Introduction
The adenoids are small pads of soft tissue that sit at the back of the nose, above the throat. Adenoids are part of the immune system. They work to trap germs that enter the nose and fight any infections.
Adenoids can be large in children aged 3-5 but will shrink when they grow to 5 to 8 years old. The adenoids will eventually shrink to nothing before going away completely at around 16 years old.
Some children will have adenoids that are too large, causing infections more often. Children who have enlarged adenoids might:
- breathe only out of their mouth
- have sinus and ear infections that keep coming back or don’t go away
- have glue ear
- have trouble sleeping or stop breathing in their sleep - also known as sleep apnoea.
When these things happen, a child may need their adenoids taken out by a surgeon. This procedure is called an adenoidectomy.
An adenoidectomy can be done on its own, or it might be done with other procedures that involve the ear, nose, and throat (ENT) system. These procedures can include:
- tonsillectomy - surgery to remove the tonsils
- insertion of grommets - tubes used to treat glue ear.
Before the procedure
Before the procedure, your child’s surgeon will usually organise tests and scans to see the adenoids properly.
These can include:
- x-ray
- CT scan
- nasal endoscopy - using a camera on a thin, flexible scope to see down the nose.
The hospital will call you before your child’s procedure to let you know:
- what time you need to arrive
- when your child needs to stop eating and drinking
- whether it is a day procedure or whether they will stay overnight in the hospital.
During the procedure
Your child will be under a general anaesthetic for the procedure. This means they will be asleep and will not feel any pain.
The surgeon will remove the adenoids through your child’s mouth. This means there will not be any cuts in the skin.
The procedure will take around 20 – 30 minutes.
It will take longer if any other procedures are happening at the same time, including:
- tonsillectomy - surgery to remove the tonsils
- insertion of grommets - tubes used to treat glue ear.
After the procedure
When your child wakes up from surgery, they might feel sleepy and sick while the general anaesthetic wears off.
When your child is ready to go home, you will be given pain medicine and specific instructions to help care for them. This will include instructions for giving pain medication and advice on which medicines to avoid. This is because some medicines can increase the risk of bleeding.
Speak to the nurse or doctor if you have concerns about medication before going home.
Management
Care at home
After surgery, your child may:
- feel stuffy or congested in their nose and throat
- smell an odd smell inside their nose
- have a sore throat.
This is normal and will settle over a few weeks as they heal. Pain can be managed with:
- over-the-counter pain relief like paracetamol
- pain relief medications given by your child’s doctor.
It is also common for children to have discharge from the nose that contains a small amount of blood. This can be gently wiped away with a tissue or washcloth.
Your child can eat and drink whatever they like if it does not cause them pain. Soft, cool foods can help manage pain.
They include:
- jelly
- pasta
- mashed potato
- smoothies
- soup
- scrambled eggs.
Your child can slowly return to their regular diet as they feel better.
When to see your doctor
If your child’s nose starts to bleed at home after surgery:
- lay them on their side
- apply firm pressure to the sides of the nose for 10 minutes.
If the bleeding does not stop, you will need to take them to the nearest emergency department as soon as possible.
You should contact your child’s surgeon or local doctor immediately if they:
- have fresh, bright red blood coming from the nose or mouth
- have fresh blood in their vomit - more than one teaspoon worth
- vomit more than 3-4 times
- cannot eat or drink because of pain
- have a temperature of 38°C or higher that does not go down.