Vincent Cumberworth BSc FRCS Consultant Ear, Nose and Throat Surgeon

Clementine Churchill Hospital Sudbury Hill Harrow Middlesex HA1 3RX
Private Secretary: Tel: 020 8872 3866 Fax: 0208872 3861

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Adenoidectomy

The adenoids are an area of lymphoid tissue which sit high at the back of the nose and are thinner in nature than the tonsil tissue. If they are excessive in size they can cause blockage of the nose with some running and also can even be large enough to have an affect on the ear. This occurs when they block the medial, inside, opening of the Eustachian tube so that it cannot ventilate the middle ear properly. In these cases there is the absorption of air and secretion of fluid. Furthermore it is also possible that there may be a small possibility of ascending infection from the adenoids up the Eustachian tube to the middle ear. They do however generally reduce in size relative to the post-nasal space, partly due to their reduction and also due to a growth in size of the skull base, around the age of 5 – 7 so adenoidectomy alone is not a common procedure, although it may need to be combined with myringotomy and grommet procedures for glue ear if the adenoids are large. The procedure may also be combined with tonsillectomy if the adenoids are large; occasionally obstruction may produce can be a factor in possible obstructive sleep apnoea.

The operation is performed under general anaesthesia and typically done as a day case, although as a tonsillectomy procedure is performed as well, there is a slightly higher possibility of needing to stay in hospital overnight. One week’s absence from school would be recommended.

There are small risks with any adenoid surgery; it is possible to get primary bleeding which occurs within the first 24 – 48 hours after the procedure which can sometimes mean a return to theatre. Typically this occurs no more frequently than in around 1% of cases and just occasionally there is a risk of a secondary bleed which may occur 7 – 10 days after the operation. This can mean reattending a local hospital or the Casualty department. As for tonsillectomy, if there are any loose teeth, these can be dislodged and it is useful to know about such teeth and also if there are any caps or crowns. Further unusual complication is of rhinolalia operta, where there is a slight nasal escape of speech. Typically this settles spontaneously, although sometimes with a little speech therapy and really is quite unusual. The adenoid size is assessed by the surgeon pre-op in theatre, whilst the child is asleep, and also care is taken to make sure that there is no submucous cleft in the palate because if there is the procedure is best avoided to reduce this specific risk. Unlike tonsillectomy, there is generally minimal significant associated discomfort.

© Vincent Cumberworth 2005