What to Expect During an Adenoidectomy

An adenoidectomy is the surgical removal of the adenoids. The subject of whether or not adenoids should be removed has been a topic of controversy in the medical community. The controversy resulted from frequently performed unnecessary adenoidectomies, as well as tonsillectomies, which were sometimes combined into one surgery. Despite the controversy, the medical community still supports the removal of the adenoids under certain circumstances.

Indications for Adenoid Removal

While some healthcare providers still like to remove both the tonsils and the adenoids at the same time, both should be looked at separately before determining whether they should be removed. Because the adenoids shrink with age, most adenoidectomies are performed on small children.

If the airway is obstructed due to adenoids, causing breathing problems, an adenoidectomy will usually be performed. The practitioner may also recommend an adenoidectomy for elective, non-emergent reasons. In these circumstances, the healthcare provider will compare the risks and benefits of the surgery.

Reasons for an elective adenoidectomy include:

• Enlarged adenoids (adenoid hypertrophy) causing sleep apnea
• Enlarged adenoids causing obstruction of the eustachian tube; ear tubes may also need to be placed
• Chronic sinusitis that is unresponsive to previous medical management
• Recurrent ​ear infections (otitis media)

Before an Adenoidectomy

Prior to surgery, the practitioner will tell you to avoid giving your child medications like ibuprofen or aspirin one week before the scheduled surgery. These medications increase the risk of excessive bleeding during the surgery and hemorrhage after the surgery.

If your child is on daily medications, you will also want to ask your healthcare provider if there are any other medications that you shouldn't give him the day of surgery.

The surgical center will call to let you know what time the surgery will take place. Because vomiting and aspiration are a risk to anyone undergoing anesthesia, you will also get instructions about your child's eating and drinking. Usually eating and drinking should be avoided after midnight the night before the surgery.

At the Hospital

Once you arrive at the hospital or surgical center, you will need to check in. You will want to bring along some toys or things for your child to do while you wait for the surgery. If your child is an infant, bring a bottle or sippy cup and extra diapers with you. While you are given a time for the surgery to take place, your appointment is based on an estimated time of your procedure and the surgeries taking place earlier in the day. Be prepared to wait.

At some point, you will be asked to complete a comprehensive health history form to help your medical team to give your child the best care possible. Make sure to inform your healthcare provider if the patient or a relative has ever had a reaction to anesthesia. Report any allergies including allergies to latex, which is used in some medical devices.

Prior to the procedure, a nurse will take some vital signs, (blood pressure, heart rate, temperature, respiratory rate, and oxygen saturation), in order to have something to compare post-surgery results.

Sometimes the patient can be given a sedative medication to reduce anxiety before surgery. The medication commonly used is called Versed (midazolam). This is not always permitted by some healthcare providers, but it can help to relax your child and help him to not remember the unpleasant experience.

How Are the Adenoids Removed?

The adenoids are removed with an adenoid curette, a microdebrider, or just suction cautery. The surgeon will cauterize the site once the adenoids are removed; this involves using an electrical current that seals the blood vessels. An adenoidectomy generally will only take about 20 minutes. If your child is also having their tonsils removed or other procedures it will take longer.

After the surgery, your child will be taken to the PACU (post-anesthesia care unit) to be observed by a registered nurse until he is more awake. The nurse will be looking at how sleepy your child is, how close his vital signs are to those taken before the surgery, if he is in pain, and if he is able to eat and drink without vomiting.

Caring for Your Child After an Adenoidectomy

After returning home, your child may be able to resume his regular diet unless he also had a tonsillectomy or is suffering from nausea and vomiting. If nausea and vomiting are an issue, it's best to stick to clear liquids such as soup broth, water, and apple juice.

If the pain is an issue, soft foods should be used. At first, avoid citrus juices, as these may cause irritation, and milk, which can contribute to mucus production. If clots or fresh blood are seen in the nose or throat (aside from blood-tinged sputum) you should go to the hospital immediately.

Your practitioner or nurse will give you very specific instructions about caring for your child at home. These instructions should be followed exactly. In general, you should monitor your child's fluid status by watching for persistent vomiting or refusal to drink fluids. Dry cracked lips, no tears, and little urine are all signs of dehydration and should be reported to your child's physician. Other things the heatlhcare provider should be notified of include heavy bleeding, fever, and excessive pain.

Swelling at the surgical site may cause the voice to change. This is normal. However, if the change persists after several weeks, seek the assistance of the healthcare provider so that your child can be checked for a condition called velopharyngeal insufficiency (the improper closing of a muscle in the back of the mouth).

Children should refrain from sports and excessive activity during recovery. Also, for 2 weeks, do what you can to prevent your child from coming into contact with people who have respiratory infections. You should keep your child home from school for at least one week or as directed by your healthcare provider.