Healthy, normal children breathe quietly through their nose during the day and do not snore or struggle to breathe at night.
Many children however with nasal obstruction, mouth breathing and snoring cope perfectly well and require no intervention.
In some however the blockage at night is sufficient to interfere with the normal pattern of sleep giving rise to poor quality sleep and a number of problems during the day. (Obstructive sleep apnoea) These may include poor behaviour, crankiness, tiredness and poor school performance. At night there may be persistent bed wetting.
The severity of the obstruction can usually be determined by a combination of a good story (history) and examination. A sleep study is helpful if doubt remains about the cause or severity of the obstruction.
Medical treatments include steroid nose sprays, antihistamines and nasal saline. Surgery usually involves adenoidectomy and/or tonsillectomy. Turbinate surgery, septal surgery, sinus surgery and palatoplasty are rarely required in children.
s - Adenoidectomy
Adenoidectomy is a common childhood operation which when performed safely and for the right reason can drastically improve the quality of life for a child.
Adenoidectomy is usually recommended in children with:
Airway obstruction, particularly if it is causing significant sleep disturbance such as sleep apnoea.
Glue ear, often at the same time as grommets are inserted. In this case removing the adenoids helps the eustachian tube function.
It is not usually advised for children with mild symptoms such as snoring or a mucky nose.
Adenoid obstructing airway
Adenoidectomy - Decision about Surgery
Frequently asked questions about adenoidectomy
When should the adenoids be removed?The adenoids lie at the back of the nose between the openings of the eustachian tubes. If they are chronically infected or physically very large, they may obstruct the nasal airway or the eustachian tubes. Adenoids are removed to help breathing or to help prevent problems with the ears.
How do you decide which children need their adenoids removed? When obstruction to breathing and eating is the problem, the decision is often made on how disturbed the sleep pattern is, and on how your child's weight is progressing. Children with poor quality sleep or significant nasal obstruction affecting their home and school life would be candidates whilst those with simple snoring or a mucky nose alone would not. In children with glue ear, removing the adenoids at the time of grommmet insertion reduces the chance of needing to re-insert grommets. Typically adenoidectomy would be considered if grommets had been needed previously.
Can my child manage without his adenoids? The adenoid's importance in the immune system (i.e. in fighting infection) fades soon after birth. Adenoids that are constantly infected cause, rather than prevent infection.
What are the risks?
Bleeding This is very very rare as a suction diathermy technique is used which vaporises the tissue and coagulates the adenoid bed.
Anesthesia Given a paediatric anesthetist, a paediatric surgeon and a hospital equipped and used to dealing with children, the anaesthetic risks of a fit child having an anaesthetic for routine ENT surgery are very small indeed.
Adenoidectomy - procedure
Preparing your child and explaining what to expect will go a long way to making the day smooth and enjoyable for everyone. Please feel free to call the play specialist on the 5th floor to discuss the books and games which are available to help prepare your child for surgery. Parents are made to feel welcome and as involved as they wish.
Adenoidectomy alone or with grommet insertion is usually a day case procedure.
Your child is usually admitted late on the morning of the surgery to acclimatize to the environment. You will also be seen by the anaesthetist (Dr. Adrian Lloyd Thomas), the resident doctor (a paediatrician) and Mr Albert to confirm details of the surgery and for you to sign the consent form.
Breakfast at least 6 hours before surgery is a good idea as it reduces any hunger. Clear fluids can be given up to 2 hours before surgery. Topical anaesthetic cream (The Magic Cream) will be put on and covered with a clear plastic film. This numbs the skin so that the anaesthetist can give the drugs needed to start anaesthesia. See Dr Lloyd-Thomas's own page for details
The operation takes 10-15 minutes though your child may be away for as long as 1/2 hour. You will be called in good time to be with your child as he/she recovers.
Suction diathermy adenoidectomy vaporizes the adenoids under video control (or with a mirror) so that all the adenoid is removed. The diathermy technique avoids the risk of bleeding during and after the operation.
Most children are a little disorientated and thirsty after the procedure and may cry despite adequate analgesia. Once they are fully awake and have had a drink they quickly improve and can go home shortly after.
Once at home most children do well with little or no pain. Occasionally there is a bad smell from the mouth and very occasionally a stiff neck which settles. Both are usually prevented by the antibiotics you will be given. The speech may change as the obstruction has been removed from the nose but will almost always normalise in the next few days or weeks.
Children usually return to school on the Monday after Wednesday surgery, though it is sensible to keep them away from children with infections for about a week. If your child becomes unwell and develops a high temperature or if there is any sign of bleeding, please contact me or the hospital immediately.
Pain is usually minimal unless combined with tonsillectomy. Dr. Adrian Lloyd-Thomas prescribes paracetamol, and ibuprufen.
Bleeding is controlled at the time of surgery. In an analysis of my last 1500 patients there were no cases of bleeding after adenoidectomy.
Temperature There is often a temperature after the surgery. Antibiotics are given as a routine, as are painkillers such as paracetamol and ibubrufen, all of which help to keep the temperature down.
Most children prefer to to return to school on the Monday following surgery but in some cases the child may be ready as early as the Friday or even the Thursday. If possible, try to keep your child away from other children with colds.
Speech can be more open and nasal after adenoidectomy as the palate has a larger gap to close for most speech sounds. This usually settles quite quickly but if prolonged an expert assessment by Debbie Sell may be advised.
Allergy in the nose. In some children who only start to breathe through their nose properly after their adenoidectomy this may be first time that allergens can affect the nasal lining. Bizarrely this can occasionally herald the onset of allergic rhinitis.