What Is An Adenoidectomy (adenoid removal)?

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Adenoidectomy(adenoid removal)

Adenoidectomy is the surgical removal of the adenoid for reasons which include impaired breathing through the nose, chronic infections, or recurrent earaches. The surgery is less commonly performed in adults in whom the adenoid is much smaller and less active than it is in children. It is most often done on an outpatient basis under general anesthesia. Post-operative pain is generally minimal and reduced by icy or cold foods.

The procedure is often combined with tonsillectomy (this combination is usually called an “adenotonsillectomy” or “T&A”) and recovery time can range from several hours to two or three days (though as age increases so does recovery time).

Adenoidectomy is not often performed under one year of age as adenoid function is part of the body’s immune system but its contribution to this decreases progressively beyond this age. Adenoid removal, also called an adenoidectomy, is a common surgery to remove the adenoids. The adenoids are glands located in the roof of the mouth, behind the soft palate where the nose connects to the throat.

The adenoids produce antibodies, or white blood cells, that help fight infections. Typically, the adenoids shrink during adolescence and may disappear by adulthood. Doctors often perform adenoid removals and tonsillectomies — removal of the tonsils — together. Chronic throat and respiratory infections often cause inflammation and infection in both glands.

What Is An Adenoidectomy (adenoid removal)?

What Is An Adenoidectomy (adenoid removal)?

Adenoidectomy is a surgical procedure that involves the removal of the adenoids, small glands located at the back of the throat. This type of surgery is often performed in conjunction with the removal of the tonsils, a procedure called a tonsillectomy. Adenoid removal is most frequently performed on children to help alleviate symptoms associated with breathing difficulties or persistent ear infections. Before a child undergoes this type of surgery, a parent or caregiver should discuss the potential side effects of adenoidectomy with a physician.

What Are the Symptoms of Adenoiditis?

Symptoms of adenoiditis can vary depending on what is causing the infection, but may include:

  • sore throat
  • stuffy nose
  • swollen glands in the neck
  • ear pain and other ear problems

When the nose is stuffy, breathing through it can be a challenge. Other symptoms of adenoiditis related to nasal congestion include:

  • breathing through the mouth
  • speaking with a nasal sound, as if you are speaking with a pinched nose
  • difficulty sleeping
  • snoring or sleep apnea (a condition where you stop breathing for a short amount of time during sleep)

What are the benefits of an adenoidectomy?

The benefits of surgery are relief from a blocked or runny nose and, for some children, better quality of sleep. It may also improve the quality of your child’s voice and can help children suffering from glue ear by reducing the risk of fluid collecting in the middle ear.

Are there any alternatives to surgery?

There are no other treatments for enlarged adenoids other than to leave them alone and wait for the problem to go away. If your child’s breathing is blocked during sleep, this can be serious and you should not put the operation off.

What does the operation involve?

The operation is performed under a general anaesthetic and usually takes about twenty minutes. Your surgeon will remove the adenoids through your child’s mouth. They will place a pack in the back of the nose until the bleeding stops.

What complications can happen?

  • Pain
  • Bleeding
  • Infection

How soon will my child recover?

Your child should be able to go home the same day or the day after. They will need two weeks off school to avoid catching an infection that could lead to bleeding. Most children make a good recovery.

Why might my child need a tonsillectomy and adenoidectomy?

Healthcare providers are not in complete agreement about when a child should have a tonsillectomy or adenoidectomy. But here are some guidelines that are followed.

  • Tonsillectomy
  • A tonsillectomy may be recommended if your child has throat infections that keep coming back. A throat infection means your child has a sore throat with fever. Or he or she also has swollen neck glands or drainage from the tonsils. Or your child also has a positive strep test. Your child has any of the following:
  • 7 or more throat infections in 1 year
  • 5 or more throat infections in each of 2 years
  • 3 or more throat infections in each of 3 years

A tonsillectomy may also be recommended if your child has recurrent throat infections and any of these:

  • Is unable to take antibiotic medicine or has antibiotic medicine allergies
  • Has episodes of fever, sores in the mouth, sore throat, and swollen neck glands
  • Has had an infected area near the tonsils
  • A tonsillectomy may also be recommended if your child has:

Abnormal breathing while sleeping with enlarged tonsils. This might be brief episodes where your child stops breathing.

