In this article, we look at what adenoids are, symptoms of their enlargement, and reasons for having them removed. We also explain the adenoid removal procedure, risks and possible complications, and recovery following surgery.
What are adenoids?
Children are more likely than adults to have enlarged adenoids.
Image credit: OManu5, 2017
Adenoids are glands that are high up in the throat behind the nose and roof of the mouth. They are part of the body's immune system.
The adenoids catch germs in the nose before they can cause illness. However, these glands can become swollen as they fight off bacteria or viruses.
When this happens, the adenoids may enlarge and interfere with breathing and sleeping. They may also feel sore or painful.
Ongoing enlargement of the adenoids can also block the eustachian tube, which connects the ears to the nose and drains fluid from the middle ear. This blockage causes fluid to build up in the ear, which can lead to repeated ear infections and temporary hearing loss.
If enlarged adenoids are causing symptoms, a doctor may initially try to treat the problem with medications or other treatments. If symptoms are persistent, the doctor may then recommend surgery to remove the adenoids. This surgery is called an adenoidectomy.
Adenoids tend to be largest during early childhood, after which they begin to shrink. For most people, the adenoids become very small or disappear once they reach their teenage years. As a result, adenoid removal mostly occurs in young children.
Symptoms of enlarged adenoids
Most of the time, enlarged adenoids affect children. Infants and younger children may not be able to express that they are in pain or are experiencing other symptoms of enlarged adenoids. Some signs to look out for in babies and children include:
- breathing through the mouth frequently
- the nose being stuffy or runny without illness
- a dry mouth and cracked lips
- noisy breathing
- a nasal-sounding voice
- frequent or persistent ear infections
- poor-quality sleep or pauses in breathing during sleep
These signs do not always mean that a child's adenoids are swollen, but it is important to see a doctor to determine the cause.
Reasons to have adenoids removed
A recurring ear infection can be a reason to remove the adenoids.
The doctor will take a child's medical history into account before recommending adenoid removal. This procedure may be beneficial if one or more of the following problems are occurring:
- snoring or sleep apnea due to enlarged adenoids
- recurring ear infections that do not respond to antibiotics
- a buildup of fluid in the ear and earaches from adenoid swelling
- repeated infection of the adenoids that does not clear up with antibiotics
- excessive daytime sleepiness due to adenoids interfering with sleep
- behavior or learning issues as a result of poor-quality sleep
What happens during adenoid removal?
Doctors usually place children under general anesthesia during adenoid removal, which means that they will be sleeping and unable to feel any pain. It is important to avoid all food and drink for several hours before surgery to prevent vomiting during the procedure.
For the adenoidectomy, surgeons use an instrument to see inside the throat and nasal cavity. They can access the adenoids through the back of the throat, so they do not need to make any external incisions.
The surgeon will cauterize or cut away the adenoid tissue. In most cases, the surgery takes less than an hour, and the child can go home on the same day if there are no complications. Children who are very young, have certain higher-risk conditions, or have any trouble breathing may need to stay in the hospital overnight for observation.
Removal of both adenoids and tonsils
In many cases, a doctor may remove the tonsils along with the adenoids. The tonsils are also glands that help protect against germs. However, they sit in the back of the throat rather than behind the nose.
Sometimes, both the tonsils and adenoids become swollen and infected. The removal of both glands at the same time is known as a tonsilloadenoidectomy.
Not everyone who needs an adenoidectomy will require tonsil removal and vice versa. Doctors base the decision to remove either or both of these glands on the child's specific symptoms and medical history. Children who tend to have swelling of both the tonsils and adenoids may be good candidates for a tonsilloadenoidectomy.
Risks and complications of removal
Side effects of an adenoidectomy can include fever, nausea, and vomiting.
Surgeons perform around 130,000 adenoid removals each year in the United States. Adenoid removal surgery is generally safe, and healthy children will have a low risk of complications. However, the possible side effects and risks of an adenoidectomy include:
It is vital to seek immediate medical assistance if the child bleeds from the nose or mouth following adenoid removal.
Recovery after adenoid removal
The lack of incision during the surgery means that stitches are unnecessary. The child may feel pain or discomfort in the throat, nose, and ears for several days following surgery.
The doctor may prescribe pain relievers or recommend over-the-counter (OTC) medications to help relieve any pain. These should never include aspirin, which can increase a child's risk of developing Reye's syndrome.
In general, most children recover from adenoid removal within 1–2 weeks. Doing the following may help with a child's recovery:
- Offering plenty of fluids to help prevent dehydration. Popsicles may be helpful if the child is not drinking enough or feels sick. If signs of dehydration occur, contact a doctor immediately.
- Eating soft foods can help with a sore throat, but drinking is more important than eating. The child is likely to start eating normally again after a few days.
- Keeping the child home from school or day care until they are eating and drinking normally, no longer need pain medicine, and are sleeping well.
- Avoiding airplane travel for at least 2 weeks after surgery.
A mild fever is typical on the day of surgery, but it is essential to call a doctor if the fever is 102°F or higher or if the child seems very unwell. Some noisy breathing and snoring for up to 2 weeks after surgery is not unusual, but this will usually stop once the swelling subsides.
If enlarged adenoids are causing breathing issues, problems swallowing, or recurrent ear infections, removing them may be the best option. The surgery is safe and effective for most children.
However, there are some things to consider before deciding on adenoid removal. Recent research suggests that removing a child's adenoids or tonsils may increase their risk of developing respiratory, infectious, and allergic conditions later in life.
Adenoid removal, as with all surgery, also carries a small risk of infection or other complications. Adenoids can sometimes grow back after surgery, but this is rare.
Most children who undergo adenoid removal will recover without any long-term health issues. However, parents and caregivers should discuss both the benefits and risks with a doctor before moving forward with the procedure.