Adenoidectomy - Procedure, Recovery & Who Needs It?

What are Adenoids?

Adenoids are a patch of soft tissue located at the back of the throat in the nasal passage. Like lymph nodes, they are part of the body's immune system. They help filter bacteria and other harmful particles that enter through the nose, which keeps the body safe from infection. The glands can become swollen as they fight germs.

In children, adenoids are larger when compared to the size of the airway. They can sometimes cause a blockage, which can impact the child's ability to breathe through their nose. This can lead to mouth breathing, snoring, and sleep apnea. They can also be tender and painful.

Adenoids usually shrink as children get older and they develop a strong immune system. By adulthood, they are often barely visible on medical imaging. However, the adenoids can become enlarged again later in life and in some cases cause breathing problems.¹

What is an Adenoidectomy?

An adenoidectomy is a surgical procedure that removes the adenoids. Doctors sometimes perform adenoid removal alongside a tonsillectomy, which removes the tonsils. The tonsils are located in the back of the throat on either side of the tongue.

In most cases, an ear, nose and throat (ENT) surgeon performs adenoidectomies on children, although some adults may benefit from the surgery.

The surgeon performs the procedure under general anesthesia, meaning the child is asleep during the surgery. It's a fairly common procedure that can often be performed quickly as an outpatient procedure.²

Adenoidectomy vs. Tonsillectomy

An adenoidectomy is the removal of the adenoids, while a tonsillectomy is the removal of the tonsils. These are two separate procedures, although a doctor may perform both at the same time. They may refer to this as tonsils and adenoids or T and A.

Doctors usually perform adenoidectomies and tonsillectomies on children, although they are not uncommon in adults.

Another difference is regarding anesthesia. Adenoidectomies typically require general anesthesia, while tonsillectomies are sometimes done under general or local anesthesia. The method of anesthesia chosen is based on the safest option for each person. It’s determined by the anesthesiologist, surgeon, and patient. 

Also, some people may take longer to recover from a tonsillectomy and find it more painful than an adenoidectomy.³

Who Needs an Adenoidectomy?

A doctor should take a person’s full medical history before recommending an adenoidectomy. 

Although adenoidectomies are typically safe and straightforward, all surgeries carry risks. Therefore, doctors might only recommend the operation for children who have swollen adenoid glands that cause the following problems:³

• Difficulty breathing through the nose
• Mouth breathing
• Snoring
• Sleep apnea
• Nasal obstruction
• Difficulty eating or drinking
• Recurrent infections

An adenoidectomy is frequently recommended for children who experience recurring ear infections or chronic sinus infections.

Although adenoidectomies are more commonly performed in children, some adults may benefit from the procedure. For example, a doctor may suggest an adenoidectomy for adults who experience recurrent sinus or ear infections, or whose adenoids are enlarged and block the throat. 

Adenoidectomy Procedure

Before the adenoidectomy procedure, you’ll consult your child’s ENT surgeon. They'll inform you of the risks and benefits associated with the surgery. They’ll also cover what you can expect during and after the procedure and the recovery.

How to Prepare for Surgery

You'll receive instructions from your doctor or nurse on how to prepare your child for the surgery. It's important to follow these directions carefully to reduce the risk of complications. This discussion is also an opportunity to ask questions and clarify expectations.

Preparation for the surgery often requires:

• Not taking certain medications such as blood thinners, aspirin, and nonsteroidal anti-inflammatory drugs (NSAIDs) a week or more before surgery
• Not eating or drinking anything for at least 6 hours before surgery
• Asking someone to drive you home after the procedure
• Signing a consent form indicating that they understand the risks and benefits of the surgery

Procedure Steps

The procedure steps depend on if the child is having their tonsils removed at the same time. For removal of the adenoids, the procedure is as follows:⁴

1. In the operating room, the anesthesiologist administers a general anesthetic to put the child to sleep and ensure they cannot feel pain.
2. The surgeon inserts a tool into the child’s mouth to keep it open.
3. They access the child’s adenoids through the back of the child’s throat. There will be no visible scars outside of the throat.
4. The surgeon removes the adenoid tissue using special tools.
5. The surgeon may use stiches and/or absorbent packing material to control bleeding.
6. A nurse then takes the child to a recovery room and monitors them closely as they recover from the general anesthetic.
7. Once the child is awake and stable, a doctor assesses them. The doctor will confirm they can breathe, cough, and swallow easily. They will also check the surgical site to ensure it isn’t bleeding or swelling excessively. Then, the child will be discharged. 

Typically, the procedure takes less than an hour and the procedure occurs on an outpatient basis. Some people are required to stay overnight in the hospital. 

If a child has trouble breathing or experiences other complications, they may need to stay in the hospital overnight so doctors can observe them.

Aftercare & Recovery

Although pain medicine is given during the surgery, you may still feel pain and discomfort for a few hours or more. The symptoms might persist for several days, but most people make a full recovery within two weeks.

Follow your doctor's aftercare instructions for optimal recovery. Recommendations might include:

• Resting for the first few days following the surgery
• Drinking plenty of fluids to prevent dehydration
• Eating soft foods such as mashed potatoes for the first week or so
• Avoiding airplane travel for at least 2 weeks because of air pressure changes at high altitudes

Both adults and children can use over-the-counter (OTC) pain medications as necessary if directed by their healthcare provider. However, children should not take aspirin because it increases the chance of developing Reye’s syndrome. This rare disorder causes organ damage, and doctors have linked it to aspirin. 

Symptoms like bad breath, noisy breathing, and snoring may continue for a couple of weeks following the surgery. However, once the tissue swelling subsides, these symptoms should resolve.

Recovery is usually uncomplicated. Speak to a healthcare provider if you or your child feel particularly unwell. 

Adults usually take longer to recover than children. Adult adenoids might be larger and more difficult to remove. This can make the procedure more painful and prolong recovery.

Side Effects and Risks 

Around 130,000 adenoid removal procedures take place each year in the United States.⁵ 

Adenoid removal surgery is generally safe. Healthy children have a low risk of complications. However, after surgery, some people experience:

• Sore throat
• Difficulty swallowing
• Fever
• Ear pain
• Runny nose
• Bad breath
• Pain at the back of the nose

More serious but less common complications include:

• Bleeding from the mouth or nose
• Infection
• Reaction to anesthesia

Any sign of bleeding from the nose or mouth requires immediate medical assistance. In addition, if you have a fever that doesn't subside within the first day or is 102°F or higher, contact your doctor immediately.

How Much Does an Adenoidectomy Cost?

The cost of an adenoidectomy varies depending on your insurance coverage and the facility where you have the procedure, among other factors.

In general, adenoidectomies are fairly simple and quick, so the cost is usually on the lower end of the spectrum for surgical procedures. You can expect to pay around $3,000 for a combined adenotonsillectomy procedure.⁶

Summary

An adenoidectomy is a common and simple procedure that removes the adenoids. It's typically done to relieve symptoms of obstruction such as difficulty breathing or eating, recurrent sinus or ear infections, or sleep apnea.

Most people tolerate the surgery well with few complications. Recovery is typically quick and easy. You can return to normal activities within a couple of days and expect a full recovery within two weeks.