Very large tonsils that block breathing through the nose or cause difficulty swallowing

Adenoidectomy

What Is An Adenoidectomy (adenoid removal)?

What Is An Adenoidectomy (adenoid removal)?

Adenoidectomy is recommended if your child has a lot of trouble breathing through the nose. It may also be recommended if your child has:

  • A long-term (chronic) sinus infection
  • Middle ear infections that keep coming back
  • A chronic middle ear infection with fluid and already has ear tubes

What is a tonsillectomy and adenoidectomy for children?

Your child may have been referred to an ear, nose, and throat surgeon (ENT) to have the tonsils and adenoids removed. This surgery is called a tonsillectomy and adenoidectomy. Often the tonsils and adenoids are removed at the same time. But sometimes only one or the other is removed. Your child’s ENT will discuss this with you.

The tonsils are tissue located on either side of the back of the throat. The adenoids are located behind the nose and at the top (roof) of the mouth. Both the tonsils and adenoids are part of the immune system, the part of the body that fights infection and disease.

Why might my child need a tonsillectomy and adenoidectomy?

Healthcare providers are not in complete agreement about when a child should have a tonsillectomy or adenoidectomy. But here are some guidelines that are followed.

  • Tonsillectomy
  • A tonsillectomy may be recommended if your child has throat infections that keep coming back. A throat infection means your child has a sore throat with fever. Or he or she also has swollen neck glands or drainage from the tonsils. Or your child also has a positive strep test. Your child has any of the following:
  • 7 or more throat infections in 1 year
  • 5 or more throat infections in each of 2 years
  • 3 or more throat infections in each of 3 years

How do I get my child ready for a tonsillectomy and adenoidectomy?

Your child’s healthcare provider or ENT may want to do some tests before surgery. If your child has problems while sleeping, a sleep study may be done.

The ENT will explain the surgery and answer any questions. Make sure you talk with your child’s ENT about:

Any medicines that your child should not take before surgery. This includes over-the-counter medicines.

When your child needs to stop eating and drinking. For example, it is common not to eat or drink after midnight the night before surgery.

When your child needs to arrive at the hospital or facility

What to expect and how to care for your child after surgery

When your child can get back to normal activities, including returning to daycare or school

And if your child gets sick before surgery, call his or her ENT. Surgery may need to be rescheduled.

What happens during a tonsillectomy and adenoidectomy for a child?

Your child will probably have the surgery as an outpatient. That means that he or she will go home the same day as the surgery. The surgery usually takes between 30 and 45 minutes. Your child will get medicine to sleep during the surgery (general anesthesia). Some children may need to stay overnight.

This may include children who:

  • Are not drinking well after surgery
  • Have other health problems
  • Have complications after surgery, such as bleeding
  • Are younger than age 3
  • Have sleep apnea diagnosed by a sleep study
  • In general, the surgery will go as follows:
  • Your child will be given general anesthesia.
  • Medicines and fluids will be given by IV.
  • The ENT will remove your child’s tonsils and adenoids through the mouth. There will be no cut on the skin.

What happens after a tonsillectomy and adenoidectomy for a child?

  • After the surgery, your child will go to a recovery room where he or she can be watched closely.
  • Your child will receive medicine for pain.
  • After your child is fully awake, a nurse will bring your child back to the day surgery area.
  • Your child’s throat will be very painful for the first 2 days. Pain may last up to 2 weeks.
  • Instructions for caring for your child at home may include:
  • Making sure your child drinks well. This helps to prevent dehydration and helps to lessen pain. Stay away from milk, orange, and other citrus juices.
  • Giving pain medicine. Your child’s ENT will tell you what to give your child. Call your child’s ENT if you are unable to control your child’s pain.
  • Giving your child soft, warm foods to eat. Avoid hard and spicy foods.
  • Letting your child be active while at home. He or she should stay away from heavy or rough play. Your child’s ENT will tell you when your child can go back to all normal activities.
  • Staying away from others with colds or other respiratory infections.
  • Make sure you take your child to all follow-up appointments with the ENT. And call the ENT if your child is not getting better, or if you have any questions or concerns.

