What are the adenoids?
Adenoids are small glands in the throat, at the back of the nose. In younger children they are there to fight germs. We believe that after the age of about 3 years, the adenoids are no longer needed.
Do we need our adenoids?
Your body can still fight germs without your adenoids. They probably only act to help fight infection during the first three years of life; after then, we only take them out if they are doing more harm than good.
Why do adenoids cause problems?
- Sometimes children have adenoids so big that they have a blocked nose, so that they have to breathe through their mouths.
- They snore at night.
- Some children even stop breathing for a few seconds while they are asleep. The adenoids can also cause ear problems by preventing the tube which joins your nose to your ear, from working properly.
Some benefits of removing adenoids
For children with glue ear
For children over three years of age, removing the adenoid at the same time as putting grommets in the ears seems to help stop the glue ear coming back.
Removing the adenoid may reduce the problem of a blocked nose when your child has a cold
Is there an age limit for adenoidectomy?
Adenoidectomy is generally avoided in children under 12 kgs, approximately 2 and a half years of age, because of the small risk of blood loss during or after the operation. There is no upper age limit, but the adenoid has usually shrunk to almost nothing by the teens.
How are the adenoids removed in the 21st century?
The traditional technique is to use a curette, which is a special type of surgical cutting device. This is a safe technique, although a consideration for small children having the operation is that the blood loss may be higher at the time of surgery.
Other techniques are becoming more popular.
- Electric diathermy and Coblation dissection have the advantage of less blood loss at the time of surgery. At our hospital, we are using coblation and microdebrider.
- The laser has fallen out of favor because of the much higher levels of pain after the operation.
Is it true that the adenoid may grow back?
This is possible but uncommon.
Who is suitable for day case surgery and who would require inpatient stay?
Generally, children who are fit and well with no bleeding or bruising disorders are fit for day surgery.
What is the recovery time after surgery?
It is wise to allow a one week convalescence period.
Is there any long-term risk to having your adenoids removed (e.g. reduced immune function)?
There is no good evidence that adenoidectomy reduces immune function or makes people more prone to chest infections. If possible, it is probably wise to avoid adenoidectomy in children less than 2 and a half years of age as the adenoids may be helping develop their ability to fight off infections.
What makes you decide to remove the tonsils at the same time?
If your child gets lots of tonsillitis (sore throats) or has difficulty breathing at night then we may decide to take out the tonsils at the same time as the adenoids.
Preparing for your child’s operation or things to do before your child’s operation
Arrange for a week at home or off school after the operation.
Things we need to know before the operation
Let us know if your child has a sore throat or cold in the week before the operation – it will be safer to put it off for a week. It is very important to tell us if your child has any unusual bleeding or bruising problems, or if this type of problem might run in your family.
How is the operation done?
- Your child will be asleep.
- We will take his or her adenoids out through the mouth, and then stop the bleeding. This takes about 20 minutes.
- Your child will then go to a recovery area to be watched carefully as he or she wakes up from the anesthetic.
- He or she will be away from the ward for about an hour or two in total.
How long will my child be in hospital?
In our hospitals, adenoid surgery is done as a day case, so that he or she can go home on the same day as the operation. Some surgeons may prefer to keep children in hospital for one night. Either way, we will only let him or her go home when he or she is eating and drinking and feels well enough.
Most children need no more than a week off nursery or school. They should rest at home away from crowds and smoky places. Stay away from people with coughs and colds.
Can there be problems?
- Adenoid surgery is very safe, but every operation has small risks.
- The most serious problem is bleeding, which may need a second operation to stop it. However, bleeding after adenoidectomy is very uncommon. It is very important to let us know well before the operation if anyone in the family has a bleeding problem.
- During the operation, there is a very small chance that we may chip or knock out a tooth, especially if it is loose, capped or crowned. Please let us know if your child has any teeth like this.
After the operation
- Some children feel sick after the operation. This settles quickly.
- A small number of children find that their voice sounds different after the surgery. It may sound like they are talking through their nose a little. This usually settles by itself within a few weeks. If not, speech therapy is helpful.
- Your child’s nose may seem blocked up after the surgery, but it will clear by itself in a week or so.
Your child’s throat may be a little sore
- Give painkillers as needed for the first few days.
- Prepare normal food. Eating food will help your child’s throat to heal.
Your child may have sore ears
- This is normal. It happens because your throat and ears have the same nerves. It does not usually mean that your child has an ear infection.
Your child may also feel tired for the first few days
Keep your child off school for 2 to 7 days
- Make sure he or she rests at home away from crowds and smoky places.
- Keep him or her away from people with coughs and colds.
ABOUT HOARSENESS & MICROLARYNGOSCOPY
What is Hoarseness?
