Adenoidectomy (Adenoid Removal): Meaning, Surgery, Procedure

Adenoidectomy is the surgical removal of the abnormally enlarged adenoid glands. The procedure is also known as Adenoid Removal.

Anatomy and Physiology of Adenoid Glands

Adenoids, also known as the nasopharyngeal tonsil, are masses of lymphoid tissue behind the nasal pharynx, above the roof of the mouth. They are pyramidal-shaped structures composed of lymphoid tissue. The pyramid's tip is extended towards the nasal septum, and the base sits at the posterior wall of the nasal pharynx. The adenoidal surface is invaginated by several folds with some crypts. The adenoid is covered with the ciliated epithelium as the respiratory tract. 

The function of the adenoids is protective as they are part of the immune system. This ring of tissue is the first site to encounter microorganisms and pathogens as they are located at the entry of the respiratory and alimentary tract. White blood cells circulate through the adenoids and other lymphoid tissue, reacting to the foreign bodies.

Adenoids are bigger when in children. As an individual age, these adenoids start to shrink and usually disappear with time.

Adenoidectomy is generally performed to remove the adenoids that become enlarged, swollen or chronically infected. This can be due to infections, allergies or other reasons. Adenoidectomy also helps treat other conditions such as:

1. Breathing problems
2. Ear infections
3. Snoring issue
4. Sleep apnea

Adenoidectomy procedure is one of the most commonly performed procedures in children. In children, due to bacterial or viral infections, allergies or other reasons, the adenoids may swell and get infected, leading to adenoiditis. Some of the children may also be born with abnormally enlarged adenoids.

Adenoidectomy is a short and straightforward procedure usually done on an outpatient basis. The procedure usually takes 15 to 30 minutes to complete, depending on the patient's age. Adenoids are removed under general anaesthesia (medication used to reduce the sensation in the body) by a specialized team of anaesthetist, otorhinolaryngologist (ENT surgeon), and other medical staff. The following steps are carried out during the procedure:

1. For surgery, the patient will be placed in a rose position (the surgeon sits behind the patient, and the patient’s neck and head are extended).
2. The surgeon will then administer general anaesthesia to the patient.
3. The surgeon will widely open the mouth of the patient using a small tool known as a retractor. Other than the surgical site, the rest of the patient’s body will be draped (covered with a sterile material) to reduce the risk of infection at the surgical site.
4. The surgeon will then remove the adenoid glands using one of the following surgical methods. The surgical method to be used will depend on the surgeon.
   1. Electrocautery: a procedure in which electricity is used to heat and remove the tissue.
   2. Coblation: a procedure in which radiofrequency (RF) energy is used to remove the tissue.
   3. A cutting tool called a debrider can also be used to remove the adenoid tissue.
5. The surgeon will also use absorbent material or an electrical device to stop the bleeding.
6. Post-surgery, the patient will be shifted to a recovery room to monitor vitals and post-operative recovery.
7. The patient’s vitals will also be monitored throughout the procedure.

Before the adenoidectomy, the doctor/surgeon will discuss and prepare the patient for the surgery. These steps often involve:

Before Adenoidectomy

Before undergoing adenoidectomy, the patient’s ENT specialist will discuss with following:

1. The ENT specialist will inform the patient whether to stop taking any medications.
2. The patient will be advised to avoid taking medications like ibuprofen or aspirin a week before surgery, as these medicines cause blood thinning.
3. The ENT specialist may also prescribe some medicines that the patient needs to take on the day of the surgery. The patient should take these medicines with a sip of water.
4. If the patient is an infant, then the mother of that infant may feed the breast milk or formula milk six hours before surgery.
5. The ENT specialist will examine the patient’s adenoid glands by placing a camera inside the nose or via an X-ray.
6. The ENT specialist will also recommend some routine tests a few days before the surgery which include:
   1. Urine test: To check for diabetes and infection in the urinary tract.
   2. Blood tests: To check for blood type, infection, blood clotting time, and anaemia (a condition in which the body does not have enough blood cells to carry oxygen to the entire body).
   3. Chest X-ray or magnetic resonance imaging (MRI) scan: To rule out any problems associated with the lungs or the heart.
   4. Polysomnogram (sleep study): If the patient has obstructive sleep apnea, the ENT specialist will conduct this test or an X-ray to check for nasal blockage.
7. The patient should inform the ENT specialist if he/she has a cold or throat problem within seven days before surgery. 
8. The surgeon will postpone the surgery if the patient has a fever or cough as it can cause complications during surgery.

