Often, tonsils and adenoids are surgically removed at the same time. Although you can see the tonsils by looking in your child's throat, adenoids aren't directly visible. Your child's doctor has to use a small mirror or a special scope to get a peek at your child's adenoids.
So, what are adenoids anyway? They're a mass of tissue, located in the passage that connects the back of the nasal cavity to the throat. Adenoids — which are also called nasopharyngeal tonsils but are separate from the tonsils in the throat — filter out bacteria and viruses entering through the nose and produce antibodies to help the body fight infections.
Some doctors believe that adenoids may not be important at all after kids reach their third birthday. In fact, adenoids usually shrink after about 5 years of age, and they often practically disappear by the teenage years.
What Are the Symptoms of Enlarged Adenoids?
Because adenoids trap germs that enter a child's body, adenoid tissue sometimes temporarily swells as it tries to fight off an infection. There are several symptoms associated with enlarged adenoids. You may notice that your child:
- complains of difficulty breathing through the nose
- is breathing through the mouth
- talks as if his or her nostrils are pinched
- breathes noisily
- snores while sleeping
- stops breathing for a few seconds while sleeping (called sleep apnea)
If enlarged adenoids are suspected, your child's doctor may:
- Ask about and then check your child's ears, nose, and throat.
- Listen to your child's breathing through a stethoscope.
- Feel your child's neck near the jaw.
To get a really close look, the doctor may even want to take one or more X-rays. For a suspected infection, the doctor may prescribe oral antibiotics or maybe an injection of penicillin.
When Is Surgery Necessary?
If enlarged or infected adenoids keep bothering your child and medicine doesn't stop them from coming back, the doctor may recommend surgically removing them with a procedure called an adenoidectomy. This may be recommended if your child experiences one or more of the following:
- difficulty breathing
- sleep apnea
- recurrent infections
Having your child's adenoids removed is especially important when repeated infections lead to sinus and ear infections. Badly swollen adenoids can interfere with ear pressure and fluid movement, which can sometimes lead to hearing loss. Therefore, kids whose infected adenoids cause frequent earaches and fluid buildup may need to get an adenoidectomy as well as ear tube surgery.
And although adenoids can be taken out without the tonsils, if your child is having tonsil problems, they may need to be removed at the same time. A tonsillectomy with an adenoidectomy is the most common operation for children.
What Happens During the Surgery?
Surgery, no matter how common or simple the procedure, is often frightening for both the child and parent. You can help prepare your child for surgery by talking about what to expect. During the adenoidectomy and/or tonsillectomy:
- Your child will receive general anesthesia. This means the surgery will be performed in an operating room so that an anesthesiologist can monitor your child.
- Your child will be asleep for about 20 minutes.
- The surgeon can get to the tonsils and/or the adenoids through your child's open mouth — there's no need to cut through skin.
- The surgeon removes the tonsils and/or the adenoids with a series of incisions and then cauterizes (or seals) the blood vessels.
Your child will wake up in the recovery area. In most cases, the total time in the hospital is 5 to 10 hours. However, kids who have trouble breathing or show signs of bleeding will return immediately to the operating room. And kids under 3 years of age and those with chronic disease, such as seizure disorders or cerebral palsy, will usually stay overnight for observation.
The typical recuperation after a tonsillectomy and/or an adenoidectomy often involves a week or more of pain and discomfort due to the exposure of the throat muscles. Because of throat pain, your child will probably prefer eating a lot of soft foods, like ice cream, pudding, and soups.
About a week after surgery, everything should return to normal. The cut area will be left to heal naturally, which means there are no stitches to worry about. There's a small chance any tissue that's left behind can swell, but it rarely causes new problems.
After surgery, a child's symptoms typically disappear immediately, unless there's a lot of swelling that could lead to some temporary symptoms.
Understanding Enlarged Adenoids
Even though some kids may need surgery, it's important to remember that enlarged adenoids are normal in others. If your child's adenoids aren't infected, the doctor may choose to wait to operate because the adenoids may eventually shrink on their own as adolescence approaches.
Reviewed by: Aaron S. Chidekel, MD
Date reviewed: October 2007