ADENOIDECTOMY

 

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206WHAT ARE ADENOIDS

Adenoids are tissue that is similar to the lymph nodes or "glands" found throughout our body. They are located high in the throat behind the nose and the roof of the mouth (soft palate) and are not visible through the mouth without special instruments.                                                                                                             The function of  adenoids  are to catch incoming germs while we breath.  Children who have their adenoids removed do not have a greater incidence of infection following surgery. 

INDICATIONS FOR SURGERY

·          Chronic nasal congestion

Children with enlarged adenoids often have difficulties with continuous

nasal congestion, frequent colds and “sinus-like infections”.  They may be more prone to post nasal drip causing chronic cough and upper respiratory concerns. 

Nasal obstruction and mouth breathing are common.  Removing the adenoids can greatly improve these symptoms.

·          Obstructive Sleep Apnea

For some children, the adenoids become so enlarged that they are causing obstructive problems during your child’s sleep.  Common symptoms include snoring, very restless sleep (tossing and turning), frequent arousals, fatigue or hyperactivity during the day.  A common cycle occurs…as your child slips into a deep sleep, the airway relaxes and obstructs, your child’s oxygen saturation decreases, as a result your child’s brain responds by arousing your child.  Your child then moves and self arouses, and goes into a light sleep.  This cycle continues all night, not allowing your child the deep sleep (REM sleep) they require.  Some parents will hear pausing or gasping during this cycle.  Lack of sleep has been shown to impact negatively on school performance, concentration and behavior.

·          Chronic Ear infections or Middle Ear Effusions (fluid in the ear)

Removing a child’s adenoids can often help resolve long term problems with ear infections  or middle ear effusions.  Adenoids often enlarge and cause obstruction of the eustachian tube (a small tube that connects the middle ear space to the back of the nose).  This does not allow the middle ear space to drain and ventilate properly, which can lead to chronic ear issues.  Tympanostomy tubes (ear tubes) are often used in this situation.  Children over 2 years of age or children who require additional sets of tubes will often benefit from an adenoidectomy.

 

RISKS
As with any surgery, there are some associated risks.  

·          Your child will receive general anesthesia for the procedure.  There is a small risk of complication occurring due to  the anesthesia.

·          There is a very low risk of postoperative bleeding which would require a trip back to the hospital for evaluation. 

·          Mild discomfort for generally 1-3 days.

·          Most children are feeling back to themselves within one to three days following the surgery.  Some of the common complaints following the surgery may include ear pain, neck pain, congestion, fever, night terrors, nausea, very bad breath.  We will give you a prescription for Tylenol and Codeine that should be taken every 4 hours as needed, to help relieve the discomfort.  24 hours following the surgery, you may give your child Motrin to help with the discomfort.  We will also prescribe an antibiotic to help lessen the bad breath.


SO MY CHILD NEEDS SURGERY, WHAT IS THE NEXT STEP…

·          Choose the date.  You can pick the date you would like during your appointment with us, or just give us a call.  New Haven patients should call 203-785-2591 and Madison patients should call 203-245-0496. 

·          A preoperative tour is available for you and your child if you are interested.  We strongly recommend taking advantage of this tour.  During the tour, your child will meet with a Child Life Specialist (if age appropriate) who will help prepare your child for surgery using age appropriate play and descriptions.  You will also meet with a pediatric anesthesiologist and pediatric nurse.  To schedule an appointment, please call 203-688-7996.

·          All the appropriate paper work will be completed during your visit with us, and in most cases, there is no need for further preoperative physicals or paperwork prior to the surgery.

 

THE DAY OF SURGERY….

·          The surgery is preformed in the Pediatric Operating Room at Yale.  The procedure will take approximately 20-30 minutes.  Your child will receive an (IV) intravenous in order to receive medication and fluids during the surgery.  Following the operation, your child will go to the pediatric recovery room (PACU or Post-Anesthesia Care Unit).  You can be with your child at this time.  Some children are disoriented and upset as they come out of the anesthesia.  This is normal.  Your child will be ready to go home once they are drinking and acting like themselves again.  This normally takes an hour or two.  You will be given 2 prescriptions, an antibiotic and one for pain medicine.  Please take as directed.

 

 

WHAT TO EXPECT FOLLOWING SURGERY…

·          There are no limitations in diet following the surgery.  If fact, children who eat and drink well have a quicker, easier recovery.  They may eat or drink anything that they want… just as long as they eat and drink.  If your child is having postoperative pain, ensure that they are taking their pain medicine.  This will make it easier for them to eat. 

·          Narcotics are very effective in reducing the pain.  However, it does make some children feel nauseous or ‘funny’.  You may give your child Ibuprofen (Motrin) 24 hours following surgery.  This is very effective in controlling the pain.

·          There are no limitations in activity.  Children will self limit themselves.  Most children will return to school and other extracurricular activities 2-3 days following the operation.  However, they may return sooner if they are feeling up to it.

·          Common complaints following surgery….

o         Fever, even up to 102.  Ensure your child is receiving Tylenol.  Please call us if your child has a persistent fever over 101.5 for more than 48 hours.

o         Horribly bad breath.  This is very common following the surgery.  It can last up to a couple of weeks.  The antibiotic that your child will be taking will help to reduce the odor.  You can also use breath mints or gum and ensure proper mouth care.

o         Snoring.  Some children may snore initially following surgery.  This occurs due to swelling and usually resolves in the first week.

o         Congestion and cold-like symptoms.  This may continue for a couple of weeks following surgery.

o         Voice changes.  It is common for children to have a temporary change in their voice.  It will return to normal with time.

o         Stiff/sore neck.  This may occur as a result of positioning during surgery.  Warm soaks, Tylenol or Motrin and range of motion exercises of the head will help to reduce the discomfort. 

o         Pain or popping in the ears. 

o         Night terrors.

 

SITUATIONS THAT NEED MEDICAL ATTENTION

·          If your child has any bleeding (from the mouth or nose or vomiting blood), go to the emergency room.

·          If your child has not voided in 24 hours, please call us or go to the emergency room.

·          If your child has a fever greater that 101.5 for more than 48 hours, please call us.

 

FOLLOW-UP

·         All the postoperative visits are scheduled with our nurse practitioners, Wendy Mackey or Lisa Gagnon. 

·         We would like to see your child three to six weeks following the surgery for a postoperative check. 

·         Please call (203) 245-0496 to schedule an appointment.  

 

 

If you ever have questions or concerns, we would be happy to talk to you or see your child at any time.  (203) 245-0496