Adenoidectomy

What the Operation Is

The adenoids — properly called the pharyngeal tonsil — sit at the back of the nose, behind the soft palate. In children, the adenoids enlarge as part of normal immune development and usually shrink during adolescence. In some children, they become large enough to block nasal breathing (causing mouth breathing, snoring and chronic congestion), interfere with Eustachian tube function (causing glue ear and recurrent ear infections), or contribute to obstructive sleep apnoea.

Adenoidectomy is the surgical removal of this tissue. It is performed through the mouth under general anaesthetic with no external scars. The operation typically takes 15 to 30 minutes. It is very commonly combined with tonsillectomy ("adenotonsillectomy") for paediatric OSA, and with grommet insertion for glue ear and recurrent middle-ear infections.

Risks & Complications

1. Bleeding (approximately 1–4%)

There is a risk of bleeding of approximately 1–4%, infection, and pain. The pain can be severe in the first few days. Taking the painkillers regularly and flushing out the nose with saline (salt water) to remove the debris that collects after the operation will substantially help. Any fresh red bleeding from the nose or mouth — more than a streak in saliva — should prompt urgent assessment.

2. Globus sensation

A feeling of a lump in the throat may develop temporarily, typically lasting two or three weeks but occasionally longer. This reflects local swelling and gradually settles.

3. Taste disturbance

Approximately 8–13% of patients notice taste disturbance after this operation — usually because the mouth-gag used during surgery has pressed on the small nerves of the tongue. This is normally short-lived. There is a 0.9% risk of long-term abnormality in taste function. Numbness or weakness of the tongue is theoretically possible but has not been a feature in my practice.

4. Damage to teeth

There is a very rare risk of damage to teeth, particularly from the mouth-gag. Please tell the surgical team about any dental work or loose teeth before the day of surgery.

5. Voice change in professional singers

Some professional singers have noticed a change in the tonality of their upper octaves after this operation. This is uncommon but worth raising at the consent appointment if you sing professionally.

6. Nasal regurgitation

Very rarely, there can be persistent escape of fluid into the nose during swallowing (velopharyngeal insufficiency). This is extremely rare and has not happened to any of my patients. It is more likely in children with subtle congenital differences of the palate (such as a submucous cleft palate) — which is one of the reasons careful palate assessment is performed before surgery.

7. Grisel's syndrome

Grisel's syndrome is an extremely rare complication in which inflammation around the back of the throat after adenoidectomy is associated with abnormal movement at the upper cervical spine, causing neck pain and limited neck rotation. It is exceptionally uncommon and has not happened to any of my patients. Children with Down syndrome are at slightly higher background risk for upper cervical spine instability.

8. Anaesthetic risks

Standard general-anaesthetic risks apply, which the anaesthetist will discuss separately.

Aftercare

• Painkillers: regular paracetamol and ibuprofen (weight-based doses for children) for the first week.
• Saline nasal rinses or sprays — gentle nasal saline keeps the back of the nose clean and helps clear debris as the adenoid bed heals.
• Eat normally — slightly abrasive food keeps the throat muscles moving.
• Time off school or work: usually one to two weeks.
• Avoid strenuous exercise for two weeks.
• Air travel: avoid for at least two weeks (longer if combined with tonsillectomy or grommet insertion).

When to Call the Hospital or Attend A&E

• Fresh red bleeding from the nose or mouth.
• Worsening pain after the first week, or pain with fever.
• Inability to swallow fluids or signs of dehydration.
• Persistent severe limitation of neck rotation (very rare — possible Grisel's syndrome).
• Persistent fluid escape into the nose when swallowing.

Booking, Consent and Next Steps

If you or your child is being considered for adenoidectomy, the secretarial team can arrange a consultation. See also Tonsils & Adenoids, Paediatric ENT, Tonsillectomy Consent, and Grommet Insertion Consent if the operation is being combined with grommets.