What is Adenoidectomy?

The adenoids are a mass of lymphoid tissue located behind the nasal passages. Infected adenoids may become enlarged or chronically infected, and subsequently lead to obstructed breathing, snoring/sleep apnea, sinus or ear infections, or other problems. Adenoidectomy is a surgical procedure performed to remove the adenoids.

Effects of Adenoidectomy

Most children have less trouble breathing through the nose and fewer and milder sore throats and ear infections after adenoidectomy.

In rare cases, adenoid tissue that has been removed may grow back, but this usually does not cause a problem.

Candidates for Adenoidectomy

Enlarged adenoids are blocking the airway, which may be suspected if the child:

  • Has enlarged adenoids
  • Snores excessively
  • Has trouble breathing through the nose (nasal obstruction)
  • Has episodes of not breathing during sleep(sleep apnea)

The child has chronic ear infections that:

  • Interfere with child’s education
  • Persist despite antibiotic treatment
  • Recur 5 or more times in a year
  • Recur 3 or more times a year during a 2-year period

Adenoidectomy may be recommended if the child has chronic or repeated bouts of tonsillitis.

The adenoids normally shrink as the child reaches adolescence, and adults rarely need adenoidectomy

Notify Your Doctor If Your Child Has:

1. A sudden increase in the amount of bleeding from the nose unrelieved by pressure, ice, and head elevation.
2. A fever greater than 101.5 degrees F which is persistent despite increasing the amount of fluid they drink, cool baths, and acetaminophen/Tylenol. A child with a fever should try to drink approximately one-half cup of fluid each waking hour.
3. ersistent sharp pain or headache which is not relieved by the pain medication they were prescribed.
4. Increased swelling or redness of the nose or eyes.

Your Consultation

In most situations, the surgery is performed as an outpatient at either the hospital or the surgicenter. In both facilities, quality care is provided without the expense and inconvenience of an overnight stay. An anesthesiologist will monitor your child throughout the procedure. Usually, the anesthesiologist will call the night before surgery to review the medical history. If he/she is unable to reach you the night before surgery, he/she will talk with you that morning. If your doctor has ordered preoperative laboratory studies, you should arrange to have these done several days in advance.

Your child should not take aspirin, or any product containing aspirin, within 10 days of the date of your surgery. Non-steroidal anti-inflammatory medications (such as ibuprofen/Advil or naproxen/Aleve) should not be taken within 7 days of the date of surgery. Many over-the-counter products contain aspirin or non-steroidal anti-inflammatory type drugs, so it is important to check all medications carefully. If there is any question, please call your doctor’s office or consult your pharmacist. Acetaminophen/Tylenol is an acceptable pain reliever. Often, your doctor will give you several prescriptions for post-operative pain at the visit BEFORE the operation. It is best to have these filled prior to the date of your surgery.

It is advised that you be honest and up front with your child as you explain his/her upcoming surgery. Encourage your child to think of this as something the doctor will do to made them healthier. Let them know that they will be safe and that you will be close by. A calming and reassuring attitude will greatly ease your child’s anxiety. You can assure them that most children have minimal pain following an adenoidectomy. Let them know that if they do have pain, it will only be for a short time, and that they can take medicines which will greatly reduce it.

Your child must not eat or drink anything 6 hours prior to their surgery time. This even includes water, candy, or chewing gum. Anything in the stomach increases the chances of an anesthetic complication.

If your child is sick or has a fever the day before surgery, call the doctor’s office. If your child wakes up sick the day of surgery, still proceed to the surgical facility as planned. Your doctor will decide if it is safe to proceed with surgery. However, if your child has chickenpox, do not bring your child to the office or to the surgical facility.

The Adenoidectomy Procedure

It is important that you know precisely what time you are to check in with the surgical facility, and that you allow sufficient preparation time. Bring all papers and forms with you, including the preoperative orders and history sheets. Your child is to wear comfortable loose fitting clothes (pajamas are OK). Leave all jewelry and valuables at home. He/she may bring a favorite toy, stuffed animal, or blanket.

During Surgery
In the operating room, the anesthesiologist will usually use a mixture of gas and an intravenous medication for the general anesthetic. In most situations, an IV will have been started either in the preoperative holding room or after the child has been given a mask anesthetic. During the procedure, your child will be continuously monitored by pulse oximeter (oxygen saturation) and heart rhythm (EKG). The surgical team is well trained and prepared for any emergency. In addition to the surgeon and the anesthesiologist, there will be a nurse and a surgical technician in the room.

After the anesthetic takes effect, the doctor will remove the adenoids through the mouth. There will be no external incisions. The base of the adenoids will be cauterized with an electrical cauterizing unit. The whole procedure usually takes less than 45 minutes. Your doctor will come to the waiting room to talk with you once your child is safely in the recovery room.

Recovery

After surgery, your child will be taken to the recovery room where a nurse will monitor him/her. You will probably be invited into the recovery room as your child becomes aware of their surroundings and starts looking for you. Your child will be able to go home the same day as the surgery once he/she has fully recovered from the anesthetic. This usually takes several hours.

