Adenoidectomy

Adenoids are masses of tissue located at the back of the nose. They are similar to the lymph nodes or "glands" found in the neck, groin and armpits. Adenoids work as part of the body's immune system by filtering germs that you breathe in through your nose. Adenoids can swell when you are sick. Large adenoids may also run in families. Enlarged adenoids can block the nasal passages and lead to mouth-breathing, sinusitis, or snoring. They can also block the eustachian tube, which is the drainage system for the ear, and lead to ear infections.
An adenoidectomy may be recommended if your child has had:
  • Chronic or recurrent sinusitis
  • Inability to breathe through the nose
  • Heavy snoring with disrupted sleep affecting daytime behavior
  • Recurrent or chronic ear infections

Preparation

For at least two weeks before any surgery, your child should not take any aspirin, ibuprofen (Motrin) or other medications containing blood-thinners. Acetominophen (Tylenol) can be given. After dinner the night before the adenoidectomy, your child will not be allowed to eat or drink anything, not even water. Anything in the stomach may be vomited when anesthesia is induced, which is dangerous and can cause pneumonia or other lung problems. You will usually receive a phone call from the hospital the day before your child’s scheduled surgery confirming the time you should arrive and reviewing NPO (no food or drink) instructions. You may also receive a phone call or have an appointment before the surgery with a nurse who works in the anesthesia department to review what to expect from an anesthesia perspective and make sure your child does not have any medical conditions that may increase his or her risks of general anesthesia.

Procedure

Adenoidectomies are usually performed as an outpatient procedure for healthy children without other medical conditions. This means that your child will be able to go home the day of the surgery. When you and your child arrive at the hospital or surgery center, the anesthesiologist or nursing staff will meet with you to review your child’s history. They will discuss with you the options for your child to go off to sleep. You will decide with the anesthesiologist whether it would be best to accompany your child to the operating room as he or she falls asleep or to give a medication to your child to drink to relax him or her before the surgery. The anesthesiologist will work with you to come up with a plan that will minimize anxiety and maximize safety for your child’s anesthesia experience. Your child will then be taken to the operating room and given a general anesthetic (laughing gas). A needle (intravenous catheter) for giving medications and fluids is put in after your child is asleep so he or she won’t feel it. The I.V. generally stays in until right before your child is discharged from the recovery room.

The surgery itself usually takes about half an hour, but your child may be in the operating room longer than that, as time is needed to put your child under anesthesia and to wake him/her up after the procedure. Today, there are many different technologies available for surgeons to use to remove the adenoids. The approach used for your child will depend on a number of factors and your surgeon's experience and preference.

Recovery

Following surgery, your child will go to the recovery room. Some children wake up from general anesthesia disoriented. They do not remember what happened to them and may become upset. The recovery room nurses are very used to these reactions and will be able to determine if your child is in pain and needs more medication or needs to see a familiar face. Your child may feel sick to his/her stomach and medication can be given to help with this. It may take several hours for your child to completely wake-up and for the majority of the anesthesia to leave his or her system. Your child will be able to drink liquids and have popsicles once he/she is awake. Your child will usually be able to eat a normal diet by the day following surgery.

When you get home, it is important to encourage your child to drink a lot and get lots of rest. Most children are back to normal within 24 to 48 hours after surgery. Some children take a few days longer to recover. Snoring and mouth-breathing may continue for several weeks after surgery. In addition, your child may feel more congested or have nasal drainage. Bad breath is also common and is caused by scabs that form after surgery. All of these symptoms are usually gone in 7 to 10 days. Do not allow your child to blow his/her nose but you can dab frequently with a tissue. If your child has bleeding from the nose, you should contact your child’s surgeon.

Your child can exert him/herself whenever his/her energy level has returned. He/she may return to school when he/she feels up to it, usually within a few days.

Most children have mild or no pain after adenoidectomy. Some experience a sore throat, headache or ear pain that lasts a few days. Tylenol (acetaminophen) may be used for pain relief. It is also normal to have a low-grad fever (< 101.5F) for a few days following surgery. If a fever is above this level or your child experiences a very stiff neck, you should contact your child’s surgeon.