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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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 snoring and rhinorrhoea (running nose) and also can even be large enough to have an effect on the ear.  This occurs when they block the medial, inside, opening of the Eustachian tube preventing adequate ventilation of the middle ear this process leads to absorption of air and secretion of fluid.  Furthermore there may be a small possibility of ascending infection from the adenoids up the Eustachian tube to the middle ear.

Adenoids do 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.  Consequently “isolated” adenoidectomy is not a common procedure, although it may be combined with myringotomy and grommet procedures for glue ear if the adenoids are large, with the intention of reducing the risk of recurrence of glue ear.  The procedure may also be combined with tonsillectomy if the adenoids are large; occasionally adenoidal obstruction can be a contributory factor to obstructive sleep apnoea.

Adenoidectomy is generally avoided in children weighing less than 15kg, typically approximately three years of age, because of the small risk of blood loss during or after the operation. There is no upper age limit, but the adenoidal tissue usually shrinks to become minimal by teenage years.

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.

The traditional technique is to use a curette, a special type of surgical cutting device. This is a safe technique, although a consideration for small children having the operation is that the blood loss may be marginally higher at the time of surgery.  Suction diathermy and Coblation dissection have the possible advantage of less blood loss at the time of surgery.

There are small risks with any adenoid surgery; “primary” bleeding can occur within the first 24 – 48 hours after the procedure, which sometimes necessitates a return to theatre.  Typically this occurs no more frequently than in around 1% of cases.  In 10 – 15% of cases there is a risk of a secondary bleed which may occur 7 – 10 days after the operation.  This can require reattending a local hospital or A and E Department.  It is very important to inform the medical and nursing staff if a child has any unusual bleeding or bruising problems, or if there is any familial history of this type of problem.

As with tonsillectomy, if there are any loose teeth these can be dislodged and it is helpful to know about such teeth and also if there are any caps or crowns.

A further unusual complication is of rhinolalia operta, where there is a slight nasal escape of speech.  Typically this settles spontaneously, although sometimes it requires a little speech therapy.  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: if this is the case the decision may be made not to proceed with surgery to minimise this specific risk.

Unlike tonsillectomy, there is generally minimal significant associated discomfort. Typically 2 to 7 days off school are advised following the surgery; most children are discharged home on the day of surgery. They should rest at home, away from crowds, smoky places and people with coughs and colds.