Adenoids: What They Are and When They Need to Be Removed

Parents often hear the word “adenoids” from a doctor but do not always understand what stands behind it. Some children only need observation and treatment, others need surgery. Let’s look at what adenoids are in simple terms, where they are located and in which cases they need to be removed.

What Adenoids Are and How to Tell They Are Causing Problems

Adenoids are an enlarged nasopharyngeal tonsil, a cluster of lymphoid tissue in the upper part of the pharynx, behind the nasal cavity. Adenoids are located deep, and they cannot be seen during an ordinary throat examination: endoscopy or a special mirror is needed. Normally the tonsil takes part in the work of the immune system, but with frequent infections or allergy it grows and blocks nasal breathing. This most often happens at the age of 3–7, and adenoids are rare in adults.

Doctors distinguish three grades: in the first, the adenoids block up to a third of the airway, in the third, almost completely. Signs:

• the child breathes through the mouth, especially during sleep, and snores;
• the voice is nasal, and the child wakes up not well rested;
• frequent runny noses, ear infections, reduced hearing;
• a prolonged cough at night.

When Adenoids Are Removed and When Treatment Without Surgery Is Enough

Adenoids become a chronic condition when inflammation does not go away for months. This is called adenoiditis. Size alone is not a reason for surgery: by the age of 10–12 the lymphoid tissue shrinks in many children. In the early stages, nasal rinsing with saline solutions, topical hormonal sprays as prescribed by a doctor, and allergy treatment are used.

Surgery is recommended when treatment does not help, and there is:

• constant difficulty with nasal breathing and pauses in breathing during sleep;
• recurrent ear infections and reduced hearing due to fluid in the middle ear;
• a chronic inflammatory process in the nose and sinuses;
• changes in the bite and the shape of the face.

The question of what age to remove adenoids is decided individually: most often it is 4–7 years. As for what time of year is better — the operation is usually scheduled outside the season of acute infections, after full recovery.

How Adenotomy Is Performed: the Classic Method, Laser and Radiofrequency Ablation

Adenotomy is the removal of adenoids under general anesthesia. The classic technique involves removal with a special instrument — an adenotome. Endoscopic techniques let the doctor see the nasopharynx on a screen and remove tissue more precisely. Radiofrequency ablation destroys tissue by controlled heating and injures the surrounding structures less. Laser removal is used in some clinics as indicated. The choice of method depends on the child’s condition, the degree of overgrowth and the clinic’s equipment. It is important for parents to know: the operation is safe with proper preparation, and the general anesthesia is chosen by the anesthesiologist according to age and weight. For more details, see the page on adenotomy at Helyos.

What Is Checked Before Adenoid Removal

Before the operation the child is examined by an otolaryngologist, then an endoscopy of the nasopharynx is performed and, if necessary, a hearing test. A complete blood count, a coagulogram and a consultation with an anesthesiologist are mandatory. The child must be healthy: an acute runny nose or ARVI is a reason to postpone the operation by 2–4 weeks.

How Recovery After Adenotomy Goes

The operation takes 15–30 minutes, after which the child stays under observation for several hours. The child is usually sent home the same day or the next. For the first 7–10 days a gentle regimen is needed:

• soft, cool food, nothing hot or spicy;
• no hot baths, sauna or physical exertion for 2 weeks;
• nasal rinsing as recommended by the surgeon;
• do not give antipyretics or painkillers without agreeing it with the doctor.

Warning signs: bleeding from the nose or mouth, temperature above 38.5 °C, severe pain, refusal to drink. In that case you need to contact the doctor urgently.

What Changes After Adenoid Removal: Breathing, Sleep, Hearing and the Risk of Regrowth

After the operation, breathing usually becomes freer, snoring and night-time pauses in breathing disappear, the child sleeps better, hearing improves, and the ears and nose get sick less often. The voice may remain nasal for several weeks. Regrowth is possible, especially if the operation was done in small children or if there is an allergy. That is why after adenotomy it is important to treat allergic rhinitis and be monitored by an ENT doctor.

ENT Care for Adenoids: Otolaryngology and Surgery

Diagnosis and treatment are carried out by doctors of pediatric otolaryngology and surgery in otolaryngology. The doctor will assess the size of the adenoids, suggest observation, conservative treatment or surgery, and accompany the child until recovery.

Cost of Consultations and Helyos Specialists Involved in Treating Adenoids

The treatment involves a pediatric otolaryngologist, a surgeon-otolaryngologist, an anesthesiologist and a pediatrician. For the current cost of consultations and tests, see the page on prices for medical services.