Next steps

Before you agree to the test or the procedure for your child make sure you know:

  • The name of the test or procedure
  • The reason your child is having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • When and where your child is to have the test or procedure
  • Who will do the procedure and what that person’s qualifications are
  • What would happen if your child did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and how will you get the results
  • Who to call after the test or procedure if you have questions or your child has problems
  • How much will you have to pay for the test or procedure
  • Caring for your child at home
  • Pain
  • Your child will have some pain after the operation.

Your child will have a sore throat. She may also have an earache, which is caused by the sore throat. Five or 6 days after the operation, your child’s sore throat or earache may get worse for a short time. This is normal.

Your child may also have a stiff neck. If this becomes bad, call your doctor.

Follow these instructions when your child goes home after the procedure.

You may give your child medicine for pain.

You may receive a prescription for pain medication before you leave the hospital. Follow the dosage instructions give to you by the pharmacist. Although these prescription pain medications can be beneficial, they are also potentially very dangerous if not used properly.

When using these medications, if you notice any changes in either breathing or level of drowsiness that concern you, stop the medication and seek medical attention. If your child is unresponsive, call 911 immediately.

Do not give your child over-the-counter medicine that may have a sedative effect (makes people sleepy) while giving the prescription for pain medicine. Examples of these medicines are decongestants and antihistamines. Discuss these medications with your pharmacist.

You may give your child acetaminophen (such as Tylenol or Tempra) if he has pain. Give the dose printed on the bottle for your child’s age. Do not give your child ibuprofen (Motrin, Advil, or Midol) or ASA (Aspirin) for 2 weeks after the surgery. These medications could increase your child’s risk of bleeding after the operation. Check with the nurse or doctor first before giving these medicines to your child.

Adenoidectomy surgery facts

Adenoidectomy is a surgical procedure performed to remove the adenoids.

Adenoids are a mass of lymphoid tissue located behind the nasal passages.

All surgical procedures have risks and potential complications.

Understanding what is involved before, during, and after adenoidectomy can help your child (and you) recover from the surgery as easily as possible.

Pediatric adenoidectomy

Your doctor has recommended an adenoidectomy for your child. The following information is provided to help you prepare for the surgery, and to help you understand more clearly the associated benefits, risks, and complications. You are encouraged to ask your doctor any questions that you feel necessary to help you better understand this procedure.

The adenoids are a mass of lymphoid tissue located behind the nasal passages. Adenoids may become infected and  remain enlarged or chronically infected, and subsequently lead to obstructed breathing, snoring/sleep apnea, sinus or ear infections, or other problems. Adenoidectomy is a surgical procedure performed to remove the adenoids.

These instructions are designed to help your child (and you) recover from the adenoidectomy as easily as possible. Taking care of your child can prevent complications. Your doctor will be happy to answer any questions that you have regarding this material. If your child is having ear tube surgery (myringotomies and tympanostomy tubes placed) in conjunction with his/her adenoidectomy, please visit the following article for further information: Myringotomy.

Before adenoidectomy surgery

In most situations, the surgery is performed as an outpatient at either the hospital or the surgicenter. In both facilities, quality care is provided without the expense and inconvenience of an overnight stay. An anesthesiologist will monitor your child throughout the procedure. Usually, the anesthesiologist will call the night before surgery to review the medical history. If he/she is unable to reach you the night before surgery, he/she will talk with you that morning. If your doctor has ordered preoperative laboratory studies, you should arrange to have these done several days in advance.

