Adenoidectomy is a solution your doctor may recommend if your child constantly breathes through their mouth or gets sick frequently. Usually performed on children between the ages of 1 and 7, this adenoid surgery helps prevent problems such as sleep apnea and ear infections.
In this article, you will find information on how an adenoidectomy is performed, how the surgical process proceeds, and what you need to pay attention to during the recovery period after an adenoidectomy. We will also cover the length of hospital stay after an adenoidectomy and potential complications.
What Is an Adenoidectomy (Adenoid Surgery)?
Adenoids and Their Functions
The adenoid is a tissue structure located behind the nose that is part of the body's defense mechanism. Positioned in the nasopharynx region, known as the adenoid region, this tissue is the first line of defense against viruses and bacteria entering through the nose. Known in medical terms as the pharyngeal tonsil or adenoid, it forms part of a protective ring called Waldeyer's Ring, along with the tonsils in the throat and similar tissues at the base of the tongue.
The function of the adenoid is to recognize microorganisms entering the body through the mouth and nose and to produce antibodies against them. It plays an important role in the development of the immune system during childhood. It begins to grow around the age of 2-4, continues to grow until age 5-6, and then begins to shrink, regressing to adult size by age 11. After puberty, the function of the adenoid decreases and disappears completely in many people.
Adenoid Enlargement and Resulting Problems
Adenoid enlargement is seen more frequently during the nursery and preschool period. Frequent infections and the presence of allergies cause the adenoids to grow larger than normal. Some children may be born with abnormally large adenoids. Additionally, exposure to cigarette smoke can contribute to adenoid enlargement.
Enlarged adenoids block nasal breathing, leading to constant mouth breathing and nasal congestion. This can cause problems such as snoring and sleep apnea, where breathing stops during sleep. By blocking the opening of the Eustachian tube, enlarged adenoids can lead to fluid accumulation in the middle ear, ear infections, and hearing loss. Furthermore, recurrent sinusitis and lower respiratory tract infections may also occur.
Children with long-term nasal congestion develop a characteristic appearance known as "adenoid face." In this facial appearance, the middle part of the face is flattened, the mouth is constantly open, the upper jaw protrudes forward, and the palate structure becomes arched and narrow. Dental occlusion problems and frequent cavities develop. Children with adenoid problems are generally loss of appetite and their growth and development are slower compared to their peers.
When Surgery Is Necessary
Adenoid surgery is recommended in the presence of certain conditions. The surgical age is generally 3 years and older, but if it causes sleep apnea, it is operated on at a much earlier age. Conditions where adenoid surgery is necessary are as follows:
Constant (longer than 3 months) nasal congestion and enlargement sufficient to cause mouth-breathing during sleep
Sleep apnea and intermittent cessation of breathing during sleep
Middle ear infections or fluid accumulation in the middle ear that recurs 3-4 times a year or more
Frequent sinusitis or recurrent adenoiditis
Asthma and respiratory allergies that are difficult to control with medication
Swallowing problems and speech disorders
Growth and development retardation
In cases where medication is insufficient, the adenoids must be surgically removed. Removing adenoids that are no longer functioning does not create a deficiency in the immune system.
How Is Adenoidectomy Surgery Performed?
Preoperative Preparation
After the decision for surgery is made, some preparations must be made for your child. First, routine blood tests and an evaluation by the anesthesiologist are performed. These tests check for bleeding disorders and liver and kidney functions. You should clarify with your doctor why the surgery is necessary and get information about the anesthesia and technique to be used.
It is vital that your child is fasting on the morning of the surgery. Eating and drinking are stopped after the time given by your doctor. Choose comfortable clothing and you can bring a toy or item your child likes. If there are signs of fever or flu, be sure to inform the physician, as active infections must be treated first.
It is also important to prepare your child psychologically. Talk about the surgery in a calm and reassuring tone. Organize your admission and discharge plan in advance.
Surgical Process and Techniques
Adenoid surgery is performed under general anesthesia. Before your child goes to the operating room, a sedative is given. In addition, an anesthesiologist monitors your child continuously during the surgery.
The surgery is performed through the mouth, so there is no visible incision from the outside. Various techniques can be used:
Classic curettage method: The adenoid is scraped and removed with special instruments called curettes. Then, the adenoid cavity is checked with an endoscope to see if any remnants remain.
Coblation (plasma technology): Uses low-temperature radiofrequency energy to vaporize the tissue without burning it. In this method, heat damage does not occur and healing is accelerated. Excess tissue is vaporized by the plasma effect with radiofrequency energy and removed by vacuuming with a special device.
Microdebrider: Shaves the adenoid with a rotating blade mechanism and vacuums it simultaneously. It is a reliable method, especially for protecting sensitive areas near the openings of the Eustachian tubes that carry air to the ear.
The adenoid region is viewed with the help of a camera, and the procedure is performed without damaging surrounding tissues. If necessary, ear tubes can also be inserted in the same session.
