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Adenoidectomy is the removal of the adenoid: a pad of lymphoid tissue that sits behind the nose, at the top of the throat above the tonsils, and cannot be seen simply by opening the mouth. The adenoid is active during the early years as part of the immune system and shrinks on its own with age, but it can enlarge enough to block the nasal airway and to interfere with drainage of the middle ear and the sinuses. A point about naming matters before any decision. In everyday Arabic usage the phrase for nasal adenoids in children refers to this pad of tissue, and it is entirely different from nasal polyps, which affect adults with allergy and chronic sinusitis; the conditions and the operations are not the same. Likewise, removing the adenoid does not automatically mean removing the tonsils. Each is a separate decision, and they are combined in one session only when there is evidence for both. Surgery is usually considered for persistent mouth breathing and snoring with witnessed pauses in breathing or restless sleep, for a nasal voice with chronic discharge, for repeated middle-ear infections with fluid behind the eardrum causing temporary hearing loss that affects speech and learning, or for recurrent sinus infections that do not settle with treatment. **Candidacy is decided by an ENT examination** with nasal endoscopy, a hearing test and tympanometry, and sometimes a sleep study — not by snoring alone and not by parental decision. What the operation does not do is equally important. It does not weaken a child's immunity; that widespread belief needs correcting, because lymphoid tissue is distributed throughout the body and takes over the adenoid's role, and children do not fall ill more often afterwards. It does not cure allergic rhinitis, and it does not end every case of snoring, which may persist because of the tonsils, enlarged turbinates, excess weight or another anatomical narrowing. Rarely, in very young children, residual tissue can regrow and needs later assessment.
The surgeon assesses adenoid size with a flexible nasal endoscope and questions the parents in detail about sleep, snoring, breathing pauses and mouth breathing. A hearing test and tympanometry are usually requested, and a sleep study may be added when significant apnoea is suspected.
The operation is always performed under full general anaesthesia. The child's head is positioned and the mouth is held open with a retractor. The anaesthetist explains waking and monitoring to the parents, and allergies and chronic conditions are checked once more before starting.
The adenoid is reached through the mouth using a mirror or an endoscope that displays the space behind the nose, so there are no external incisions on the face or neck and no visible wounds afterwards. The soft palate and throat are protected during the work.
The enlarged tissue is removed by curettage, coblation or a fine electrosurgical instrument, preserving the surrounding muscles and the openings of the Eustachian tubes. Bleeding is then controlled by pressure or diathermy and the area is checked before finishing.
The ears are examined in the same session, and small ventilation tubes may be placed in the eardrum if there is chronic fluid behind it. The child is woken and monitored for several hours and usually goes home the same day; very young children and those with severe apnoea stay overnight.
Tell the surgeon every medicine and supplement your child takes, any drug allergy, and any tendency to bleed or bruise easily or family history of clotting problems. Call the clinic if your child develops a cold, cough or fever close to the date, since anaesthesia may be postponed for safety. Follow the fasting rules exactly as the anaesthetist sets them — usually no food or milk for a defined number of hours, with clear fluids allowed until a stated time. Bring the hearing test, other reports and the vaccination record. At home, prepare the prescribed painkiller, cold drinks, ice lollies and soft food. Explain to your child in simple, honest words what will happen, and plan about a week at home away from nursery or school.
Expect temporary bad breath, throat or ear pain, a nasal voice and congestion for several days; all of this eases over one to ten days. Encourage plenty of fluids, which matter more than food in the first days, and offer soft cool or lukewarm meals while avoiding spicy, acidic, crunchy or dry foods. Give the prescribed painkiller on a regular schedule and never give aspirin to a child. Keep the child away from rough play, swimming and air travel until the surgeon allows them. Do not be alarmed by deep sleep or mild snoring that lasts about two weeks because of swelling. **Seek care immediately for: bleeding from the nose or mouth, repeated swallowing or vomiting of blood, fever above 38.5 C with refusal to drink and signs of dehydration such as reduced urination and lethargy, or breathing difficulty, blue lips, or pain not relieved by the painkillers.**
Usually 20 to 40 minutes, with a few hours of monitoring and same-day discharge in most cases.
Dr. Marwan Ibrahim Al Halalmeh is an ENT specialist with Jordanian Board certification and higher specialty training. Following work at the Royal Medical Servic…
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