Adenoidectomy in Singapore

What Is an Adenoidectomy?

An adenoidectomy is a surgical procedure to remove the adenoids, which are small lumps of immune tissue located behind the nose at the top of the throat, and is a commonly performed procedure in children.

Adenoids form part of the Waldeyer ring, a circle of lymphoid tissue around the back of the nose and throat, and part of the ear. They are part of the body’s immune system and help fight early infections and germs that enter through the nose and mouth. Large adenoids may block nasal airflow or interfere with the Eustachian tube function, which connects the ears to the back of the nose.

In many children, adenoids commonly enlarge during childhood, but often begin to shrink between ages 5 and 7. By adulthood, little adenoid tissue usually remains, and adenoid hypertrophy is uncommon. Adenoid hypertrophy affects breathing through the nose.

Most operations are performed in children, although an adenoidectomy in adults may occasionally be appropriate. Surgical removal of the adenoids may help resolve ear fluid problems when observation or other medical care has not. The surgeon works through the mouth, so there is no skin incision or visible scar. The operation may be combined with a tonsillectomy or insertion of ear ventilation tubes, called grommets.

Who Needs an Adenoidectomy

An adenoidectomy may be recommended when enlarged adenoids or chronically infected adenoids cause persistent breathing, sleep, ear or sinus problems in a child.

• Nasal obstruction and nasal congestion in the child’s nose can cause mouth breathing, difficulty breathing, a blocked nose, dry mouth, snoring and disturbed sleep.
• If the airway repeatedly narrows or closes during sleep, a child may have obstructive sleep apnea. Signs include pauses in breathing, gasping, restless sleep, daytime irritability, poor attention or slow growth.
• Enlarged adenoids can obstruct the Eustachian tube, causing otitis media. Fluid may remain behind the eardrum, causing glue ear, hearing loss, or recurrent middle-ear infections. This otitis media can lead to hearing loss. Persistent hearing difficulty can affect speech and learning.
• Adenoids can also become infected, causing adenoiditis and chronic infections. Chronic inflammation and chronic infections may contribute to a runny nose, nasal discharge, bad breath, cough, upper respiratory infections or rhinosinusitis.

Surgery is not always the first step. Mild symptoms may settle after an infection or as the adenoids shrink. Depending on the cause, care may include observation, saline, allergy treatment, an intranasal steroid spray or antibiotics for bacterial infection. Smoke and other airway irritants should be avoided. Surgery is appropriate when symptoms are significant, persist despite nonsurgical care, or cause complications.

When to See an ENT Specialist

Seek an ear, nose, and throat (ENT) assessment if a child:

• Regularly snores when well
• Appears to stop breathing during sleep
• Has recurrent ear infections
• Struggles with nasal breathing
• Seems not to hear clearly

Poor concentration, daytime sleepiness, behavioural changes, delayed speech or growth concerns may be reasons to get the adenoids removed.

The ENT specialist will review the child’s symptoms, infections, allergies, sleep, and school performance. A slim flexible nasal endoscope may be used to see the adenoids in the nasal cavity. Hearing tests and tympanometry can check for fluid behind the eardrum that may cause hearing loss. A sleep study may be advised if sleep apnea is suspected or breathing risk needs clarification.

Persistent adenoid hypertrophy in an adult is unusual, since most children outgrow it. Symptoms may still result from infection or allergy, but another growth in the nasopharynx, the space behind the nose in the nasal cavity, may need to be excluded.

How to Prepare for an Adenoidectomy

Preparation for an adenoidectomy includes a medical and medication review, fasting and planning for safe care after discharge.

• Tell the surgeon and anaesthetist about any medical conditions, allergies, sleep apnea, previous anaesthetic reactions, and any history of unusual bleeding.
• List all prescription medications, over-the-counter products and supplements. Medicines that increase bleeding may need adjustments, but never change them without medical advice.
• Contact the clinic if the child develops fever, a runny nose, a significant cough or another infection. Surgery may need to be postponed.
• Follow fasting instructions exactly, including when to stop eating, drinking milk and clear liquids.
• Stop smoking and vaping before surgery. Keep children away from second-hand smoke.
• Arrange for someone to take you and your child home. Adults must not drive after a general anaesthetic.

What Happens During an Adenoidectomy?

The adenoidectomy procedure is usually done through the mouth under general anaesthesia in about 30 minutes.

1. Once the patient is asleep, an instrument holds the mouth open, and an endoscope may show the adenoids behind the soft palate for adenoid removal.
2. The surgeon removes the obstructing adenoid tissue with instruments that may cut, shave, cauterise, or use radiofrequency energy.
3. Bleeding is then controlled.
4. There is no external cut, skin stitch or usual need for reconstruction.
5. If the tonsils also obstruct the airway, or if persistent ear fluid requires drainage, a tonsillectomy or grommet insertion may be performed during the same anaesthetic.
6. The removed tissue may be sent for laboratory examination when the history or appearance warrants it, particularly in adults.