Duration of Surgery
The surgery itself takes about 10-15 minutes. According to some sources, it is completed between 15-30 minutes. With the patient falling asleep and waking up, the total time is about 45 minutes. Especially if the vaporization method is used, the operation time is around 10-15 minutes.
Hospital Stay After Adenoidectomy
Two hours after the surgery, the effect of general anesthesia wears off. After 4-5 hours of monitoring following the surgery, the patient is checked and usually discharged. The total hospital stay is between 8-12 hours.
Since the probability of complications with the vaporization method is very low, the patient can be discharged on the same day depending on their condition. Usually, they are discharged on the evening of the surgery. However, patients with a risk of bleeding, those living far away, those who cannot take adequate nutrition, or those experiencing severe nausea and vomiting are kept for 1 night.
Recovery Process After Adenoidectomy
First 24 Hours
Your child should not eat anything for the first 3-3.5 hours after surgery. This period is necessary for the effect of general anesthesia to pass and for the surgical area to stabilize. In the first hours, nausea may occur due to the effect of anesthesia and swallowed blood.
Whether there is bleeding in the first 1-2 hours after surgery is closely monitored. This check is usually done during the hospital stay. In the first days, your child may be restless and cry; this is normal.
Cold foods are the hero of the first day. Ice cream, cold milk, ayran, yogurt, compote juice, and fruit juices can be given. Especially ice cream reduces both pain and edema with its cold effect. In addition to these, soft foods such as custard, pudding, and mashed potatoes softened with milk should be preferred.
Things to Consider During the Recovery Period
The recovery process after adenoid surgery is on average one week. Under normal conditions, there is no objection to your child returning to their normal life after a period of 3-4 days.
In some children, there is a noticeable relief in breathing during sleep on the night of the surgery. However, in some children, relief may not be as early and obvious due to secretions accumulated in the adenoid and nose. Your child may continue to breathe wheezily, snore, and breathe through the mouth.
It takes 2-3 weeks for the surgical area to heal completely and for preoperative complaints to resolve. During the recovery process, you should keep your child away from infected people. It is important to spend a week away from infection environments.
You can take a bath the day after the surgery, provided it is not too hot and not for a long time. In the first week, post-surgical nasal discharge, intermittent nasal congestion due to edema, nighttime coughs, and slightly pink-colored nasal discharge may occur. The use of cold steam at night helps to reduce coughing.
Nutrition and Beverage Recommendations
Liquid and soft foods should be taken on the day of surgery. Foods such as water, milk, fruit juices, pudding, yogurt, and ice cream are suitable. In the following days, soft vegetable dishes, pasta, and rice can be added.
After a week, you can switch to normal nutrition, excluding hard foods that may irritate the throat such as bread crusts, biscuits, and chips. Definitely avoid acidic products. Carbonated drinks, orange juice, and lemon juice can cause irritation in the throat.
Drinking plenty of fluids is vital. If sufficient fluids are not taken, fever may rise. Fever due to low fluid intake may occur in the first 2 days, so plenty of water should be drunk. Do not use baby bottles or straws; sucking and vacuuming can increase the risk of bleeding.
Pain Management
Since there is no nerve tissue in the area where the adenoid is located, the process after surgery is not troublesome. Pain is not expected after surgery in the adenoid region. Adenoidectomy is a less painful operation than tonsillectomy and painkillers are often not needed.
Even if there is mild pain, it decreases every day. Paracetamol can be used easily as a painkiller in the postoperative period. You should use the medications recommended by your doctor regularly.
Return to Normal Activities
Generally, a minimum of 3 days of rest is recommended. One week of rest is sufficient for recovery. Do not send your child to school for the period recommended by your doctor. This period can be between 5-7 days.
Sports activities should be restricted for one week. Although the possibility of postoperative bleeding is quite low, it is necessary to pay attention to rest for the first 3 days and up to 1 week. A check-up is usually done 1 week after the surgery.
Potential Postoperative Complications and When to See a Doctor
Potential Complications
Adenoid surgery is a safe procedure and complications are rare. However, like any surgical intervention, it carries some risks and it is important that you know them.
Bleeding is the most common complication after surgery. The incidence is around 0.5%. The vast majority of bleeding occurs in the first 24 hours. It is usually in the form of slight oozing and can be brought under control by rinsing the mouth with ice water. In cases where bleeding cannot be stopped with local interventions, re-operation may rarely be required.
Velopharyngeal insufficiency is a very rare complication. Its incidence is between 0.03% and 0.06%. It is a situation where food escapes into the adenoid and nose because the soft palate cannot fully close the adenoid during swallowing. It is mostly a temporary problem and resolves within 2-4 weeks. It can rarely be permanent.
Voice changes can be seen after surgery. Removing the adenoid can lead to slight changes in voice tone. Although this situation is usually temporary, it returns to normal within a few weeks as the tissues heal. After the surgery, some children may experience temporary nasal speech.
