Adenoidectomy in children
The adenoids are a small pad of immune (lymph) tissue at the very back of the nose, above the roof of the mouth. You can't see them by looking into your child's mouth. They are usually largest between about two and six years of age, and they naturally shrink from around seven.
Adenoidectomy is an operation to remove the adenoids. It is one of the more common operations in children's ear, nose and throat (ENT) surgery.
How can adenoids cause problems?
Blocked nose and mouth breathing. Large adenoids can block the back of the nose, so a child breathes through the mouth, snores, or has a constantly blocked or runny nose.
Breathing problems during sleep. Together with large tonsils, large adenoids can contribute to snoring and pauses in breathing during sleep (obstructive sleep apnoea).
Repeated adenoid infections. Some children have frequent infections with fever, swollen neck glands and thick discharge from the nose that keep coming back despite antibiotics.
Glue ear and ear infections. The adenoids sit close to the openings of the Eustachian tubes, which drain and ventilate the middle ear. Enlarged or infected adenoids can contribute to fluid behind the eardrum (glue ear).
When is an adenoidectomy considered?
Many children with large adenoids do not need surgery, and the adenoids shrink with age. Your GP or ENT surgeon may suggest a period of watching and waiting or a nasal spray first. An adenoidectomy may be discussed when:
enlarged adenoids are contributing to sleep-disordered breathing or sleep apnoea
adenoid infections are frequent (around five or more a year), confirmed by a doctor, and have not settled with appropriate antibiotics
a child has ongoing glue ear or repeated ear infections. For some children who need grommets, removing the adenoids at the same time can lower the chance of the fluid returning compared with grommets alone.
Checks before surgery
At the consultation the surgeon will ask about your child's symptoms, sleep, ears and general health, and examine the ears, nose and throat.
The surgeon will also look carefully at the roof of the mouth. Occasionally a child has a hidden split in the muscle of the palate (a submucous cleft palate). Signs include a split uvula (the small dangling tissue at the back of the throat). In these children the adenoids help close off the back of the nose during speech, so removing them can make the voice more nasal. If this is suspected, surgery may not be suitable, or a speech pathologist's assessment is arranged first.
Please tell us about any bleeding problems in your child or your family, and any medicines your child takes.
The operation
Adenoidectomy is done under general anaesthetic. The adenoids are removed through the mouth, so there are no cuts on the face or neck. The surgeon uses a small camera (an endoscope) to see the adenoids clearly and to protect the openings of the Eustachian tubes. Any bleeding is controlled before your child wakes up.
Adenoidectomy is often done at the same time as grommets or a tonsillectomy. Your surgeon will let you know whether your child is likely to go home the same day and will give you written aftercare instructions, including pain relief and when your child can return to childcare or school.
Risks
All surgery has risks. Your surgeon will talk with you about the ones that apply to your child. For adenoidectomy they include:
Bleeding. This can happen in the first 24 hours, or between about five and ten days after surgery as the area heals.
A change in the voice. The voice can sound more nasal, or fluid may come out of the nose when drinking. This is usually mild and settles. If it continues, a speech pathologist can help, and rarely further surgery is needed. The risk is mainly in children with an unrecognised submucous cleft, which is why the palate is checked beforehand.
Neck stiffness. Rarely, in the first two to three weeks, inflammation can affect the joints at the top of the neck, causing a stiff or twisted neck and fever (Grisel syndrome). This needs prompt assessment and is treated with rest, a neck collar, physiotherapy and anti-inflammatory medicine.
Scarring. Very rarely, scarring narrows the back of the nose.
Symptoms continuing. Snoring, a blocked nose or ear problems may not fully resolve, particularly if other causes are present.
Anaesthetic risks, which your anaesthetist will discuss with you.
When to seek help after surgery
Go to your nearest emergency department or call 000 if your child:
has bleeding from the nose or mouth, or vomits or spits blood
has trouble breathing
Contact our rooms or your GP promptly if your child has a stiff or twisted neck, a fever, or pain that is not controlled with the recommended pain relief.
Related information
Referral
To see an ENT surgeon and claim a Medicare rebate you need a current referral from your GP or another specialist. Your GP can email the referral to our Bella Vista rooms (near Norwest) at admin@entsurgeons-sydney.com.au or our Parramatta rooms at admin@agioshealth.com.au. We see children at both.
This page is general information only and is not a substitute for advice from your own doctor. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner. In an emergency, call 000 or go to your nearest emergency department.
Sydney ENT Surgeons
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