Adenoidectomy in KPHB, Hyderabad

The operation is done at Sinocare ENT Hospital with your child fully asleep (general anaesthetic). It is done through the mouth and takes fifteen to thirty minutes. Your child comes in the morning and has the operation. They wake in recovery with you nearby and drink within a few hours. Most go home the same day. There is a check-up in the first week or two. Most children are back at school within three to five days.

The signs parents describe, almost word for word:

• Snores every night, loud enough to be heard from another room
• Sleeps with the mouth open, neck stretched back, restless, sometimes sweating
• Pauses in breathing during sleep, then a gasp
• Wakes tired, is irritable in the day, is called inattentive at school
• Speaks with a blocked, nasal voice
• A nose that is always runny or blocked, and never fully clears between colds
• Repeated ear infections, or fluid behind the eardrum with hearing loss. Large adenoids block the tube that lets air into the ear. That is why so many children have both problems.

Adenoids shrink on their own with age. If a child is coping, waiting is reasonable. It is what most children with small adenoids are advised. The operation is for a child whose sleep is broken every night, or whose hearing and speech are affected. Even then, the sprays get a fair trial first.

Adenoids are graded by how much of the airway they block, and the grade decides the treatment. Smaller adenoids are treated with medicine. Salt water (saline) sprays come first. A steroid nasal spray is added where the swelling keeps coming back or is inflamed. It is used the right way, and for long enough to judge. Surgery is for the child whose adenoids still block the airway after that. It is also for the higher grades, where the back of the nose is mostly blocked and no spray will change it.

Your child is fully asleep. It is all done through the mouth, with no cuts on the outside and no stitches.

Coblation adenoidectomy, seen through a camera. The older way was blind scraping (curettage): the adenoid scraped away by feel, without being seen. A thin camera (endoscope) placed through the nose shows the adenoid bed directly. So the tissue is removed while it is seen, and the amount taken is chosen, not guessed. Coblation removes tissue at a fairly low heat instead of burning through it. That means less bleeding during the operation, and less pain afterwards, than the older methods.

It takes fifteen to thirty minutes. It is often done with small ear tubes (grommets) when there is fluid behind the eardrums. When the tonsils also block the airway, tonsillectomy can be done in the same sitting. Going to sleep once instead of twice is a real help for a small child.

• A look at the back of the nose, with a thin camera or an X-ray, to confirm the adenoids really are large. A blocked nose in a child has other causes, allergy most of all.
• A hearing test with an eardrum pressure check (tympanometry) where there are ear symptoms.
• A sleep study where the blockage sounds severe, or the child has other health conditions.
• Fasting exactly as told. It is the most common reason a child’s operation is put off on the morning, so the instructions are written down for you.

The same day. Children usually wake with a sore throat and a nose that feels blocked. They drink within a few hours, and most go home the same day. Adenoidectomy alone is far easier than tonsillectomy.

Days 1 to 4. Sore throat, bad breath, and a blocked nose. The nose can feel worse than before, because the area is swollen. Some children have a nasal-sounding voice for a while. Soft food, plenty to drink, and paracetamol at regular times.

Week one. Most children are back to normal in three to five days, and back at school within a week. Breathing through the nose usually gets better in the first week or two, as the swelling settles. The change in a child’s sleep is often the first thing parents notice.

Avoid crowds and infections for a week, and swimming for as long as advised.

Every operation carries risks, and you are told them before you agree to it. For adenoidectomy they are uncommon, and each one has a plan attached.

• Bleeding. Uncommon. It usually happens at the time of surgery, and now and then in the days after. It is kept rare by removing the tissue while it is seen, and by controlling the area before the child wakes. Any significant bleeding from the mouth or nose at home means going to a hospital emergency department straight away. You are given that instruction in writing.
• Regrowth. Adenoid tissue can grow back, mostly in children operated on very young. Seeing the area with the camera, rather than scraping blind, leaves less behind. Now and then, a second operation is needed.
• A nasal-sounding voice. After removal, air can escape into the nose during speech for a while. It is usually short-lived and rarely lasts. It matters more in a child with a split in the roof of the mouth (a cleft palate). That is why the palate is checked before surgery.
• Neck stiffness or ear pain for a few days, settled with simple painkillers.
• Infection, uncommon, treated with antibiotics.
• The anaesthetic. The anaesthetist, the doctor who puts your child to sleep, goes through it with you beforehand.