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Adenoids and Adenoidectomy
What
are adenoids and tonsils? The adenoids are a single
clump of tissue in the back of the nose (nasopharynx). They are
located (in the adult) on the back wall of the throat (pharynx)...about
one inch above the uvula (the little teardrop shaped piece of
tissue that hangs down in the middle of the soft palate). The
tonsils are two clumps of tissue, on either side of the throat,
embedded in a pocket at the side of the palate (roof of the mouth).
The lower edge of each tonsil is beside the tongue...way in the
back of the throat.
What function do
they serve? Aren't they important?
The tonsils and the adenoids are mostly composed of lymphoid
tissue, which is found thoughout the gastointestinal tract and
on the base of the tongue. Lymphoid tissue is composed of lymphocytes...which
are mostly involved in antibody production. Since we generally
consider antibody production to be a good thing, many studies
have been performed to try to clarify the importance of the tonsils.
To date, there seems to be no adverse effect on the immune status
or health of patients who have had them removed. Any noticable
effect has generally been positive. It appears that the tonsils
and adenoids were not "designed" to effectively handle
the multitude of viral infections that occur in children in an
urban population. Rather, the immune system, including the tonsils
and adenoids, developed during a era where the child was rarely
exposed to a large number of other people and the germs they carried.
It may also be that these organs are relatively more important
in dealing with certain types of infections, such as worms or
other parasites, that are relatively uncommon in today's society.
It is clear that in many cases, the tonsils and/or the adenoids
become "dysfunctional" and are more of a liability than
an asset.
Why
are the adenoids removed? There are a number of
well-established valid reasons for removal (called an adenoidectomy).
Some patients will have more the one reason. The most common are
listed below.
| Blockage of the back of the nose...they
are too big. |
This is now one of the more common reasons
for removal. The adenoids may be large enought to cause "mouth
breathing", snoring, or even sleep apnea (blockage of
breathing during sleep). This degree of enlargement may be
associated with chronic fluid or infection in ears. Inability
to breathe throught the nose causes a reduction in smell (and
therefore taste). This is most commonly seen in pre-school
children but can exist as early as several months of age.
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| Chronic and recurrent fluid or infections
of the ears. |
The adenoids may be enlarged or chronically
infected to the extent that they cause ear problems...either
recurrent infections or chronic fluid. The infection or blockage
may affect eustachian tube function. An adenoidectomy is often
recommended for children who continue to have ear problems
after the first set of tubes. We will occasionally recommend
an adenoidectomy with the first set of tubes if some of the
other problems exist. |
| Chronic
or recurrent sinus infections...or "rhinosinusitis". |
Similar to the problem with the middle ear,
enlarged or infected adenoids may cause accumulation of nasal
secretions or recurrent sinus infections. Many surgeons feel
that an adenoidectomy is the most appropriate surgical procedure
for young children with severe sinus problems. |
Should
the tonsils be removed also? In general, only
if they are enlarged, or otherwise have been causing problems
themselves. The tonsils rarely, if ever, are associated with ear
disease. However, if we are removing adenoids because they are
enlarged or obstructed, we tend to be relatively aggressive with
borderline enlarged tonsils. Too often, several months later,
when we left such tonsils, they became enough of a problem to
warrant removal.
Will
the child outgrow the problem? In general, yes...the
adenoids usually shrink (regress) in the second decade of life.
However, years of any of the problems above may be too high of
a price to pay for waiting. In particular, blockage and sleep
apnea may result in permanent adverse changes in facial or dental
development...in addition to the adverse effects on growth and
learning caused by chronic poor sleeping.
How
are adenoids removed? General anesthesia is the
norm. Most often, with the assistance of a small mirror, adenoid
tissue is "shaved" or curretted from the back of the
nose. Occasionally, some other devices or electocautery is used.
With the advent of special cautery devices, we almost always completely
dry the surgical site before the patient wakes up, eliminating
the low-grade bleeding that used to be associated with adenoidectomies.
The procedure typically takes 5-15 minutes to complete.
What
are the complications of adenoidectomy? Complications
are rare, and usually minor. Anesthetic risk is usually related
to the health of the patient...serious anesthetic complications
can occur, but are very unusual. Bleeding is rare...we have had
no serious bleeding in over 3000 patients, and only a few minor
bleeding episodes. The adenoid "bed" usually becomes
superficially infected, and can cause 7-10 days of bad breath,
but serious infections are very rare. If adenoids are routinely
removed in all children, without careful consideration and examination,
a few children will have "velopharyngeal insufficiency"...meaning
that sounds or liquids can escape up the back of the nose...afffecting
speech and/or swallowing. We have never encountered that complication,
but it has been reported by other surgeons. In other words, some
children should not undergo adenoidectomy - because of their special
anatomy.
What
should we expect post-operatively? Adenoidectomy
typically is much less painful than a tonsillectomy. Most children
need no pain medications...a few benefit from acetaminophen (Tylenol).
Bad breath is common for 7-10 days. A few children will complain
of a stiff or sore neck (from irritation of the neck muscles underneath
the adenoid bed). We do not limit activity (playing or swimming)
although some surgeons may do so. The patient may consume a normal
diet. We usually see patients 2-4 weeks post-operatively - to
ensure normal function and healing. See
additional information.
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