15447 Adenoidectomy Adenoid Removal

Overview

Adenoids are small pads of soft tissue at the very back of the nose, above the roof of the mouth. They are part of the body's immune system and are most active in young children. Sometimes adenoids become enlarged or keep getting infected. When that happens, they can block breathing through the nose, cause repeated ear problems, or disturb sleep. An adenoidectomy is an operation to remove the adenoids. It is done under a general anaesthetic, which means your child will be asleep and feel nothing during the surgery.

Yes. Adenoidectomy is one of the most common operations in childhood. It is sometimes done together with tonsil removal, and sometimes on its own.

It mostly affects children between about 1 and 7 years old, because adenoids are largest in early childhood. Adults can have adenoid problems too, but this is much less common.

Symptoms

Common symptoms

• A blocked nose that lasts for weeks or months, so your child breathes through the mouth most of the time
• Snoring or noisy breathing during sleep
• A 'nasal' or stuffy-sounding voice
• Repeated colds, runny nose or sinus infections
• Repeated ear infections or fluid behind the eardrum (sometimes called glue ear), which can dull hearing
• Poor sleep, restless sleep, or waking often at night
• Mouth breathing that leads to a dry mouth, chapped lips or a sore throat in the morning

Symptoms in children

• Loud snoring, snorting or pauses in breathing during sleep
• Sleeping with the mouth open and drooling on the pillow
• Being very sleepy or grumpy during the day, or finding it hard to concentrate at school
• Poor appetite or slow eating, because breathing through the mouth makes chewing and swallowing harder
• Speech that sounds blocked or 'nasal', or difficulty saying certain sounds
• Frequent ear infections or trouble hearing, which can affect speech and learning
• In babies, trouble feeding and poor weight gain

Symptoms in older adults

• Long-standing nasal blockage or a blocked nose that does not clear with usual treatment
• Snoring or disturbed sleep, sometimes with pauses in breathing (sleep apnoea)
• Repeated sinus infections or post-nasal drip (mucus running down the back of the throat)
• Ear fullness or mild hearing changes
• Note: adenoid problems are uncommon in adults, so similar symptoms should always be checked by a doctor

Causes

Main causes

• Enlarged adenoids — the tissue grows larger than usual, often in response to repeated infections
• Repeated infections of the adenoids (adenoiditis), which can keep them swollen and inflamed
• Allergies that cause ongoing swelling and mucus in the nose and throat
• The shape and size of the child's airway, which can make even mildly enlarged adenoids cause problems
• Sometimes no clear cause is found — the adenoids are simply large for the child's age

Risk factors

• Being a young child — adenoids are naturally biggest between about 2 and 6 years old
• Frequent colds or time spent in close contact with other children, such as nursery or daycare
• Exposure to cigarette smoke or other indoor air pollution
• Allergies such as hay fever, or eczema and asthma
• Acid reflux, which can irritate the back of the nose and throat
• A family history of large adenoids or tonsils

When to see a doctor

See a doctor urgently if:

• Your child is struggling to breathe, or breathing looks like hard work
• There are pauses in breathing during sleep, or your child is very sleepy during the day
• Heavy bleeding from the nose or mouth after surgery that does not stop
• A fever with a stiff neck, severe headache or a rash that does not fade when pressed
• Your child cannot keep any fluids down, or has not passed urine for many hours

Book a routine appointment if:

• Your child has been breathing through the mouth most of the time for several weeks
• Snoring is loud, or sleep is restless most nights
• Repeated ear infections, or you think your child's hearing is not right
• Repeated colds or sinus infections that seem to merge into one another
• Speech sounds blocked or nasal, or your child's teacher has noticed changes
• You are wondering whether surgery might help — a GP can talk this through with you

Diagnosis

The doctor will start by asking about your child's symptoms — how long they have been going on, how often they get colds or ear infections, how they sleep, and whether anyone in the family has similar problems. They will then look inside the nose and throat. In children, this is usually done with a small light and a tiny mirror, or a thin flexible tube with a camera on the end (a nasendoscope). This is quick and can be a little uncomfortable, but it is not painful and children cope well.

Tests that may be done

• A physical examination of the nose, throat and neck
• Looking at the adenoids with a small mirror or a thin flexible camera passed into the nose
• A hearing test and a tympanometry test (a quick test of how well the eardrum moves, which shows if there is fluid behind it)
• A sleep study in some cases, especially if breathing pauses during sleep are a concern
• An X-ray or scan of the side of the head or the sinuses, only if the doctor thinks it is needed

What to expect at your appointment

Most children are diagnosed in a single clinic visit without any needles or blood tests. The doctor will explain what they found and talk through the options: watching and waiting, treating allergies or infections, or referring to an ear, nose and throat specialist to discuss surgery. You will have time to ask questions, and it is fine to take a few days to decide.

Treatment

Treatment depends on how much the adenoids are affecting your child. If symptoms are mild, the usual approach is to watch and wait, because adenoids naturally shrink as children grow. If allergies or repeated infections are playing a part, treating those may be enough. Surgery is considered when symptoms are troublesome and are not settling — for example, persistent blocked breathing, disturbed sleep, or repeated ear problems with hearing loss.