Hoarseness or Dysphonia means a change in the sound of someone’s voice. People suffering from hoarseness can experience a strained, husky or breathy voice.
- They may also notice a difference in loudness and/or changes in how high or low their voice sounds (Pitch).
- Changes in voice pitch are common in young children as they grow through puberty (voice ‘breaking’).
- A complete loss of voice, resulting in only a whisper, is called Aphonia.
What causes Hoarseness?
Normally when we talk/sing the vocal cords come together and vibrate. This creates a sound which we know as the voice. Hoarseness results from the vocal cords in the voice box (Larynx) not working properly. There are several causes of hoarseness, fortunately most are not serious and tend to go away after a short period of time. Common causes are:
- A viral upper respiratory tract infection, causing the voice box lining to swell (Laryngitis)
- Stomach acid/enzymes irritating the throat (Laryngopharyngeal Reflux)
- A build-up of soft tissue (polyps) or thickenings (nodules) on the vocal cords. These can develop when the voice is used too much or too loudly for long periods of time (Singer’s Nodules). Vocal cord polyps are often related to smoking.
- Problems with the strength of the lungs can also lead to a change in voice
- Rarely a growth or tumour develops on the vocal cords and or voice box. These may be noncancerous (benign) or cancerous (malignant).
- Problems with movement of the vocal cords (paralysed vocal cords). One or both of the vocal cords may be paralysed if it’s nerve is affected by infection or tumour.
How is Hoarseness treated?
A key question here is whether the hoarseness is constant or getting worse or does it come and go with periods of “normal” voice in between.
Intermittent mild episodes of hoarseness: In most cases this will settle by itself. To help relieve the symptoms one can:
- rest the voice (but don’t resort to whispering which can make matters worse).
- drink plenty of fluids (avoid too many fizzy drinks).
- avoid alcohol.
- avoid cigarette smoke.
- take Antacids if you get a buildup of acid in the throat.
Persistent and / or worsening hoarseness
People suffering from the following symptoms should seek urgent medical advice from a doctor:
- Prolonged hoarseness for more than four weeks
- repeated spells of hoarseness without reason
- Prolonged sore throat or difficulty swallowing for more than two weeks
It is particularly important to see the doctor with these symptoms if the person is a smoker or drinks more than the recommended amount of alcohol.
What will the ENT surgeon do?
The surgeon will examine the throat to help identify the cause of the hoarseness. This is done by passing a flexible telescope through the nose (Fibreoptic Endoscope). This examination is done at the time of your outpatient visit and does not require hospital admission. Depending on the clinical findings, the following treatments may be recommended:
As described above for intermittent mild hoarseness.
Voice therapy (Speech and Language Therapist):
The majority of patients will have no structural abnormality identified. The problem with their voice will be related to the way they are using their voice i.e. they are ‘straining’ it in some way. In this case a voice therapist will be able to give advice or suggest exercises that might help the quality of the voice. Voice therapy may require more than one visit to the therapist.
An operation to remove nodules, polyps and non cancerous (benign) tumors may be recommended if these are identified at the outpatients visit. This type of operation is usually done under general anesthetic using a rigid telescope (Endoscope) and a microscope (to provide magnification). It can remove the problem in the case of polyps, nodules or cysts and will provide a piece of tissue for laboratory analysis (a biopsy). If a malignant (cancerous) tumor of the larynx is diagnosed by biopsy then further treatment will be planned at a cancer team meeting and discussed with the patient.
What is Microlaryngoscopy?
Microlaryngoscopy is the examination of your larynx (voice box) while you are under a general anaesthetic.
Why do you need the operation?
Microlaryngoscopy is done to find and treat problems of the voice box, such as hoarseness. Your surgeon will put a short metal tube (laryngoscope) through your mouth into your voice box. A microscope is then used to look into the voice box to find the problem. If needed, surgery on your voice box can also be done through the laryngoscope with very fine instruments.
If there are any problem areas, a small part of the lining of the voice box is taken away for laboratory examination. This is called a biopsy. Depending on the type of problem a laser might be used. Microlaryngoscopy is quite a short operation and usually takes less than 30 minutes.
How will I feel after the operation?
You may find that your throat hurts. This is because of the metal tubes that are passed through your throat to examine the voice box. Any discomfort settles quickly with simple painkillers and usually only lasts a day or two. Some patients feel their neck is slightly stiff after the operation.
After microlaryngoscopy, you should be able to use your voice as normal after the procedure. If the surgeon has taken a biopsy from your voice box, he may advise you to rest your voice for a short period. Your voice may sound worse, especially if any biopsies have been taken. This should be temporary until the lining of the voice box heals. You can usually eat and drink later the same day