Adenoidectomy

The adenoids are made of lymphoid tissue, one of the components of the immune system. They are located behind the nose, in the space where the nose and throat meet, called the nasopharynx. The adenoids are examined endoscopically through the nose or with a lateral skull X-ray.

What is the function of the adenoids?

The adenoids play a role in protecting the body against throat and nose infections. Adenoid tissue, present at birth, begins to grow at 1.5–2 years of age and continues to grow until 7–8 years of age. Frequent upper respiratory tract infections, a genetic predisposition inherited from the parents, allergic diseases and reflux are possible factors in further enlargement of the adenoids.

What problems do the adenoids cause?

• Because children with adenoid problems cannot breathe comfortably through the nose, they struggle to breathe, especially during sleep, and sleep with their mouths open and snoring. As a result of the respiratory muscles overworking, sweating occurs, especially in the head and neck area. These children generally sleep restlessly and wake up frequently, often from nightmares.
• If adenoid enlargement is advanced, the extra effort of the respiratory muscles is not enough for breathing, and a dangerous condition called “apnea,” in which breathing temporarily stops during sleep, develops.
• If the adenoids block the ear ventilation tubes (Eustachian tubes) on either side of them, fluid may collect in the middle ear and frequent middle ear infections may occur. This causes hearing loss.
• Persistent muffled (nasal-sounding) speech occurs when the adenoids block the airway between the nose and throat.
• Constant forced passage of breathing air from the nose to the throat and from there to the windpipe creates negative pressure in the nasal cavity, causing the palate to be pulled toward the nasal cavity and collapse, resulting in a high-arched palate. As a result, the nasal cavity narrows, the face narrows, and because the child constantly breathes through the mouth, a typical facial structure called “adenoid face” develops.
• Growth hormone, which plays a role in children's growth and development, is released during deep sleep. Children with adenoid problems cannot fall into deep sleep; in other words, they sleep as if half awake. This causes delays in the child's growth and development.
• Because children with adenoid problems cannot rest sufficiently during sleep, they are tired, cranky and inattentive during the day. This leads to poorer school performance and low mood.
• Apart from the problems caused by enlarged adenoids listed above, the adenoids can frequently become inflamed, leading to postnasal drip, loss of appetite due to swallowing the drainage, nighttime coughing, and very frequent use of medication, especially antibiotics.

When is adenoidectomy performed?

If the adenoids cause such problems, they should be removed without delay. Adenoidectomy is usually performed at age 2 and older. However, it can be performed earlier if the child has “apnea” (pauses in breathing during sleep) or otherwise unexplained failure to gain weight or a halt in growth and development.

How is adenoidectomy performed?

Today, adenoidectomy is performed under general anesthesia, and the adenoids are cleared with special instruments. The operation takes about 20–30 minutes. After surgery, the patient is kept under observation for 4–5 hours and then discharged. Apart from a mild sore throat for 2–3 days after surgery, there is no significant discomfort. Liquid and soft, lukewarm foods are preferred for a few days.

If the adenoids are not removed in time, sleep apnea may continue and worsen, jaw and dental deformities may develop, permanent middle ear problems and hearing loss may occur, and growth and developmental delays may become permanent. Children whose adenoids are removed do not get sick more often, because the human body has many organs that perform the same functions as the adenoids.