There is a risk of infection, but serious infections are very rare. A superficial infection lasting 7-10 days may develop after surgery. A mild fever is a normal condition after surgery and a fever below 38°C usually drops on its own within a day or two.
Complications related to anesthesia can be seen in this procedure as in every surgery. Modern anesthesia techniques minimize these risks. Nausea and vomiting due to anesthesia drugs can be seen in the early postoperative period.
In addition, the adenoid can grow back, albeit rarely. Especially in children with allergies, regrowth can be seen until the age of 5-6. Small pieces may remain behind to avoid damaging the neck vertebrae and Eustachian tube during surgery.
Symptoms That Require Seeing a Doctor
You should consult your doctor immediately in the following situations:
If bleeding continues: Benefit can be provided with ice water or ice cream for slight oozing. If the bleeding does not stop, call your doctor and go to the emergency room.
High fever: If a fever of 39 degrees or higher is seen, consult a doctor. If a fever above 38°C continues for more than a few days, it may be a sign of infection.
Signs of dehydration: If sufficient fluid has not been taken for 24 hours, call your doctor. Low and dark-colored urine output, lethargy, and lack of interest are signs of dehydration.
Dark-colored or bloody vomiting like coffee grounds: This is a serious condition and indicates swallowed bleeding.
Severe pain: In case of severe pain that cannot be controlled with painkillers, consult your doctor.
Foul-smelling discharge: Foul-smelling discharge from the adenoid may be a sign of infection.
Respiratory distress and coughing: Especially if there is difficulty in breathing, immediate intervention is required.
If you have any concerns within the first week after surgery, do not hesitate to contact your doctor.
Frequently Asked Questions
At what age is adenoidectomy surgery performed?
There is no exact age limit for adenoid surgery. The surgery can generally be performed from the age of 1.5-2 years. However, since the immune system is not yet fully mature in children under 2 years old, the protective role of the adenoid against microorganisms is more important.
The most appropriate period is generally accepted as between 3-5 years of age. In this age range, adenoid enlargement becomes most pronounced and begins to affect the child's quality of life more. Despite this, if your child has emergency conditions such as sleep apnea or severe nasal congestion, your doctor may recommend surgery at an earlier age.
What is important is not age, but the severity of the symptoms. If your child sleeps with their mouth open, gets sick constantly, or has ear infections, surgery is evaluated regardless of age.
Is the surgery painful?
Since the surgery is performed under general anesthesia, your child will not feel any pain during the procedure. They will sleep throughout the surgery and the procedure will be finished when they wake up.
The expectation of pain after surgery is quite low in adenoid surgery. Pain in children is generally mild and decreases significantly within 3-4 days. Although some children may feel mild discomfort for 2 weeks after surgery, this is considered normal.
The painkillers recommended by your doctor will be sufficient for pain management. It is important to give the painkiller regularly so that your child does not feel discomfort when swallowing. Thus, they will not refuse to drink water and the recovery process will accelerate.
How long does the recovery process take?
The recovery process is generally completed within 10 days. Pain and sensitivity may be seen in the first 1-3 days. During this period, your child may feel tired and need rest.
Full recovery and adaptation occur within 2-3 weeks. Many children regain their old energy within a few days. Rest is especially important in the first week. Afterwards, your child can return to their normal activities.
The speed of recovery varies from child to child. While some children sleep comfortably on the night of the surgery, in others, relief may be a little later due to secretions in the adenoid and nose. You need to be patient.
When can they return to school after surgery?
Your child can return to school within 5-7 days after surgery. Most doctors recommend a 1-week rest period. This period is necessary both for recovery and to protect against the risk of infection.
It is important not to rush to return to school. During the first week, your child should stay away from children who have caught an infection and avoid crowded environments. Also, food options at school may irritate the surgical area.
After the doctor's check-up 7 days after the surgery, if everything is fine, your child can return to school life. Remember that they should pay attention to what they eat and drink for the first 15 days.
Do adenoids grow back?
The possibility of the adenoid growing back is quite low. Only one in every 10 adenoids removed by surgery may grow back. The regrowth rate is lower than 1%.
In some children who have surgery at a young age, adenoid tissue may rarely grow back. This risk is slightly higher, especially in children under 3 years old and children with an allergic constitution. The reason for this is that small pieces of tissue that could not be completely cleaned during the surgery remain.
You do not need to worry in case of regrowth. In children with an allergic constitution, when allergy treatments are applied regularly, the regrowth of the adenoid can usually be prevented. Your doctor can re-apply treatment methods when deemed necessary.
In Summary, Adenoid Surgery
Adenoid surgery is a safe procedure that significantly improves your child's quality of life. The recovery process usually takes a week and complications are rare. You need to pay attention to your doctor's recommendations, especially in the first days.
After the surgery, your child will breathe more comfortably, sleep better, and get sick less often. Thus, their growth and development will also accelerate.
When you follow the instructions given by your doctor, your child will return to their normal life in a short time. If you have any concerns, do not hesitate to contact your doctor.
