Adenoiditis, Adenoid Surgery, Snoring, Block Nose/Runny Nose in Children

In this video, Dr Kevin Soh discusses how adenoid hypertrophy and adenoiditis can cause runny nose, block nose, ear infection, hearing loss, snoring, sleep apnea, academic underperformance and growth retardation in children.

What are Adenoids?

The adenoid is found high in the throat, right behind the nose and needs special instruments in order to see it.

What role do they play in our body system?

They act as “policeman” and help to form antibodies to “germs” that invade the nose, mouth and
throat. This function maybe important in young children up to 3 years of age but there is no evidence
that it will be important thereafter.

Will my child suffer a loss of immunity after the removal of his adenoids?

The adenoids are only a very small part of our immune system. There are other lymph nodes in the body
that would act as defense mechanism. Many studies have shown that children that have their
tonsils/adenoids removed suffer no loss in their immunity to diseases.

Children who have their adenoids removed do not, on average, have any more illnesses than children who “keep” their adenoids. In fact, some children will get fewer illness like runny nose, middle ear infections after their adenoids are taken out.

The Examination

The primary methods used to examine adenoids are:

• Medical history
• Physical examination
• X-rays/Endoscopy

What should I expect at the Examination?

The doctor will ask about your problems of the ear, nose, and throat and examine the head and neck. He will use a small lighted instrument to look into these areas.

Adenoids are checked via nasal optic examination using a flexible child endoscope to evaluate the upper airway condition of children who are cooperative. A topical anesthetic is applied to the nasal cavity. This procedure is done in the clinic.  The examination begins with an assessment of the nasal cavity and its structures up to the nasopharynx with a good view of the auditory tube. Generally the nasal optic examination is painless and well tolerated by children. Recording is usually done so that it is possible to review the images.
X-ray would be used if the child is uncooperative with the nasal optic examination. This is helpful in determining the size and shape of the adenoids.

What complications/risks will I have if my child doesn’t go for the surgery?

Enlarged adenoids can cause running nose, ear infection, snoring, obstructive sleep apnea and in some instances
hearing problem thus causing nose and throat obstruction to breathing while you are sleeping. For a
better understanding on the implications of enlarged adenoids, please watch my video featured here.
I have explained in detail the problem enlarged adenoids could have on the child and the risks of not
treating this problem.

Outgrowing Your Adenoids

Some of you may be asking, will the adenoids outgrow itself as the child grows up?  If your adenoids are so large that they literally obstruct your breathing at night, then wouldn’t you think that this is a more important issue that needs to be dealt with? Doctors will also say that children will “grow out of it.” Yes, in most cases, they will, but based on all the recent studies, there’s plenty of evidence that before they “grow out of it,” there can be potential long-term consequences, including your risk for developing obstructive sleep apnea, ear infection etc.  During the formative childhood years, chronic mouth breathing interferes with normal facial growth. This results in a smaller upper airway passage which increases the risk of obstructive sleep apnea and lead to an increased risk of cardiovascular problems in later years.

In What Cases are Adenoids Surgery (Adenoidectomy) Needed?

This is one of the common childhood surgery. Although this surgery is common in childhood, it is not exclusively a childhood operation; adults can also have their adenoids removed if necessary. The tonsils can be removed without the adenoids and vice versa.

How is the surgery done?

The surgery is done under general anesthesia and this procedure is usually done as a day procedure.
This surgery usually takes between 30 minutes. The child needs to fast 4 hours prior to the surgery.
No food/drinks/water is allowed. For a younger child, there will be a shorter fasting period. The
operation is done via the oral cavity therefore no incision will be made on the nose or face.

What are the latest techniques for removing the adenoids?

Specialised instruments such as coblation, radiofrequency and microdebrider are used to improve healing and reduce the side effect of pain after surgery.

What should my child take note prior to my surgery?

If the child has fever on the day prior to the surgery date, the doctor should be informed as the
surgery might be postponed if the child is found unfit for surgery. It should also be brought to the
doctor’s attention if the child has any history or family history of bleeding disorder or has any problem
with previous anesthetic event.

What to expect right after the surgery?

After the surgery, the child might be still sleepy as he/she is still recovering from the general
anesthesia but this effect will wear off after sometime. After which, he will be allowed to drink and eat.
Should there might a slight presence of blood in the child’s sputum but this is normal.

What are the things to take note after the surgery?

Few days after the surgery, the child may experience sore throat and dryness of the mouth but it will
slowly improve after sometime when the throat muscles are back to normal. Normal eating habits
should be resumed. Pain killer that has been prescribed to the child must be taken to
minimize any throat discomfort and the entire course of antibiotics should be completed.

Is there any diet restrictions post surgery?

No, there is no diet restriction post surgery and normal diet is greatly encouraged.

The more your child drinks, the sooner the pain will subside. Water, apple juice, grape juice, and Gatorade are excellent sources of liquid. Soft foods such as ice cream, sherbet, yogurt, pudding, apple sauce and jello, should also be encouraged. Other soft, easily chewed foods are also excellent.

Avoid hot or spicy foods, or foods that are hard and crunchy.

Is there anything I should avoid post surgery?

During the first week post surgery, it is encouraged that the child should avoid contact with people
suffering from coughs, colds or other infections. Contact with smoking individuals and crowded places
should also not be encouraged.

Is there any follow up with the doctor post surgery?

Post surgery follow-up date will be given upon discharge from the hospital. Please do come for the appointment as the post surgery follow-up care is important in preventing possible complications.

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