Adenoidectomy — How It Works, Benefits & Recovery — Procedure Guide, Recovery & Risks | MyMedicPlus

Adenoidectomy is the surgical removal of the adenoid glands, lymphoid tissue located at the back of the nasal cavity where the nose meets the throat (the nasopharynx). Adenoids are part of the immune system in early childhood and typically shrink naturally by adolescence. However, when they become chronically enlarged or infected, they can obstruct the nasal airway and block the Eustachian tube openings, leading to recurrent middle ear disease, chronic nasal obstruction, mouth breathing, and sleep-disordered breathing. Adenoidectomy is one of the most commonly performed surgical procedures in children, usually performed between ages 2 and 7. It is frequently combined with tonsillectomy (adenotonsillectomy) or myringotomy with grommet insertion when these conditions coexist. The procedure is minimally traumatic, performed entirely through the open mouth with no external incisions, and is associated with a low complication rate in appropriately selected patients. Adenoidectomy is the surgical removal of the adenoid glands, lymphoid tissue located at the back of the nasal cavity in the nasopharynx. Adenoids are part of Waldeyer's lymphoid ring and play a role in early immune development, usually beginning to involute from around age seven. When adenoids become chronically enlarged, infected, or obstructive, surgical removal is required. Adenoidectomy is one of the most common paediatric surgical procedures globally, with approximately 130,000 performed annually in the United Kingdom and over 500,000 in the United States. It is performed by ENT (ear, nose, and throat) surgeons, also known as otolaryngologists, in a day-surgery setting. The procedure is often combined with tonsillectomy (adenotonsillectomy) or myringotomy with grommet insertion when otitis media with effusion co-exists. Children with Down syndrome, cleft palate, or craniofacial anomalies have higher rates of symptomatic adenoid hypertrophy and are more frequently referred for adenoidectomy.

Adenoidectomy is indicated primarily in children aged 2–7 who have symptoms attributable to adenoid hypertrophy. The main indications include recurrent acute otitis media (three or more episodes per year), otitis media with effusion (glue ear) persisting for 3 or more months, chronic nasal obstruction causing persistent mouth breathing, adenoid facies, or altered speech, obstructive sleep-disordered breathing or obstructive sleep apnoea confirmed by clinical history or polysomnography, and recurrent adenoiditis or chronic rhinosinusitis where the adenoid tissue acts as a bacterial reservoir. In adults, adenoidectomy is less common but may be indicated for similar symptoms where imaging confirms persistent adenoid tissue. Contraindications include coagulopathies, submucous cleft palate (risk of velopharyngeal insufficiency post-operatively), and active acute infection at the time of planned surgery. Referral to a paediatric ENT surgeon should occur when symptoms are persistent or recurrent despite medical management.

Adenoidectomy is performed under general anaesthesia in a day-surgery setting. The child is positioned supine with the neck extended and mouth held open by a Boyle Davis gag or similar retractor. The surgeon accesses the adenoid tissue through the open mouth; no external incisions are made. Several techniques are used. The traditional cold curettage method uses a ring curette to mechanically remove the adenoid tissue under direct palpation or mirror visualisation. The microdebrider (powered rotary shaver) removes tissue under direct endoscopic vision through the nose, allowing complete removal and reducing regrowth. Electrocautery removes and coagulates tissue simultaneously, with lower primary haemorrhage rates. Coblation adenoidectomy uses a radiofrequency probe to ablate tissue at low temperatures, associated with less thermal damage to surrounding tissue. The entire procedure takes 30–45 minutes. Haemostasis is achieved by packing or cautery, and the patient is allowed to wake and recover in a monitored post-anaesthesia unit. Adenoidectomy is performed under general anaesthesia in a day-surgery setting. The child is positioned supine with the neck extended and mouth held open by a Boyle Davis gag or similar retractor. The adenoid tissue is removed from the posterior nasal wall using a curette, coblation wand (radiofrequency energy that dissolves tissue at low temperatures), or microdebrider. The surgical field is directly visualised with a flexible nasopharyngoscope inserted through the nasal passage, ensuring complete tissue clearance and avoiding injury to adjacent structures including the Eustachian tube orifices and soft palate. Haemostasis is achieved with diathermy or packing if required. Concurrent grommets are inserted in the same sitting if indicated. The procedure takes approximately 15–30 minutes. Postoperative recovery in the anaesthetic recovery room typically lasts 30–60 minutes before discharge, usually the same day.

Adenoidectomy provides substantial clinical benefit in appropriately selected children. Resolution or significant improvement of obstructive sleep-disordered breathing occurs in 70–90% of children, with normalisation of nocturnal oxygen saturation and improvement in daytime behaviour and school performance. Reduction in the frequency of acute otitis media is achieved in approximately 70–80% of children, particularly when adenoidectomy is combined with grommet insertion for otitis media with effusion. Nasal airway obstruction and chronic mouth breathing typically resolve within weeks of surgery. Improvement in nasal speech quality, reduction in snoring, and improved appetite due to easier nasal breathing are consistently reported. Studies demonstrate significant improvements in quality of life scores for both patients and caregivers after adenoidectomy. In children with chronic rhinosinusitis, adenoidectomy alone (without sinus surgery) reduces the frequency of sinusitis episodes in a significant proportion of patients, reflecting the role of adenoid biofilm as a reservoir for pathogens.

Adenoidectomy is generally a safe procedure but carries recognised risks. The most clinically significant is primary haemorrhage (within 24 hours) occurring in approximately 0.5–1% of cases, which may require return to theatre. Secondary haemorrhage occurring 5–10 days post-operatively is less common but can be alarming and requires urgent medical review. Anaesthetic risks are generally low in healthy children but include laryngospasm, aspiration, and drug reactions. Incomplete removal of adenoid tissue is possible with traditional curettage, and adenoid regrowth occurs in approximately 5–10% of patients (more common in children under 3 years), potentially requiring repeat surgery. Temporary or rarely permanent hypernasality of speech (velopharyngeal insufficiency) may follow if an underlying submucous cleft palate was not identified pre-operatively — this is an important contraindication to check. Wound infection, nasopharyngeal stenosis (very rare), and torticollis (Grisel syndrome, extremely rare) are described complications. Post-operative nasal discharge for 2–4 weeks is common but expected.

Most children are discharged home on the same day of surgery, once they have woken from anaesthesia, achieved adequate pain control, and tolerated oral fluids. Mild-to-moderate throat pain and nasal congestion are expected for 1–2 weeks and managed with regular paracetamol and ibuprofen. A soft diet — including cold fluids such as ice lollies — is recommended for the first 5–7 days to reduce throat irritation. Children typically return to school and normal activities within 1–2 weeks. Strenuous physical activity and contact sports should be avoided for 2 weeks to reduce bleeding risk. Parents should be informed about the warning signs of secondary haemorrhage (fresh bright-red blood from the mouth or nose) and instructed to seek immediate medical attention if this occurs. A temporary nasal or hollow quality to the voice is common for 2–3 weeks as the nasopharynx adjusts; this almost always resolves spontaneously. Follow-up at 4–6 weeks allows assessment of recovery and resolution of pre-operative symptoms.