Miss 2 is now on the waiting list for surgery. She needs her adenoids removed, her turbinates (inside her sinuses) reduced, and her tonsils will continue to be monitored.
What are adenoids?
Adenoids are soft tissue located located behind the sinuses; they are part of the body’s lymphatic system (so are tonsils). When they are working properly, they help to recognise bacteria and viruses entering through the nose and produce white blood cells to fight off infection.
Adenoids are particularly useful during early childhood while the body is still encountering new bacteria and viruses for the first time and building up the immune system. Doctors tend to consider them most useful up to age 7; in adolescence they begin to shrink and by adulthood they can practically disappear.
Why do adenoids needs removing?
Sometimes in childhood the adenoids swell and stay swollen. This can be due to frequent infections, due to a chronically over-active immune system (i.e. in an atopic child there might be ongoing aero-allergens and food allergies), or for reasons unknown.
This swelling is particularly problematic the younger the child is because their airways are so small to begin with! Also, swollen adenoids often aren’t the only problem. Look at the picture above and imagine that there is also swelling in the nasal passage (swollen turbinates) and that there are also swollen tonsils in the throat – that can result in a highly miserable toddler!
What are the possible side effects of swollen adenoids?
- Obstructive sleep apnea. The swollen adenoids can intermittently block airflow. It sounds like your child is silent and then there’s a big noisy sucking in of air.
In Miss 2 it can be so loud that I can hear it through her closed bedroom door and can sound like something’s fallen off a shelf and hit the floor! It’s a crappy and frightening thing as a parent that can result in just sitting with them in the dark either to check that they are breathing or to give them a gentle nudge to help them breathe again.
- Snoring and heavy mouth breathing.
- Snotty / blocked nose.
- Repeated ear infections. The swollen adenoids can block the Eustachian tubes and prevent fluid draining from the ears to the throat.
- Blocked ears meaning that everything sounds a bit like it’s underwater.
- Blocked nose meaning a deadened sense of smell. This can also impact their ability to taste foods.
- Sinus headaches / pressure (in conjunction with blocked nose).
- Sore throat and/or difficulty swallowing.
- Fatigue. They might seem like they’re getting enough hours of sleep but in reality the quality of sleep is poor because their body is struggling to get enough oxygen through the night. It’s a bit like starting each day on a half tank of gas.
- Developmental delays. Sleep is critical for young children. During those early years, they are rapidly growing and learning. They need sleep to focus during the day; to have time for their brain to make connections between all the things they have learned or experienced; and their brain releases a growth hormone while they sleep. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can make it harder for them to stay on track.
- Behavioural difficulties. Poor sleep, fatigue and pain/discomfort, trouble hearing: these can result in daily misery that they don’t know how to express.
Why didn’t the doctor identify this earlier?
Your normal doctor (a GP) and even a paediatrician can’t see that the adenoids are swollen. You need to be referred to the Ears-Nose-Throat clinic at your local children’s hospital. They will be able to look in their nose and throat during the initial visit and then may request a facial x-ray and/or CT scan for confirmation. They may also monitor the adenoids over a few visits in order to confirm that they are chronically enlarged and not temporarily swollen due to infection; they may also try medications for a few months to see if these help.
It can be a bit like diagnosing the wind – you can’t see the wind but you can see the effects of the wind. You may even have the referral because of something unrelated (like repeated ear infections) and as a result of that find out that the adenoids have been swollen all along.
What does surgery (an adenoidectomy) involve?
Surgery will normally take place at a hospital (probably as an outpatient). The doctor will review medical history in advance and make recommendations about pausing medications. You will normally be advised not to take anti-inflammatory medications within 7 days of surgery. They will also discuss post-operative pain medication.
The day of the surgery will involve a period of fasting; food or water won’t be permitted because they can impact the anesthetic. It’s a good idea to have family support and a game plan of how to distract your child; an older child may understand why they can’t eat but a toddler is likely to just focus on the fact that they are off routine and they are HUNGRY!
During surgery, your child will be under a general anesthetic. The surgeon will enter through the mouth and the adenoids will be removed with an electrical cauterizing unit. You can watch videos of adenoidectomies (like this one); they aren’t pleasant to watch but it can be useful to help you understand what will happen.
What happens after surgery?
Depending on the age of your child, they may keep them in the hospital overnight for monitoring or they may go to a recovery room and then go home the same day.
They may feel quite groggy and tired for the next few days and also have some nausea; vomiting once or twice is normal but contact your doctor if vomiting persists.
A light, cool diet for the next few days is generally recommended (avoid hot liquids).
I’m sure my parents don’t have fond memories of me having my tonsils out when I was 4. I still remember staying overnight in the hospital! Mostly my memories are positive ones due to the fact that I got to spend a week lording it over my baby brother that I got to eat jelly and ice cream. No memory of the pain remains but the joy of those unexpected treats has lasted decades!
They will prescribed antibiotics and some light pain relief. They need lots of rest for 4-5 days to promote healing but the good news is that it is a much faster heal time than for having tonsils removed. They will also generally have 7-10 days off school and 3 weeks off sports, exercise, and swimming.
They will generally have post-surgery check-ups; your doctor will talk you through potential complications and when to seek immediate medical care.
They may have nasal stuffiness for a few months after surgery and may need nasal drops. Snoring may continue for several weeks after surgery (and may temporarily get louder). Their voice may temporarily change for a few weeks to a few months!
Keep in mind that removing the adenoids may only be one part of a wider treatment plan. If the chronic inflammation was linked to allergies then you will still need to work with a doctor to create an ongoing allergy treatment plan.
Looking for more information? I read through a wide number of sites and this was the one I found most useful.