On the day of Adenoidectomy

1. The patient should go to the hospital before the scheduled time.
2. The patient or his/her parent will be asked to sign the consent form before the surgery.
3. If the patient is a child, then his/her stomach must be empty on the day of surgery.
4. The patient will be instructed to remove his/her street clothes and jewellery and wear a hospital gown.
5. A nurse will place an intravenous catheter in the patient’s hand or forearm, and then general anaesthesia will be administered.
6. The vitals of the patient will also be monitored.
7. The patient will be shifted to the operation theatre for the procedure.

The patient almost always recovers to a healthier life with far fewer breathing and ear problems after the procedure. A patient who has undergone adenoidectomy can expect the following after the surgery:

The recovery process at the hospital

1. Post-surgery, the patient will be moved to the hospital ward so that he/she can recover.
2. In the case of children, they may temporarily have a sore throat, ear aches, bad breath, or stuffy-feeling nose as he or she recovers.
3. The ENT specialist will prescribe some medications such as painkillers.
4. In case the procedure is performed in the afternoon, and if the patient requires medical observation, they will be advised to remain in the hospital for one night.

Recovery process/expectation after hospital discharge

1. The patient should follow all the instructions and medications as prescribed by the ENT specialist.
2. In case the patient is a child, then
   1. Avoid school for five days to avoid infection development. 
   2. He/she should avoid a smoky environment and individuals with cough/cold.
   3. Avoid playing rough sports for a week post-surgery.
   4. Avoid blowing the nose for seven days after surgery. Use a cool-mist humidifier if their nose gets stuffy.
3. Dietary habits:
   1. The patient would be able to eat and drink within a few hours post-surgery.
   2. To avoid dehydration, the patient should drink plenty of water and fluids.
   3. Initially, the patient should consume soft foods like soups, fruit juices, or mashed potatoes.
   4. Children can start eating foods regularly depending on their comfort.
   5. The patient can also be given medicines such as paracetamol to relieve pain so that he/she can swallow food easily. A painkiller can also be given an hour before the meal.

First follow-up appointment

1. The ENT specialist will recommend a follow-up three to four weeks after surgery.
2. The ENT specialist will check how the patient is recovering during the follow-up.
3. The ENT specialist might also change the medication or advise the patient to continue with the previous medication for some more time, depending on the condition and recovery of the surgical area.
4. The ENT specialist will advise the patient for further timely follow-ups as well.

Adenoidectomy is a simple procedure and can have a positive impact on the patient’s quality of life. Below mentioned are some of the benefits of adenoidectomy:

1. Fewer throat infections
2. Reduced mouth breathing
3. Reduced ear infections
4. Improved vocal quality
5. Reduced ear fluid build-up and ear aches

An adenoidectomy is a safe procedure and complications are rare. However, as with any type of surgery, adenoidectomy has few complications associated with it. The risks and complications of adenoidectomy include:

1. Excessive bleeding
2. Infection
3. Permanent changes in vocal quality
4. Risks from the use of anaesthesia
5. Breathing problems
6. A tooth being knocked or chipped during the operation

When is consultation with the doctor needed?

The patient can consult the doctor if he/she experiences:

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

Delaying an adenoidectomy procedure can increase the severity of the pain and discomfort leading to reduced quality of life. Below mentioned are some of the common risks of delayed adenoidectomy:

1. Increased breathing problems
2. Recurrent ear infections
3. Snoring issues
4. Sleep apnea

The cost of adenoidectomy ranges from ₹40,000 to ₹80,000. The cost varies based on the following factors:

1. Age of the patient
2. Type of the procedure done
3. The medical condition of the patient
4. The type of hospital facility availed - individual room or shared.