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Should my child have his adenoids removed?

Many parents struggle with decisions about adenoid removal and how to make the right choice for their child. We asked Dr. David Brown, an ear, nose and throat specialist at C.S. Mott Children’s Hospital, to fill us in on the procedure and why it is recommended for some children. 

Adenoids are located in the nasal pharynx, and may interfere with both sinus and ear drainage if enlarged.

Adenoids are located in the nasal pharynx, and may interfere with both sinus and ear drainage if enlarged.

Making decisions about your child’s healthcare can be difficult. This is particularly true for surgical procedures, no matter how safe and routine they have proven to be. Adenoid removal is most often a case in which a doctor might make a recommendation, and the parents make the ultimate decision. To help you with your decision, it is important to be informed about what the adenoids are, what happens during removal and how it may benefit your child.

What and where?

When I discuss adenoid removal with parents, we typically start by discussing exactly what and where adenoids are. Adenoids are made of lymphatic tissue, a type of tissue present throughout the gastrointestinal tract. They have a small part in promoting immunity, but children normally have enough outside of the adenoids to support their immune system. Adenoids are found in the back of the nose in a place called the nasal pharynx. It is difficult to see without special equipment, so it cannot be examined by most general pediatricians.

Why?

It can be difficult to see the connection between adenoids and the symptoms your child has. Adenoid removal is often recommended for children who have chronic nose drainage or sinus infection, chronic ear aches or multiple sets of tubes, or breathing problems like sleep apnea.  When adenoids are swollen or infected, they can inhibit normal breathing, leading children to mouth breathing. They can also block natural nasal drainage, leading to sinus infections and frequent yellow-green build up. If a child is on a second set of ear tubes, it may be helpful to remove the adenoids. Ear tubes are meant to help promote normal draining of the middle ear, and enlarged adenoids can get in the way of this drainage. Additionally, if problem adenoids are not removed, they can harbor infection and their biofilms, or areas of bacteria growth, can reduce the effectiveness of antibiotics.

How?

Once you feel comfortable with what the adenoids are and the benefits of removal, the next step for many parents making a decision about adenoidectomy for their child is to understand how the procedure is performed. For most healthy children, this is an outpatient procedure. It is a little more involved than some outpatient procedures, however, since it requires anesthesia and a breathing tube. The removal is all completed through the mouth, using a mirror tool to view the adenoid area. Different surgeons prefer different tools which may involve suction, scraping or electric heat to remove the tissue and reduce bleeding. The procedure itself takes only five minutes.

Then what?

Most often, children do very well after the removal, only taking basic amounts of ibuprofen or acetaminophen to reduce pain for a few days if necessary. Because of the location of the adenoids, children will often complain of either a head or ear ache, or occasionally both, not knowing exactly where the sensation is coming from. Some children do not complain of any pain. Due to its location, the wound from the removal is allowed to naturally close and may take a few weeks to fully heal. As it heals, children may experience smelly breath. Additionally, adenoids may continue to grow in children until around age five to seven. If a child has adenoid removal at a very young age, there is a chance that their symptoms related to infected or swollen adenoids will return as adenoids grow. Finally, surgeons may adjust the process to only remove part of the adenoid due to potential complications with the soft palette if necessary. In certain cases, a full removal of the adenoids would leave too large of a gap around the soft palette, resulting in difficulty with eating or speaking normally. A partial removal usually removes this risk, but on rare occasions follow up therapy is required. For many children, the benefits of adenoid removal are palpable, offering a quick relief of their sinus or ear symptoms and very few or no side effects.

Is it right for us?

Almost always, I tell families that adenoid removal is their option. There is rarely a time when adenoid removal is a necessity. At the same time, there are few side effects and only very rare occasions where the removal could be detrimental, namely for children who have preexisting conditions such as cleft palate or Down Syndrome. Understandably, parents of children who make fine candidates for removal are worried about anesthesia and tracheal tubes. Today, however, we know more about small child anesthesia and there are fewer risks associated with the procedure.

In my time as an otolaryngologist, families who have chosen adenoid removal for their child were typically very pleased. Those who have decided against it often reconsider at a later date.  Of course, it is still a choice in most cases, and it is important to do what is best for your family and your child’s health.

Learn more about the medical services offered by ear, nose and throat specialists at Mott, or call 877-475-MOTT (877-475-6688) to speak with a Mott Patient Advisor.


About Mott Children’s Hospital

University of Michigan C.S. Mott Children’s Hospital is consistently ranked one of the best hospitals in the country. It was nationally ranked in all ten pediatric specialties in U.S. News Media Group’s “America’s Best Children’s Hospitals,” including #3 in the country for heart and heart surgery. In November, the hospital moves to a new state-of-the-art facility that will be home to cutting-edge specialty services for newborns, children and women.