ADENOIDECTOMY

Adenoids, like tonsils are lymphoid tissues. They are situated at a slightly higher level than tonsil, at the back of the nose, whereas tonsils are at the back of the mouth. Lymphoid tissues are centres which produces infection-fighting cells. However after the first year of life, both the adenoids and tonsils do not serve any great function as we have different areas of the body to serve that purpose. Adenoidectomy is the operation to remove adenoids.

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Why have the operation

The commonest reason for the operation is treating obstructive sleep apnoea, where the adenoids are removed together with the tonsils to improve airway and breathing during sleep. It is also commonly performed in conjunction with grommets insertion, as this will prolong the effect of grommets.

Other reasons for adenoidectomy could be when enlarged adenoids causes nasal blockage.

How is the operation done

The operation requires a general anaesthetic (putting patient to sleep), and is done through the mouth where instruments are pass upwards towards the back of the nose. There are several ways to perform adenoidectomy. Some surgeons use a ‘scraper’ to scrape off the tissue blindly. Miss Cheang uses suction diathermy, where a mirror is used to directly visualised the area, and the adenoids are burnt off with a diathermy instrument.

Does it hurt

There might be some mild discomfort, but adenoidectomy rarely has any significant pain.

After the operation

Normally you will be observed on the ward over a period of 4 hours. You should be able to eat and drink as when comfortable to do so. There could be symptoms of nasal congestion and nasal discharge for the first few days. Not uncommonly there might be unpleasant odour due to burnt tissue mixing with snot. This will settle with time. If there are signs of fever, unwell and coloured nasal secretions, antibiotics might be needed.

How long do I have to be off work

It is advisable to have a period of convalescence of 1 week after the operation. Physical exercise or strenuous activities should be refrained. Likewise social gatherings and activities should be kept to a minimum to reduce the risk of acquiring infection.

Possible complications

The main complication for adenoidectomy is post-operative infection or haemorrhage. Infection can be treated with antibiotics. Bleeding from the back of the nose could present as a nose bleed or coming out from the mouth. Medical attention should be seeked immediately should there be any signs of haemorrhage. The risk of this is extremely low, and is normally associated with infection.

Is there any alternative treatment

There are no alternative treatment for obstructive sleep apnoea. For mild or moderated adenoidal enlargement, steroid drops could be tried over a period of time, as it reduces inflammation of the lining of the nose. However it doesn’t achieve any significant reduction of the bulk of the adenoidal tissue.

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