While some physicians still like to remove both the tonsils and the adenoids at the same time, both should be looked at separately before determining whether they should be removed. Because the adenoids shrink with age, most adenoidectomies are performed on small children.
Conditions requiring immediate removal of the adenoids include:
- severe obstruction of the airway
- cancer of the tonsil
- bleeding of the adenoids that can't be stopped
The physician may also recommend an adenoidectomy for elective, non-emergent reasons. In these circumstances, the physician will compare the risks and benefits of the surgery.
Reasons for an elective adenoidectomy include:
- enlarged adenoids (adenoid hypertrophy) causing sleep apnea
- enlarged adenoids causing obstruction of the eustachian tube; ear tubes may also need to be placed
- chronic sinusitis that is unresponsive to previous medical management
- recurrent ear infections (otitis media)
What to Expect Before an Adenoidectomy
Prior to surgery, the physician will tell you to avoid giving your child medications like ibuprofen or aspirin one week before the scheduled surgery. These medications increase the risk of excessive bleeding during the surgery and hemorrhaging after the surgery. If your child is on daily medications, you will also want to ask your physician if there are any other medications that you shouldn't give him the day of surgery.
The surgical center will call to let you know what time the surgery will take place. Because vomiting and aspiration are a risk to anyone undergoing anesthesia, you will also get instructions about your child's eating and drinking. Usually eating and drinking should be avoided after midnight the night before the surgery.
At the Hospital
Once you arrive at the hospital or surgical center, you will need to check in. You will want to bring along some toys or things for your child to do while you wait for the surgery. If your child is an infant, bring a bottle or sippy cup and extra diapers with you. While you are given a time for the surgery to take place, your appointment is based on an estimated time of your procedure and the surgeries taking place earlier in the day. Be prepared to wait.
At some point, you will be asked to complete a comprehensive health history form to help your medical team to give your child the best care possible. Make sure to inform your doctor if the patient or a relative has ever had a reaction to anesthesia. Report any allergies including allergies to latex, which is used in some medical devices.
Prior to the procedure a nurse will take some vital signs, (blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation), in order to have something to compare post-surgery results to. Sometimes the patient can be given a sedative medication to reduce anxiety before surgery. The medication commonly used is called Versed (midazolam). This is not always permitted by some physicians, but it can help to relax your child and help him to not remember the unpleasant experience.
The surgeon will be able to remove the adenoids through the mouth by making several small incisions. The surgeon will cauterize the site once the adenoids are removed; this involves destroying the tissues in the area to stop the bleeding. An adenoidectomy generally will only take about 20 minutes.
After the surgery, your child will be taken to the PACU (post-anesthesia care unit) to be observed by a registered nurse until he is ready to go home. The nurse will be looking at how sleepy your child is, how close his vital signs are to those taken before the surgery, if he is in pain, and if he is able to eat and drink without vomiting.
Caring For Your Child After an Adenoidectomy
After returning home, your child may be able to resume his regular diet unless he also had a tonsillectomy or is suffering from nausea and vomiting. If nausea and vomiting are an issue, it's best to stick to clear liquids such as soup broth, water and apple juice. If pain is an issue, soft foods should be used. At first, avoid citrus juices, as these may cause irritation, and milk, which can contribute to mucous production. If clots or fresh blood are seen in the nose or throat (aside from blood-tinged sputum) you should go to the hospital immediately.
Your doctor or nurse will give you very specific instructions about caring for your child at home. These instructions should be followed exactly. In general, you should monitor your child's fluid status by watching for persistent vomiting or refusal to drink fluids. Dry cracked lips, no tears, and little urine are all signs of dehydration and should be reported to your child's physician. Other things the doctor should be notified of include heavy bleeding, fever, and excessive pain.
Swelling at the site may cause the voice to change. This is normal. However, if the change persists after several weeks, seek the assistance of the physician so that your child can be checked for velopharyngeal insufficiency (the improper closing of a muscle in the back of the mouth).
Children should refrain from sports and excessive activity during recovery. Also, for 2 weeks, do what you can to prevent your child from coming into contact with people who have respiratory infections. You should keep your child home from school for at least one week or as directed by your doctor.
Medline Plus. Adenoid Removal. Accessed: May 31, 2009 from http://www.nlm.nih.gov/medlineplus/ency/article/003011.htm
Nemours Foundation. Enlarged Adenoids. Accessed: May 31, 2009 from http://kidshealth.org/parent/medical/ears/adenoids.html#
Paradise, J.L., Tonsillectomy and adenoidectomy in children. Accessed: May 31, 2009 from http://www.uptodate.com/home/index.html(subscription required)