Adenoidectomy

Indications

Obstructive sleep apnoea (OSA) in children, in combination with tonsillectomy 

Glue ear (otitis media with effusion), in combination with grommet insertion – increases longevity of effect of grommets 

Nasal obstruction due to adenoidal hypertrophy (somewhat controversial)

Procedure

Exposure as for tonsillectomy. The adenoid is removed using a curette, followed by a pack for haemostasis, or by suction monopolar diathermy or Coblation, under direct vision using a mirror.

Operative time

10-15 minutes.

Complications

Bleeding This may be reactionary or secondary, but is significantly rarer than after tonsillectomy (<1%).

Halitosis Warn parents about this – it will pass with time.

Nasal regurgitation of liquids / hypernasal speech Almost always resolves within weeks, but this is the reason adenoidectomy is performed with caution in those with submucous cleft palate.

Grisel’s syndrome Atlanto-axial subluxation. Extremely rare.

Post-operative management

Discharge the same day or stay overnight for post-operative monitoring, depending on the indication (see UK multidisciplinary consensus statement on OSA). Follow-up may be booked depending on the indication for surgery.

TTO

Simple analgesia, if required.

 Page last reviewed: 4 January 2023