Most patients go home after several hours. In the recovery room, overnight monitoring may be advised for very young children, those with severe sleep apnea, important medical conditions, breathing problems, bleeding, poor fluid intake, or having had combined procedures.

What to Expect After Surgery for Enlarged Adenoids

Side effects for an adenoidectomy are usually mild and should improve as healing progresses. Most children recover within 1 to 2 weeks after an adenoidectomy, although nasal breathing may improve more gradually.

• Staff monitor breathing, bleeding, alertness, pain and drinking. Nausea or vomiting can follow an anaesthetic. Discharge is usual once the patient is awake, stable and managing fluids.
• An adenoidectomy causes temporary inflammation at the back of the nose, so a blocked nose, sore throat, ear discomfort, bad breath, noisy breathing or a temporary nasal quality to the voice can occur in children.
• Sore throat pain, which is common after the procedure, may last a few days but typically starts to lessen within the first two days.
• A small amount of blood-tinged mucus may be expected under some discharge protocols, but fresh or continuing bleeding is not normal.
• Give pain medicine as instructed for the child. Pain medicine helps most in the first days. Do not give aspirin to a child unless prescribed. Antibiotics are not routine.
• There is no external wound to dress, and teeth can be brushed normally.
• Fluids are important because dehydration worsens discomfort.
• Cool or cold foods and soft foods may be easier at first, followed by the usual diet as tolerated.
• A cool mist humidifier can ease a dry throat.
• Follow advice on nose blowing, travel and bathing.
• Children usually return to school or work after about a week if they are eating, drinking and feeling well.
• Strenuous exercise, swimming and contact sports may have to wait till one to two weeks later, or until cleared by the doctor.
• Follow-up checks healing, breathing, sleep, voice and ear symptoms.

Expected benefits of an adenoidectomy include easier nasal breathing, quieter and better sleep, and fewer problems related to chronic adenoid or middle-ear disease. For children with frequent infections, the surgery may also reduce the frequency of antibiotic use and can help with speech delays linked to hearing problems. Results vary.

Symptoms may persist due to enlarged tonsils, allergies, turbinate swelling, structural narrowing, or weight-related airway collapse. Adenoid tissue can remain or regrow, especially in younger children, so some children may need a revision adenoidectomy, but this is uncommon.

Risks and Possible Complications after an Adenoid Removal

An adenoidectomy is generally well tolerated, but it carries risks from surgery and general anaesthesia. Possible complications of an adenoidectomy include:

• Bleeding
• Infection
• Dehydration
• Trouble breathing
• Difficulty breathing from swelling
• Reaction to the anaesthetic
• Temporary voice change

A lasting overly nasal voice or difficulty sealing the nose from the mouth during speech and swallowing is rare, but the risk is higher with a palate abnormality. Persistent symptoms, scarring and adenoid regrowth are also possible, sometimes with neck pain.

Seek urgent medical attention after the surgery if there is fresh blood from the nose or mouth, blood in vomit, black or brown vomit, trouble breathing, inability to swallow fluids, signs of dehydration, repeated vomiting, severe or worsening pain, unusual drowsiness, a stiff neck, or a high or persistent fever.

How Barrie Tan ENT Can Help

Barrie Tan ENT Head & Neck Surgery can assess whether adenoid disease is causing symptoms and whether observation, medical care, or an adenoidectomy is appropriate.

If adenoid surgery is recommended, Dr Tan will explain the benefits, alternatives, anaesthetic plan, combined procedures, costs and individual risks for removing the adenoids.

If you or your child has persistent mouth breathing, snoring, disrupted sleep, nasal blockage, recurrent ear infections or hearing concerns, contact Barrie Tan ENT Head & Neck Surgery to arrange an adenoidectomy assessment at Gleneagles Hospital.

FAQs about an Adenoidectomy

How do I know if my child needs his adenoids removed?

Your child may need adenoid removal if persistent enlargement is causing nasal obstruction, sleep apnoea, recurrent ear disease, hearing problems, or a chronic infection that has not improved with appropriate medical care. An ENT assessment is needed because symptoms and their effects matter more than size alone.

What causes adenoids in children?

Adenoids are normal immune tissue, not a disease. They can become enlarged due to repeated viral or bacterial infections, allergies, chronic inflammation, or a child’s natural anatomy. They usually become smaller as a child grows.

Why shouldn’t you remove adenoids?

Adenoids should not be removed when the symptoms are mild, temporary, or likely to respond to observation or medical care. Surgery also carries risks, including bleeding and anaesthetic complications. Removing adenoids does not usually weaken the immunity, but an operation should have a clear expected benefit.

What is the best age to remove adenoids?

There is no single best age. An adenoidectomy is most often performed in young children, commonly between the ages of 2 and 7, but timing should be based on symptom severity, complications, overall health and the likelihood that waiting will help or cause harm.