Adenoid Removal Surgery in Kids: When is it Necessary?

Many parents have heard of children needing their tonsils and adenoids removed, but have you ever stopped to think about what your adenoids really do and where they are located?

The term “adenoids” is really a misnomer — the adenoids are really one patch of tissue located at the back of the nasal passage, above the uvula and are out of sight to the visible eye. The adenoid is made up of lymphatic tissue that helps fight infection, similar to the tonsils. When this tissue comes into contact with viruses and bacteria that are breathed in through the nose, the adenoid can swell, causing your child to sound congested. The adenoid can also be larger in some children than others from birth, not necessarily related to infection. Typically, after the age of 5, the adenoid tissue shrinks on its own.

Common symptoms of an enlarged adenoid includes:

• Chronic nasal congestion
• Mouth breathing, due to difficulty breathing through the nose
• Snoring
• Pauses in breathing when sleeping
• Nasal sounding voice
• Frequent or persistent middle ear fluid

The most common complications that occur from this chronic obstruction of the nasal passages include:

• Frequent respiratory infections
• Sinus infections
• Chronic middle ear fluid or infections

Obstructive sleep apnea. This can lead to poor sleep, daytime sleepiness, and can even lead to pulmonary hypertension and heart failure in the most serious cases.

If your child has any of these symptoms, talk to your pediatrician about a referral to a pediatric ear nose and throat (ENT) doctor to determine if the adenoid should be removed. An ENT can use a little camera to look up in the nasal passages to get a better idea about the size of the adenoid tissue. If it is determined that the adenoid is contributing to your child’s problems, medications such as nasal steroids can be used to try to shrink the tissue.

If conservative treatments fail, an adenoidectomy can be performed. The number of adenoidectomies performed over the past 40 years has decreased dramatically, as ENT physicians are much more judicious in determining who will truly benefit from removal. The post-operative course can be difficult, with pain and bleeding being the most common risks.

Sources:

• Healthy Children
• Sleep Apnea.
  Healthy Children
• Tonsillitis.
  Diagnosis and Management of Childhood Obstructive Sleep Apnea Syndrome.
  Pediatric Adenoidal Hypertrophy and Nasal Airway Obstruction.
  Pediatrics in Review
• Tonsils and Adenoids: An Update.

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