation is planned 

Your child will need to fast before the operation. As a general guide, children should stop eating solid foods at least 6 hours before surgery. The hospital will give you specific fasting instructions. 

Your child's team may ask you to stop giving medicines that can affect bleeding, such as aspirin or ibuprofen, in the days before surgery. 

Plan for your child to have at least a week off school or nursery after the operation. 

What happens during the procedure? 

The operation is performed by an ear, nose and throat (ENT) surgeon. Your child will be under general anaesthetic throughout, which means they will be fully asleep and will not feel any pain. 

1. Your child is given a general anaesthetic and goes to sleep
2. The surgeon accesses the adenoids through the mouth or nose – no cuts are made to the skin
3. The adenoids are removed using a curette (a small scraping tool) or electrical instruments that use heat or radio frequency energy to remove the tissue
4. Any bleeding is stopped using a heated tool that seals the area. 

Recovery from Adenoidectomy 

In hospital 

After the operation, your child will be taken to a recovery area while the anaesthetic wears off. Most children wake up within one to two hours. They will then be observed for around four to six hours before going home, to make sure they can breathe, cough, swallow, and eat or drink comfortably. 

Most children go home the same day as the operation. If there are any complications, they may need to stay in hospital overnight. 

At home 

Your child should recover within about a week to two weeks. During recovery, they may experience: 

• A sore throat and sore ears; ear pain is normal after the operation and does not usually mean there is an ear infection 
• A blocked nose, which typically clears within a week 
• Bad breath during the healing period 
• Nausea or an upset stomach, particularly in the first 24 hours 
• A raised temperature for the first day or two 
• Tiredness for the first few days 
• A temporary change to their voice, which usually returns to normal within a few weeks.

To support your child's recovery at home: 

• Give paracetamol or ibuprofen as directed on the packaging to manage pain; never give aspirin to children under 16 
• Encourage your child to eat normally as soon as they are ready, as eating helps the throat to heal; cold foods such as ice lollies and soft foods such as mashed potato can be soothing in the first few days 
• Make sure your child drinks plenty of fluids 
• Keep your child away from people with colds, coughs, or other infections 
• Avoid smoky environments, which can irritate the nasal passages.

Most children need about a week off school or nursery. 

Risks and complications 

Adenoidectomy is a common, safe operation and complications are rare. 

Known risks include: 

• Bleeding: The most serious risk. Bleeding that requires a second operation to stop it occurs in approximately 1 in every 200 procedures. Seek medical help immediately if you notice any bleeding from your child's throat or nose after they go home. 
• Dental damage: A very small chance of a tooth being chipped or knocked during surgery, particularly if teeth are loose, capped, or crowned. Tell the hospital about any such teeth before the operation. 
• Nasal regurgitation: A rare complication where fluids leak through the nose when swallowing. This usually settles on its own. It is more likely in children with a weakness in the roof of the mouth, which is why surgeons assess for this before operating. 
• Voice change: A small number of children find their voice sounds different after surgery, as though they are speaking through their nose. This usually resolves within a few weeks. If it does not settle, speech therapy can help. 
• Infection: Antibiotics can treat any infection at the site of removal. 
• Regrowth: The adenoids can occasionally grow back, though this is uncommon. A further operation may be needed if problems return. 
• Reaction to the anaesthetic: Rare, but a risk with any procedure carried out under general anaesthetic. 

When to seek urgent help