Adenoidectomy

The steps of the procedure are as follows:

1. The surgeon will take approximately 30 minutes to complete an adenoidectomy.
2. Once your child is made unconscious by administering anaesthesia, the surgeon will open their mouth using a small tool called a retractor.
3. Next, the surgeon will remove the adenoid glands using a debrided, electrocautery, or coblation. The surgical method to be used will depend on your surgeon. A comparison of different procedures for adenoidectomy is given in the table
4. During surgery, the surgeon will use absorbent material or an electrical device to stop the bleeding.

What to Ask and Tell Your Doctor?

While you and your child are at the ENT appointment, you can ask the following questions to the ENT surgeon:

1. Are there any other treatment options available for my child?
2. How will you perform adenoidectomy?
3. What kind of anaesthesia my child will receive during surgery?
4. What are the benefits of adenoidectomy?
5. What are the risk and complications of adenoidectomy?
6. What will happen if my child does not undergo this surgery?
7. Does my child need any blood tests before the surgery?
8. What can I expect while my child is recovering from surgery?
9. When can my child return to their daily activities after surgery?
10. The ENT specialist must know about any health concerns of your child. Tell the ENT specialist if your child:
11. Is diabetic or has any other health problems.
12. Is using any prescription/nonprescription medications, herbal medications, or nutritional supplements
13. Has an allergy to X-ray contrast, latex, any medicines, food, or anaesthesia.

What to Expect Before Surgery?

1. Before undergoing adenoidectomy, your child’s ENT specialist will schedule a pre-surgical appointment to have the following discussion:
2. Medicines: 
3. One or two weeks before surgery, the ENT specialist will inform you whether your child needs to stop taking any medication.
4. You should avoid giving your child ibuprofen or aspirin a week before surgery, as these medicines cause blood thinning.
5. Your child’s ENT specialist might also recommend some medicines that your child should take on the day of surgery. Your child should take these medicines with a sip of water.
6. Dietary changes: 
7. The ENT specialist will inform you about the diet your child needs to follow before adenoidectomy. The child’s stomach must be empty on the day of surgery.
8. You may feed your baby breast milk four hours or formula six hours before surgery
9. Pre-operative investigations: 
10. Your child’s ENT specialist will recommend routine tests a few days before surgery so that your child can smoothly undergo adenoidectomy.These tests include:
11. Urine test: To check for diabetes and infection in the urinary tract.
12. Blood tests: To check for blood type, infection, blood clotting time, and anaemia (a condition in which our body does not have enough blood cells to carry oxygen to the entire body).
13. Chest X-ray or magnetic resonance imaging (MRI) scan: To rule out any problems associated with the lungs or the heart.
14. Polysomnogram (sleep study): If your child has obstructive sleep apnoea, their ENT specialist will conduct this test or an X-ray to check for nasal blockage.
15. The ENT specialist might also check your child’s nose by using a camera or a light.
16. You should inform the ENT specialist if your child has a cold or throat problem within seven days before surgery. 
17. The surgeon will postpone the surgery if your child has a fever or cough as it can cause complications during surgery.

What to Expect During Surgery?

You can expect the following during surgery:

1. The ENT surgeon will perform adenoidectomy by opening your child’s mouth.
2. Your child will be kept in a rose position (the surgeon sits behind the patient, and the patient’s neck and head are extended) for surgery.
3. Other than the surgical site, the rest of your child’s body will be draped (covered with a sterile material) to reduce the risk of infection at the surgical site.

You can expect the following:

At hospital:

1. Your child will likely have a sore throat after surgery for which, their ENT specialist will prescribe a painkiller.
2. If adenoidectomy was performed in the afternoon, or if your child requires medical observation, they will be advised to remain in the hospital for one night. In that case, your child will be shifted to a general ward.

Recovery: 

1. Your child should avoid school for five days to avoid getting any infection. They should stay away from a smoky environment and individuals with cough/cold.
2. Your child will fully recover within one or two weeks after surgery and return to daily activities.
3. Post-surgery, your child will less likely have ear and breathing problems.

After the surgery, there would not be visible scars or marks on the skin as adenoidectomy is performed on the inside of your child’s mouth.

Homecare: 

1. Give all the medications to your child as prescribed by the ENT specialist.
2. Your child should not play any rough sports for a week post-surgery. 
3. They should not blow their nose for seven days after surgery. Use a cool-mist humidifier if their nose gets stuffy.

Diet: 

1. Your child would be able to eat and drink within a few hours post-surgery.
2. To avoid dehydration, give your child plenty of water and fluids.
3. Initially, give your child soft foods like soups, fruit juices, or mashed potatoes.
4. Children can start eating foods regularly depending on their comfort.
5. You can also give medicines such as paracetamol to relieve pain so that your child can swallow food easily. Give a painkiller an hour before the meal.

First Follow up Appointment

• Your child’s ENT specialist will recommend a follow-up three to four weeks after surgery. The ENT specialist will check how your child is recovering during the follow-up

When to Consult a Doctor?

Your child may experience discomforts like: 

1. Pain in the operated area
2. Throat problems
3. Ear pain
4. Stuffy nose
5. Nasal flow
6. Stiff jaw
7. Change in voice
8. Noisy breathing
9. Bad breath.

These are common discomforts that last for a few days after adenoidectomy.

Most children recover well after adenoidectomy. However, if you notice any of the following symptoms that your child experiences after adenoidectomy, consult their ENT specialist immediately:

1. Difficulty in turning neck or neck pain that does not resolve despite taking painkillers
2. Refusing to drink water or fluids
3. Bleeding from the nose or mouth
4. Puking after the first-day post-surgery or after taking medications
5. Blood or blood clots in the puke
6. Black or brown-coloured puke
7. High temperature
8. Inability to pee at least once every eight hours.