The lymphatic tissue located in the roof of the mouth which is also associated to throat are called adenoids. Adenoids release antibodies which act like a defence to fight infections in children and gradually disappear in adults. The tissue becomes enlarged in some kids as the adenoids trap germs and get infected causing recurrent infections, which needs to be removed. The surgical procedure to remove adenoids is called adenoidectomy which is mostly done in the children.
Symptoms of Enlarged Adenoids
- Breathing through mouth
- Difficulty in breathing through the nose
- Difficulty in swallowing
- Frequent ear infections
- Obstructive sleep apnea
- Sore throat
- Speech problems
The ENT specialist examines through the nasal endoscope the presence of enlarged adenoid tissue. Later blood tests will be advised to check for any infection.
- Throat examinations and cultures to detect presence of infection causing bacteria and other organisms
- Blood tests
- Head and neck X-rays to determine the extent of enlargement of adenoids and severity of infection
Complications of Adenoiditis
Recurrent infections of the middle ear cause blocking of Eustachian tubes which allow the fluid to drain from the ears leading to loss of hearing. The sinus cavities also get infected causing difficulty in breathing. Recurrent adenoiditis also cause chest infection like bronchitis if adenoids are severely infected with a virus or bacteria which may spread to the lungs and also cause bronchitis.
Treatment for Adenoiditis
Adenoiditis caused by bacteria can be treated with antibiotics and if it is caused by virus specific anti viral drugs will be prescribed. Adenoidectomy is required in the patients
- Having recurrent infections
- Swallowing and breathing problems
- Antibiotics are not useful in the treatment
Before the procedure:
- The surgery is performed as an outpatient.
- Non-steroidal anti-inflammatory medications such as ibuprofen or advil should not be taken within a week of the surgery.
- Eating or drinking should be avoided six to seven hours before surgery, includes water or candy which increases anaesthetic complications. In case of any prescribed medication to be taken before the surgery, the patient will be given a sip of water.
- An anaesthesiologist will be called the night before surgery to review the medical history.
- The patient should not use aspirin within last 10 days of the surgery.
- Acetaminophen or Tylenol can be used as a pain reliever.
- The patient should be educated about the safety of the procedure to avoid anxiety.
During the procedure:
- The procedure will be continuously monitored by pulse oximeter (oxygen saturation) and heart rhythm. Preoperative blood tests should be done to help the patient’s doctor to stop excessive bleeding during and after the procedure.
- Under general anaesthetic conditions, a surgeon will perform the adenoidectomy surgery. This is usually done in an outpatient setting which takes about less than 45 minutes.
- The surgeon uses a small tool to keep the patient’s mouth open.
- The base of the adenoids will be removed by the surgeons with a small incision using a spoon-shaped tool, curette, or by cauterization, a procedure to seal the area with heated device, and excised through the mouth.
- Electricity method called as electro-cautery, used to remove the tissue, as well as to stop bleeding will also be used by some surgeons, or radiofrequency energy method will be used in the surgery. A debrider may also be used to excise the adenoid tissue.
- The pack and absorbent material will be used in the operated area to reduce the bleeding during and after the surgery. Stitches are mostly not needed.
After the procedure:
The time for the procedure will be 30 min. The patient will be shifted to the recovery room after the procedure approximately for an hour under medical supervision and shifted to post operative room later discharged on the day of surgery or next day. A few hours after the surgery patient is allowed eating or drinking in spite of little discomfort. He will be discharged on the same day or next day.
- Complete recovery from an adenoidectomy usually takes around one to two weeks.
- A sore throat for two to three weeks after surgery is normal.
- There will be some nasal stiffness following surgery which is common and lasts for several months.
- Saline nose drops can be used to help dissolve clots and decrease oedema.
- Temporary change in voice is common following surgery which will return after a few weeks.
- Very light nasal bleeding is common after the procedure however if it is persistent and bright red in color scheduling an appointment with doctor is a must.
- An unpleasant smell that is noticeable after a few days and usually disappears after a week.
- Most of the patients require a week or two to regain normal activities exercise and swimming can be done after 2 weeks and driving not recommended for 2 months.
- Occasionally blood at the corner of the eye will be present, usually get resolved in a week or two.