Adenoid Removal (Adenoidectomy): When It Is Needed, the Surgery and Recovery

01Basics

What the adenoids are and why they enlarge

The adenoids belong to a ring of lymphoid tissue in the throat that includes the tonsils. They are largest between the ages of about three and seven, when children meet many new infections, and then gradually shrink. Because they sit where the nose meets the throat, close to the openings of the Eustachian tubes, enlarged adenoids can affect breathing, sleep and the ears.

Adenoids can enlarge with repeated colds and infections, allergies and exposure to smoke. In most children the size causes no problems, but in some it leads to persistent symptoms that do not settle as the child grows.

02Symptoms

Signs of enlarged or problematic adenoids

• Breathing through the mouth most of the time, by day and at night.
• Snoring, restless sleep, pauses in breathing or gasping; see child snoring.
• A blocked nose with a «nasal» voice.
• A constantly runny nose and frequent sinus-type infections.
• Recurrent ear infections or glue ear with reduced hearing; see fluid in the ear.
• Daytime tiredness, poor concentration or behaviour changes linked to poor sleep.

03When

When adenoid removal is recommended

• Obstructive sleep apnoea or sleep-disordered breathing: usually removing the adenoids and tonsils together (adenotonsillectomy), which resolves symptoms in most otherwise healthy children.
• Glue ear or recurrent ear infections: adenoidectomy is often added when a child needs a second set of ear tubes, or from the first set in older children, because it reduces the chance of fluid coming back; see ear tubes.
• Persistent nasal obstruction: constant mouth breathing that does not improve with nasal sprays for allergy.
• Recurrent adenoiditis or chronic rhinosinusitis in children that does not respond to medical treatment.

The decision is based on symptoms rather than size alone. An ENT specialist examines the nose, ears and throat and may look at the adenoids with a thin camera through the nose or, less often, request an X-ray. A sleep study may be arranged in selected children.

04Surgery

The operation step by step

• The operation is done under general anaesthetic.
• The surgeon opens the mouth with a small gag, looks at the back of the nose with a mirror or endoscope, and removes the adenoid tissue with a curette, suction diathermy or a coblation device.
• Bleeding is controlled with pressure or cautery; there are no stitches or external cuts.
• The procedure takes about 20 to 30 minutes, longer if combined with tonsillectomy or ear tubes.
• Most children go home the same day once they are eating, drinking and comfortable.

05Recovery

Recovery after adenoid removal

• Pain: usually mild, with a sore throat or ear ache for a few days, controlled with paracetamol and ibuprofen if suitable. Recovery is longer and more painful if the tonsils are removed at the same time.
• Nose: a blocked or runny nose, sometimes with a little blood-stained mucus, and bad breath for up to two weeks.
• Voice: the voice may sound different for a few weeks as the space behind the nose changes.
• Eating: children can eat normally; drinking plenty helps.
• School: most children return to nursery or school within about a week. Avoid contact with people who have colds and avoid swimming for about two weeks.

06Risks

Risks and possible complications

• Bleeding: uncommon after adenoidectomy alone; fresh bleeding from the nose or mouth after surgery needs urgent assessment.
• Infection: fever and foul-smelling discharge may need antibiotics.
• Regrowth: some adenoid tissue can grow back, especially in very young children, occasionally needing further surgery.
• Voice change and nasal escape: rarely, air escapes through the nose during speech (velopharyngeal insufficiency), particularly in children with a submucous cleft; it often settles but sometimes needs speech therapy.
• Neck stiffness: rare, and needs review if it develops.
• Anaesthetic risks: very low in healthy children.

07Results

What improves after adenoid removal

Most parents notice that their child breathes through the nose more easily, snores less and sleeps more quietly within a few weeks. In children with sleep apnoea, improvements in daytime behaviour, attention and growth are common. When done for ear problems, adenoidectomy reduces the need for further ear tubes. A long-standing mouth-breathing habit may persist even after the nose is clear; a speech and language therapist or myofunctional therapist can help retrain nasal breathing and tongue posture. See mouth breathing.

08Adults

Adenoid removal in adults

Adenoids usually shrink by adolescence, so adults rarely have large adenoids. When adult adenoid tissue causes persistent nasal blockage or Eustachian tube problems, it can be removed. Any new mass at the back of the nose in an adult, particularly with blocked nose on one side, nosebleeds, fluid in one ear or a neck lump, must be examined and usually biopsied to rule out other causes.

10Summary

Key points to remember

• Enlarged adenoids can cause blocked nose, snoring, sleep apnoea and ear problems.
• Adenoidectomy is a short day-case operation done through the mouth.
• Recovery usually takes about a week, longer if the tonsils are also removed.
• Most children breathe and sleep better afterwards.