It is best for your child to eat a light, soft, and cool diet as tolerated once they have recovered fully from the anesthetic. Avoid hot liquids for several days. Even though they may be hungry immediately after surgery, it is best to feed them slowly to prevent postoperative nausea and vomiting. Occasionally, a child may vomit one or two times immediately after surgery. However, if vomiting persists, your doctor may prescribe medication to settle the stomach. It is important to remember that a good overall diet with ample rest promotes healing.

They will be prescribed antibiotics after surgery, and should finish all the pills that have been ordered. Some form of a narcotic will also be prescribed (typically, acetaminophen/Tylenol with codeine), and is to be taken as needed. If you have any questions or you feel that your child is developing a reaction to any of these medications, you should consult your doctor. You should not give any other medications, either prescribed or over-the-counter, unless you have discussed it with your doctor.

An appointment for a checkup should be made 10 to 14 days after the procedure. Call the office to schedule this appointment.

It is not unusual for children to have nasal stuffiness following surgery. The nasal stuffiness may last for several months as swelling decreases. Saline nose drops (Ocean Spray) can be used to help dissolve any clots and decrease edema. You may notice persistent or even louder snoring for several weeks. A temporary change in voice is common following surgery, and will usually return to normal after several months. Your child, of course, will sound less “nasal” following surgery.

Bleeding is rare following an adenoidectomy. They may have some very light nasal bleeding, if it is minor, pediatric Neosynephrin nose drops can be used. If it is persistent and bright red in color, call your doctor. On occasion, blood at the corner of the eye may be noticed.

Most patients require at least 7-10 days off from work or school. After 3 weeks, exercise and swimming can usually be resumed, but no diving for two months. You should plan to stay in town for 3 weeks to allow for postoperative care and in case you have bleeding.

Risks

Your child’s surgery will be performed safely and with care in order to obtain the best possible results. You have the right to be informed that the surgery may involve risks of unsuccessful results, complications, or injury from both known and unforeseen causes. Because individuals differ in their response to surgery, their anesthetic reactions, and their healing outcomes, ultimately there can be no guarantee made as to the results or potential complications.

The following complications have been reported in the medical literature. This list is not meant to be inclusive of every possible complication. They are listed here for your information only, not to frighten you, but to make you aware and more knowledgeable concerning this surgical procedure.

  • Failure to resolve the ear or sinus infections, or relieve nasal drainage.
  • Bleeding. In very rare situations, the need for blood products or a blood transfusion. You have the right, should you choose, to have autologous (blood from yourself) or designated donor directed blood prepared in advance in case an emergency transfusion is necessary. You are encouraged to consult with your doctor if you are interested.
  • A permanent change in voice or nasal regurgitation (rare).
  • Need for further and more aggressive surgery such as sinus, nasal, or tonsil surgery.
  • Infection.
  • Failure to improve the nasal airway or resolve snoring, sleep apnea, or mouth breathing.
  • Need for allergyevaluation, treatments, or environmental controls. Surgery is neither a cure nor a substitute for good allergy control or treatment.

FAQs

What are moles?

A mole or nevus may be described as a dark spot or irregularity found in the skin. Generally, they first come into view in childhood or during the teen years. Moles differ in color, size and shape. Some are flesh-colored, yellow-brown or black. They may be flat or raised, smooth, hairy or warty looking.

What causes moles?

Some people are born with moles and other moles emerge after some time. Sun exposure seems to take part in the growth of moles and may even play a role in the development of atypical, or dysplastic moles. The role of heredity cannot be underemphasized. Many families have a type of mole known as dysplastic (atypical), which can be linked with a higher frequency of melanoma or skin cancer.

How is the Adenoidectomy performed?

The surgeon employs a scalpel to cut the mole and a border of good skin surrounding it. The surgeon will decide on the size of this border. Stitches are positioned either deep within the skin, or on the upper surface, depending on the depth of the excision.

For the procedure that entails no stitches, a scalpel is applied to shave the mole allowing it to be flush with the surrounding skin. Next, via an electrical instrument, the doctor cauterizes the area to prevent any bleeding. A topical antibiotic is applied to decrease risk of infection. Shaving eliminates the protruding surface of the mole, although it can leave mole cells beneath the skin and may grow back.

What should I expect after the mole is removed?

The quantity of discomfort subsequently differs on the method used. If there is discomfort, it can be alleviated with prescribed pain medication. A scab will likely develop and then heal within a week or two. In addition, any redness that takes place will vanish within two to four weeks. Most scars that do appear slowly fade over time.

What are the risks and limitations of mole removal?

The most probable risk that can happen is infection. The risks associated with mole removal also depend upon the technique used. One common condition that can come about after the excision procedure is scarring. More or less scars fade away, but some can be permanent. Scars can be removed by way of skin resurfacing or other scar revision procedures.

What preventive measures should I take?

Doctors remove many moles everyday, but there is constantly one recurring theme that dermatologists tell people: Be aware of your body and any moles that have changed over time. This is particularly true for moles that are dark or flat. Customarily, people will consult doctors and be extremely concerned about raised, lightly colored moles, but they are not concerned about the dark, black, melanoma (skin cancer) next to the mole. This is truly important.

Moreover, it is imperative to stay out of the sun and wear sunscreen when you are outside. If you do go to your dermatologist for evaluation, be receptive to a full body mole screening since it is important to look over your entire body rather than ignore areas that you may not be able to inspect on a regular basis.