Risks and benefits of adenoidectomy

Overview

Adenoidectomy is surgery to remove the adenoids, a small pad of tissue at the back of the nasal passage. This tissue is part of the immune system but can become enlarged and cause problems with breathing, ear infections, and sleep.

Yes, adenoidectomy is one of the most common surgeries in children. In the UK, it is often performed alongside tonsillectomy.

It mainly affects children aged 1 to 7 years, but adults with persistent issues may also have the procedure.

Symptoms

Common symptoms

• Persistent nasal congestion or stuffiness
• Mouth breathing, especially during the day and at night
• Loud snoring or pauses in breathing during sleep (sleep apnoea)
• Recurrent ear infections or fluid behind the eardrum
• Hearing loss or speech difficulties

Symptoms in children

• Difficulty breathing through the nose, often with mouth hanging open
• Chronic ear infections that don't respond to antibiotics
• Trouble sleeping, restless sleep, or bedwetting related to obstructed breathing
• Nasal-sounding voice or muffled speech

Symptoms in older adults

• While less common, adults can have similar symptoms of chronic nasal obstruction, sleep apnoea, or ear infections due to enlarged adenoids.

Causes

Main causes

• Enlarged adenoids are often the result of repeated infections (viral or bacterial)
• Allergies can also cause the adenoids to swell and stay enlarged

Risk factors

• Frequent ear infections or tonsillitis
• Exposure to tobacco smoke or other irritants
• Family history of enlarged adenoids
• Children who attend daycare may have more infections

When to see a doctor

See a doctor urgently if:

• If your child has pauses in breathing while sleeping, gasps for air, or is very sleepy during the day
• Severe ear pain or sudden hearing loss

Book a routine appointment if:

• Persistent mouth breathing or snoring that doesn't improve
• Recurrent ear infections (more than 3 in 6 months)
• Speech that sounds nasal or muffled
• Your child is not growing or gaining weight as expected

Diagnosis

A doctor will check your child's nose, throat, and ears with a small light or a flexible camera (nasendoscopy).

Tests that may be done

• A hearing test (audiometry) if there are ear concerns
• A sleep study (polysomnography) if sleep apnoea is suspected
• Sometimes an X-ray or MRI of the head and neck

What to expect at your appointment

The exam is quick and can be done in the clinic. The doctor will explain if surgery might help based on the size of the adenoids and the symptoms.

Treatment

For mild cases, doctors often recommend a 'watch and wait' approach, as adenoids may shrink on their own. For more severe or persistent symptoms, an adenoidectomy (surgical removal) may be advised.

Self-care at home

• Use a saline nasal spray to keep the nose moist
• Use a cool-mist humidifier in the bedroom, especially at night
• Keep your child away from tobacco smoke and other irritants
• Encourage plenty of fluids and rest during infections

Medical treatments

If an infection is present, antibiotics may be prescribed for a short time. However, antibiotics do not shrink enlarged adenoids. Steroid nasal sprays can sometimes reduce swelling caused by allergies, but they are not a cure.

When is surgery considered?

Adenoidectomy is usually considered when: symptoms are severe and don't improve over several months, your child has frequent ear infections that don't get better with treatment, or sleep apnoea is affecting their health. The operation is done under general anaesthesia and often takes about 30 minutes.

Living with this condition

After surgery, your child will need to rest at home for a few days. Plan for about 1 to 2 weeks off from school or daycare. Some swelling and a sore throat can be expected, but this usually improves quickly.

Lifestyle tips

• Avoid vigorous physical activity for about 2 weeks to reduce bleeding risk
• Encourage rest and quiet play
• Keep your child well hydrated with clear fluids
• Avoid hot, spicy, or hard foods that could irritate the throat

Diet and exercise

Offer soft, cool foods like yoghurt, pudding, and smoothies for the first few days. Avoid crunchy, sharp, or acidic foods until the throat heals. Regular activity can be resumed gradually after the first week.

Mental health and emotional wellbeing

Surgery can be a stressful experience for both children and parents. It is normal to feel anxious. Talk to your healthcare team about any worries. In older children, changes in voice or sleep can affect self-esteem; offer reassurance and seek support from a play specialist or counsellor if needed.

Prevention

Enlarged adenoids cannot always be prevented, but you can reduce the number of infections that make them worse. Good handwashing, avoiding sick contacts, and not smoking around children help.

Vaccines

To help prevent some infections that can lead to enlarged adenoids, make sure your child is up to date with all routine vaccinations, including the flu vaccine and the pneumococcal vaccine.

Screening programmes

There is no routine screening for enlarged adenoids. They are usually discovered when a child is seen for related symptoms.

Complications

If left untreated

• Persistent ear infections and fluid in the middle ear can lead to hearing loss and language delays
• Chronic mouth breathing can affect the growth of the face and teeth
• Sleep apnoea can cause poor growth, behavioural problems, and heart strain over time

Long-term outlook

Adenoidectomy is a safe and effective surgery. The vast majority of children breathe and sleep better afterwards, and the risk of serious complications is very low. For most people, recovery is straightforward, and the benefits far outweigh the risks.

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