Adenoidectomy

About adenoids

What are adenoids?

Adenoids are a collection of lymphoid tissue located at the back of the nose. In younger children, they are used to fight infection by producing antibodies.

Why remove them?

When adenoids become enlarged due to infection, they can cause a blocked nose and blockage of eustachian tubes in the ears. Enlarged adenoids can also cause obstruction of breathing, especially at night.

About the operation

Before the operation

Just prior to the day of admission, you may receive a telephone call from a nurse to run through some standard questions and will elicit any children who may not be able to proceed with surgery, for example they are unwell with a fever or have an infectious childhood ailment that may impact on surgery. The night before surgery, the ward staff will telephone you to advise you with regard to fasting times. Please let the staff member know if your child is suffering from a bad cold with a fever.

Your child will be admitted on the morning of the operation. The doctor or nurse will explain the operation in more detail, discuss any worries you may have, and ask you to sign a consent form.

If your child has a fever, or if there is any evidence of infection or productive cough the operation will almost definitely be postponed. This is because the risk of postoperative complications increase when infection is present. It is very important to tell us if your child has any unusual bleeding or bruising problems or if this type of problem might run in the family.

Before the operation, your child should be starved for six hours of food and two hours of clear fluids. Please bring this information leaflet with you on the day of surgery.

How long will the operation take?

Your child will be away from the ward for approximately one hour. The operation will be carried out under general anaesthetic, which means your child will be asleep throughout the procedure.

The adenoids are removed through the mouth and any bleeding is stopped. This takes about 20 minutes. Then your child will be taken to the recovery department until they are wide awake.

After the operation

Your child may be very sleepy at first; this is normal. Your child will be monitored very closely by the nurses for the first few hours. Regular painkillers will be given to ensure your child remains pain-free.

Once awake, your child can start taking sips of water, and after an hour may start eating, if they feel ready. Occasionally, children vomit after the operation; this may be caused by old blood which has been swallowed during surgery. It is important to avoid drinking brown or red liquids.

It is best if you encourage your child to sleep on their return to the ward as this may help to reduce any feelings of nausea.

Sips of water are allowed as soon as your child is awake, alert and the nurse and anaesthetist are happy. When alert your child may want to sit up and they will probably want to spend the rest of the day in bed resting. They may want to carry on sleeping or do quiet activities such as reading or watching television. Do reassure your child that their throat will get better.

Your child can eat and drink as tolerated after the operation. Do discuss this with the nurse.

Occasionally children may vomit after the operation. This is most often old blood (dark brown in colour) which has been swallowed during surgery. Nurses will also look for any evidence of fresh bleeding (bright red). It is therefore important to avoid giving your child red or brown drinks after the operation. Post-operative bleeding can occur, but it is unusual.

The nurse will observe your child and measure their heart rate (pulse), oxygen levels, and breathing (respirations) after he/she returns to the ward.

Possible complications

Adenoid surgery is safe, but every operation has risks.

• Bleeding is an uncommon possibility, but it is the most serious; a second operation to correct this may be required if it occurs.
• There may a small chance for tissue regrowth, particularly in very young children around the age of 1 to 2 years old. This can lead to recurrence of symptoms. These symptoms can be managed with further surgery if needed, which will be decided following another consult with your surgeon.
• There is a very small risk of infection after the procedure.
• There may be a small chance of bruising to the tongue, lips or cheeks as the surgery is done through the mouth, or the possibility of knocking a wobbly tooth, which is why we check this before surgery to minimise the risk.

After the operation

Going home

In most cases, if children recover well they can return home within three hours of surgery, if the doctor and nurses are happy. If your child is very small, they may be required to stay in overnight.

Aftercare

Once at home, your child should rest for the first two days. They may be more sleepy than usual due to anaesthetic. It is possible they may have a sore throat or sore ears for a few days. It is important to encourage eating as this helps the healing process. Your nurse will advise you about pain relief and how often you should give it. You should give pain relief regularly for the first seven days. This is also important as a child in pain is less likely to eat. Your child will need one to two weeks away from school or nursery, and where possible should be kept away from other people with coughs and colds.

Within 48 hours of discharge, if you are at all concerned about your child please contact ward F3 on telephone number 01223 217567and ask to speak to the nurse in charge, who will advise accordingly and document the telephone conversation. Alternatively, you can call the clinical nurse specialist team during office hours on 01223 216162

If you notice bleeding of more than two teaspoons of bright red blood which does not stop within a couple of minutes, seek immediate medical advice.

Following this, if you encounter any problems you should contact your GP or out-of-hours service as applicable if any of the following occur:

• You observe bleeding from the nose or mouth of more than two teaspoons of fresh bright red blood.
• Your child brings up red, black or brown vomit (this may be blood) more than once.
• Your child has a raised temperature and paracetamol and ibuprofen do not bring it down.
• Your child is not drinking any fluids.