Your child should not take aspirin, or any product containing aspirin, within 10 days of the date of your surgery. Non-steroidal anti-inflammatory medications (such as ibuprofen/Advil or naproxen/Aleve) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or non-steroidal anti-inflammatory type drugs, so it is important to check all medications carefully. If there is any question, please call your doctor’s office or consult your pharmacist. Acetaminophen/Tylenol is an acceptable pain reliever. Often, your doctor will give you several prescriptions for post-operative pain at the visit BEFORE the operation. It is best to have these filled prior to the date of your surgery.

It is advised that you be honest and up front with your child as you explain his/her upcoming surgery. Encourage your child to think of this as something the doctor will do to make them healthier. Let them know they will be safe and that you will be close by. A calming and reassuring attitude will greatly ease your child’s anxiety. You can assure them that most children have minimal pain following an adenoidectomy. Let them know that if they do have pain, it will only be for a short time, and that they can take medicines which will greatly reduce it.

Your child must not eat or drink anything 6 hours prior to their surgery time. This even includes water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication.

If your child is sick or has a fever the day before surgery, call the doctor’s office. If your child wakes up sick the day of surgery, still proceed to the surgical facility as planned. Your doctor will decide if it is safe to proceed with surgery. However, if your child has chickenpox, do not bring your child to the office or to the surgical facility.

The day of adenoidectomy surgery

It is important that you know precisely what time you are to check in with the surgical facility, and that you allow sufficient preparation time. Bring all papers and forms with you, including the preoperative orders and history sheets. Your child is to wear comfortable loose fitting clothes (pajamas are OK). Leave all jewelry and valuables at home. He or she may bring a favorite toy, stuffed animal, or blanket.

During adenoidectomy surgery

In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication for the general anesthetic. In most situations, an IV will have been started either in the preoperative holding room or after the child has been given a mask anesthetic. During the procedure, your child will be continuously monitored by pulse oximeter (oxygen saturation) and heart rhythm (EKG). The surgical team is well trained and prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room.

After the anesthetic takes effect, the doctor will remove the adenoids through the mouth. There will be no external incisions. The base of the adenoids will be cauterized with an electrical cauterizing unit. The whole procedure usually takes less than 45 minutes. Your doctor will come to the waiting room to talk with you once your child is safely in the recovery room.

After adenoidectomy surgery

After surgery, your child will be taken to the recovery room where a nurse will monitor him/her. You will probably be invited into the recovery room as your child becomes aware of their surroundings and starts looking for you. Your child will be able to go home the same day as the surgery once he/she has fully recovered from the anesthetic. This usually takes several hours.

It is best for your child to eat a light, soft, and cool diet as tolerated once they have recovered fully from the anesthetic. Avoid hot liquids for several days. Even though they may be hungry immediately after surgery, it is best to feed them slowly to prevent postoperative nausea and vomiting. Occasionally, a child may vomit one or two times immediately after surgery. However, if vomiting persists, your doctor may prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing.

They will be prescribed antibiotics after surgery, and should finish all the pills or liquid that have been ordered. Some form of a narcotic will also be prescribed (typically, acetaminophen/Tylenol with codeine), and is to be taken as needed. If you have any questions or you feel that your child is developing a reaction to any of these medications, you should consult your doctor. You should not give any other medications, either prescribed or over-the-counter, unless you have discussed it with your doctor.

How an adenoidectomy is performed

A surgeon will perform an adenoidectomy under general anesthesia, a drug-induced deep sleep. This is usually done in an outpatient setting, which means that your child can go home on the day of the surgery.

The adenoids are usually removed through the mouth. The surgeon will insert a small instrument into your child’s mouth to prop it open. They’ll then remove the adenoids by making a small incision or by cauterizing, which involves sealing the area with a heated device.

Cauterizing and packing the area with absorbent material, such as gauze, will control bleeding during and after the procedure. Stitches aren’t usually necessary.

After the procedure, your child will stay in a recovery room until they wake up. You’ll receive medication to reduce pain and swelling. Your child will typically go home from the hospital on the same day as the surgery. Complete recovery from an adenoidectomy usually takes one to two weeks.

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