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   Otolaryngology Associates

                               Adenoidectomy

             WHAT IS AN ADENOIDECTOMY?

WHY WOULD ADENOIDS BE REMOVED BUT NOT THE TONSILS?

DOES MY CHILD STAY OVERNIGHT AFTER ADENOIDECTOMY?

HOW IS THE PROCEDURE DONE?

WILL MY CHILD'S VOICE CHANGE AFTER ADENOIDECTOMY?

 

WHAT IS AN ADENOIDECTOMY?

The surgical removal of the adenoids is called an adenoidectomy. An adenoidectomy MAY BE associated with the surgical removal of the tonsils (tonsillectomy) or can be performed alone.

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WHY WOULD ADENOIDS BE REMOVED BUT NOT THE TONSILS?

Because the adenoids are located behind the nose in an area called the nasopharynx; an adenoidectomy is often performed due to problems in the ears, nose and sinuses. The indications for an adenoidectomy can be divided into two categories: chronic infections and enlargement. A chronic adenoid infection, called adenoiditis, can often be a subtle disease.

Many of these children have been repeatedly treated for other problems before the adenoids were suspected. The adenoids are located next to the Eustachian tube, which provides a drainage site for middle ear fluid. Therefore, chronic adenoiditis may lead to recurrent ear infections due to the spread of infection up the Eustachian tube. The infection may also spread forward into the nose giving your child symptoms of chronic sinus infections.

The other indication for an adenoidectomy is for adenoid enlargement. There may be no history of any infections. These children become mouthbreathers with snoring and nasal sounding voices as if they had a constant cold. Often there is associated enlargement of the tonsils. This airway obstruction can lead to changes in the growth of the facial bones and teeth and can lead to obstructive sleep apnea, which is described in detail in the  "FAQ’s" section of this site.

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DOES MY CHILD STAY OVERNIGHT AFTER ADENOIDECTOMY?

A routine adenoidectomy is performed as an outpatient surgery. In an adenoidectomy is combined with a tonsillectomy on a patient with sleep apnea, overnight monitoring in the hospital, possibly in the intensive care unit, is recommended. The adenoidectomy takes approximately 30 minutes to perform and is done while your child is asleep under general anesthesia. A special instrument holds open your child's mouth to clearly see the back of the throat. The entire procedure is performed through the mouth. There are no scars on the face or neck.

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HOW IS THE PROCEDURE DONE?

The technique for the adenoidectomy is as follows:

1. General anesthesia is administered

2. An instrument is used which opens the mouth and holds the tongue out of the way.

3. A flexible catheter is placed through the nose into the mouth behind the soft palate. The end of the catheter in the mouth is brought out to clamp to the other end of the catheter under the nose. This allows exposure of the adenoid area but allows the surgeon to use both hands to operate. A headlight and mirror are used to identify the adenoids, and the coblator is placed onto the adenoids, which are then removed while looking directly at them.

After the adenoids are removed, the bleeding blood vessels are controlled with the coblator or electrical cautery. The expected recovery time is 1-2 days. Your child may experience mild throat and neck discomfort, which usually responds to Tylenol. Narcotic pain medication is not usually needed.

Your child's diet may be advanced from clear liquids to solid food as tolerated. Although your child will feel back to himself in 2 days, it is strongly advised to limit strenuous activity (such as gym class, ballet, T-ball, cheerleading and karate) for at least one week after surgery to give the surgical area time for healing. 

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WILL MY CHILD'S VOICE CHANGE AFTER ADENOIDECTOMY?

The major risks due to the adenoid surgery include neck pain, ear infection, swelling which temporarily worsens nasal blockage, excessive scarring in the back of the throat, and voice changes. There are two types of voice changes possible. The most common one is a change in the quality of the voice. You may notice that your child has a higher pitched voice. This is mostly due to the sounds now being able to fill up a larger area of space.

The other voice change is much less common but is more troublesome. This voice change is called velopharyngeal incompetence. When the adenoids are removed, the palate may not be able to close off the area in the back of the nose. This results in a constant connection between the nose and mouth with excessive air leaving through the nose during speech.  These children may also have problems with liquids and food this problem is usually temporary and resolves within weeks to months after surgery as the soft palate muscle becomes stronger.

If the velopharyngeal incompetence has not resolved three months after surgery, a speech therapy consultation may be recommended to help train your child's soft palate muscles to close the air space. If the problem has not resolved within 6-12 months after surgery and despite speech therapy, a surgical procedure may be required to partially close of the air space which the soft palate cannot reach.

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The information provided on this web site is not intended to take the place of consultation with your physician. You should always consult a physician whenever you require diagnosis or treatment.


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