Self-care at home

• Saline (salt water) nose drops or rinses from a pharmacy can help clear a blocked nose
• Keep the air at home from becoming too dry, and avoid cigarette smoke completely
• Encourage handwashing to reduce the number of colds
• Treat hay fever and other allergies as advised, and keep bedding and rooms free of dust where possible
• For sleep, some children breathe better with their head slightly raised — check this is safe for your child's age
• Keep up with routine childhood vaccinations and general healthy eating and sleep habits

Medical treatments

Doctors may prescribe medicines to settle infection or control allergies, and these are chosen to suit your child. Some children are given a short course of medicine to reduce swelling in the nose. Others benefit from treatment for reflux or from allergy testing and avoidance advice. Your GP or pharmacist can explain what has been prescribed and why. If these steps do not help and symptoms are significant, your doctor may refer your child to an ear, nose and throat (ENT) specialist to discuss whether surgery would be worthwhile.

When is surgery considered?

An adenoidectomy may be recommended when enlarged or infected adenoids cause ongoing problems, such as: breathing through the mouth most of the time and disturbed sleep; pauses in breathing during sleep (obstructive sleep apnoea); repeated ear infections or fluid behind the eardrum causing hearing loss; repeated sinus or adenoid infections that do not settle with treatment. The operation is done under a general anaesthetic and takes about 20 to 30 minutes. The surgeon reaches the adenoids through the mouth, so there are no cuts on the face and no visible scars. Many children go home the same day. Sometimes small tubes (grommets) are put in the ears at the same time, and sometimes the tonsils are removed too. Afterwards, expect a sore throat, a blocked or nasal-sounding voice, and a soft diet for a week or so. Most children are back to normal within one to two weeks.

Living with this condition

If your child is waiting for surgery, or has decided not to have it, the day-to-day focus is on keeping the nose clear and sleep comfortable. Saline nose drops, a smoke-free home and treating allergies all make a real difference. After surgery, plan for a quiet first week: soft foods, plenty of drinks, rest, and keeping away from crowds and smoky places while healing happens. Most children are back at school within one to two weeks.

Lifestyle tips

• Keep the home completely smoke-free — this is the single most helpful change for breathing problems in children
• Use saline nose drops or rinses when the nose is stuffy
• Encourage drinking water through the day, especially after surgery
• Gentle activity is fine after surgery, but avoid rough play, swimming and contact sports for the time your surgeon advises
• Keep rooms aired and not too warm, and avoid strong smells, perfumes and smoky environments
• Keep up with school and nursery as soon as your child feels well, so normal routines return quickly

Diet and exercise

There is no special diet that shrinks adenoids. A balanced diet with plenty of fluids supports general health and healing. After surgery, start with soft, cool foods such as yogurt, soft pasta, mashed potato, ice lollies and soups, then build up as comfort allows. Avoid crunchy, spicy or very hot foods for the first week. Gentle walking and normal play are fine during recovery; ask your surgeon when it is safe to return to swimming, PE and contact sports.

Mental health and emotional wellbeing

Poor sleep and constant blocked breathing can make a child tired, grumpy or tearful, and can affect concentration and schoolwork. Parents often feel worn down too, especially if nights are broken. It helps to know this is a common and treatable problem, not anyone's fault. If your child seems anxious about the operation, explain simply what will happen, ask the hospital team about a pre-surgery visit or play session, and let them bring a familiar toy or blanket. If low mood, worry or exhaustion is affecting you or your child, speak to your doctor — support is available.

Prevention

You cannot prevent adenoids from being large, since this is partly down to age and growth. But you can reduce the number of infections and the amount of irritation that keep them swollen: keep the home smoke-free, wash hands often, treat allergies well, and avoid close contact with people who have heavy colds where practical.

Vaccines

There is no vaccine against enlarged adenoids. Keeping your child's routine childhood vaccinations up to date helps prevent some of the infections that can affect the nose, throat and ears. Ask your GP or health visitor if you are unsure what your child is due.

Screening programmes

There is no routine screening test for adenoid problems. Adenoids are checked only when a child has symptoms that suggest a problem.

Complications

If left untreated

• Ongoing mouth breathing, which can affect the growth of the face, teeth and jaw over time
• Poor sleep and daytime tiredness, which can affect mood, behaviour and learning
• Obstructive sleep apnoea — pauses in breathing during sleep — which is important to have checked
• Fluid behind the eardrum and hearing loss, which can delay speech and language in young children
• Repeated ear, sinus and throat infections
• In young children, poor feeding and slower weight gain
• Rarely, long-standing severe blockage can put strain on the heart and lungs — this is why ongoing breathing problems in sleep should always be checked

Long-term outlook

The outlook is very good. Adenoidectomy is a common, well-understood operation, and most children notice easier breathing, better sleep and fewer infections afterwards. Recovery usually takes one to two weeks. As with any operation there are small risks — bleeding, infection, a temporary nasal-sounding voice, or fluid leaking through the nose when drinking — and your surgical team will explain these and what to watch for. Many children would have improved with time anyway, since adenoids shrink with age, so surgery is a choice to discuss carefully with your doctor rather than something urgent.

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