Adenoidectomy

What is an adenoidectomy?

In an adenoidectomy, your child's adenoids are cut away from the back of their nose to help drain away fluid from inside their ears.

The operation can be done on its own, but it is usually done at the same time as an operation to put tubes (grommets) in your child's ears, or if your child has their tonsils removed.

To learn more, see Surgery to take out tonsils and Grommets for glue ear.

The adenoids are soft mounds of tissue at the back of the nose. They are part of the body's system for fighting infection.

What happens during an adenoidectomy?

The operation takes about half an hour and your child probably won't have to spend a night in hospital.

Your child will be given a general anaesthetic so he or she will be asleep during the operation.

To take out your child's adenoids, a support is put under their shoulders so that their head is tipped back a little. A breathing tube is put into their mouth. Then, their mouth is held wide open using a surgical instrument so that the surgeon can reach your child's adenoids through their mouth. The surgeon uses their finger to feel how large your child's adenoids are, then scrapes them out using a tool that's like a spoon with one sharp edge. It only takes a few minutes. The bleeding is then stopped by pressing a gauze pad against the back of your child's nose where their adenoids used to be. This takes about five minutes. Your child will not need any stitches.[5] [6] Some surgeons use a heated device to burn away the adenoids, instead of cutting them out.

If your child is also having grommets put in their ears, a tiny cut (two or three millimetres long) is made in their eardrum, fluid is drained away and the grommet is put through the opening. Different types of grommets are used but most are plastic, a few millimetres long and shaped like a dumbbell. To learn more, see Grommets.

In the past, surgeons removed children's tonsils at the same time as their adenoids. But there is no evidence that taking children's tonsils out helps glue ear. These days, children's tonsils are not usually taken out unless the tonsils keep getting infected, an infection lasts a very long time, the tonsils stop the child from swallowing easily or the child has breathing problems.[2] [3]

How can an adenoidectomy help my child?

It's not easy to say how much your child will be helped by having his or her adenoids taken out.

• If your child has bouts of glue ear that come and go, just taking o ut their adenoids (without putting in grommets) is unlikely to help your child's hearing.[2]
• But it may reduce the length of time your child has glue ear. In one study, children who had their adenoids removed had glue ear for another fours years.[7] Those who didn't have the operation had glue ear for another eight years.
• Having grommets put in as well as taking out the adenoids can help your child hear slightly better than if they had no treatment.[2] But there isn't any evidence that taking out the adenoids and putting in grommets works better than just putting in grommets.[2] The research shows that children might hear better six months after having their adenoids taken out and grommet put in. But after a year, there isn't a big difference between children who've had the operation and children who haven't.[2]
• Having adenoids take n out at the same time as taking out tonsils should reduce the number of throat infections your child gets, at least in the short term.[8] But there's no evidence that having both adenoids and tonsils taken out works any better than just taking out the tonsils. One study found that in the first two years after surgery, children who had surgery had an average of three fewer infections than children who took antibiotics instead.[8] But after two years, there was no real difference in the number of throat infections between the two groups of children. This may be because children who don't have surgery tend to grow out of throat infections anyway.

What are the risks of an adenoidectomy?

All operations have risks, and your surgeon should talk these through with you first.

Anaesthetics can have side effects. For example, your child may feel sick afterwards. It is also possible, but rare, to have an allergic reaction to the anaesthetic. If your child has any allergies you must tell your doctor. Your child's blood pressure, heartbeat, body temperature and breathing will be closely monitored.

What will happen if my child doesn't have an adenoidectomy?

Adenoids usually shrink after the age of 4 years old, and rarely cause problems in adulthood. If your child doesn't have the operation, the glue ear will often clear up by itself.[11] But it's hard to say how long this will take.[12] It might take several weeks or even months.[13]

• About 4 in 5 children aged 2 years to 4 years still have glue ear after a month and over half still have glue ear after three months.[11] [13] But it can take much longer for glue ear to clear up, especially for younger children. About 1 in 20 children aged 2 years to 4 years have glue ear for one year or more.[14] And, some children get glue ear again and again.[14]
• Most children no longer have glue ear by the time they are 7 or 8 years old.[15] By this age, the tubes that drain fluid from the ears naturally (the eustachian tubes) are bigger.
• Glue ear can take longer to clear up by itself in children whose parents smoke.[7]
• If your child keeps getting glue ear or has it for a long time, it may affect their development in the short term. They may not hear their teacher and not do so well in class. But there is no evidence that children who don't have the operation will develop any differently from children who do have their adenoids taken out and grommets put in.
• When the glue ear clears up, your child's hearing should go back to normal.

What other treatments are there?

Infected and swollen adenoids that cause glue ear can be treated with drugs. Glue ear problems can also be treated with grommets alone.

Antibiotics: These are sometimes given to children with glue ear. They can help some children recover faster. But antibiotics often cause side effects such as sickness and diarrhoea.[16] It can also be hard to get small children to take antibiotics.[17] Doctors do not usually recommend antibiotics as a treatment for glue ear.

Steroids: These can reduce swelling. Children with glue ear may be prescribed a steroid spray for them to breathe in through their nose. Combining antibiotics with steroids may clear your child's fluid better than antibiotics on their own.[18] But there isn't enough evidence to recommend this treatment.[19] The steroids only work in children's noses and don't affect any other part of their bodies.

The steroids used to treat glue ear are called corticosteroids. They are not like the steroids used by bodybuilders. Corticosteroids are similar to the steroids your body makes naturally.

What can my child expect after an adenoidectomy?

Your child may be sleepy after the operation because of the anaesthetic. They will be carefully monitored for a few hours and encouraged to eat and drink.

It will probably take a week or two for your child to recover fully and they should take it easy. It's best to keep your child off school and away from crowded places for a week so they don't pick up infections. It's important for your child to drink lots of fluid and to eat normally. Don't worry if your child starts sniffing or sneezing; it won't cause any damage or make bleeding start again.

Your child might be sick when you get home. This is normal as blood from the surgery may have gone down into their tummy. But if there is red, black or brown in the vomit more than once then contact a doctor as your child's throat may be bleeding.

Your child may have a blocked nose and a sore throat for a few days. Paracetamol should help. Some children say it hurts to open their mouth to clean their teeth at first, but you should encourage your child to brush as usual because this will help keep their mouth free of infection and help the adenoid area heal more quickly.

Try to keep your child away from cigarette smoke. This could make them feel worse after the operation and it may make the glue ear come back.[20]