I see children at the Spire Cambridge Lea Hospital, and the Nuffield Hospital, Cambridge.
Adenoids are like a tonsil in the back of the nose. They are part of the ring of immune system tissue at the back of the throat (adenoids, palatine tonsils, lingual tonsils). We find that removing the adenoids, or the tonsils, does not cause a problem with immunity. This is because there are so many other parts of the immune system that take over this function.
I can check if the adenoids are enlarged by checking for steaming on a metal spatula, placed underneath the nose, whilst the mouth is closed, or using a paediatric nasendoscope (camera) to look up the nose at the adenoids directly, which is more accurate. This piece of equipment is suitable for younger children, who are compliant, and is available at the Nuffield Hospital, Cambridge.
What problems do adenoids cause? Because of where they sit, they can block the nose. This stops the child breathing through the nose, and forces them to breathe through their mouth. Along with the tonsils, they can block the breathing during sleep. If the child stops breathing for more than 10 seconds at a time, this is called sleep apnoea. It would be worth removing the adenoids in this setting. It is useful for you to take a video of your child sleeping, to bring to clinic, so that I can see how likely sleep apnoea is. Snoring on its own is not a reason to take the adenoids out.
The adenoids can be large at the beginning of childhood, and tend to shrink during the teenage years. However, if the adenoids are large, and they remain so for a number of years, the child continues to breath through the mouth, and this can affect facial growth. This means that even when then adenoids shrink during the teenage years, the child can be left with an open mouth posture, which is cosmetically undesirable. It would be better to perform surgery before facial growth is affected.
Another reason for taking out the adenoids is in a child with recurrent glue ear. If a second set of grommets are going to be inserted for recurrent glue ear, this can be combined with the removal of the adenoids. Taking out the adenoids makes it less likely that the glue ear will recur.
Adenoidectomy involves coming into hospital, and having a general anaesthetic, so the child will be fully asleep. Once asleep, I keep the mouth open with a metal clamp. Then I use a rubber string to pull the palate up so I can see the adenoids with a small mirror placed in the mouth. I use a coblation wand, or diathermy wand, to dissolve, or burn away, the adenoids. Then we wake the child up, take the child to the recovery area, and from there to the ward. In general, the operation is not painful, but it is normal for the child to cry in the recovery area as it is an unusual environment. Generally, the child will go back to sleep and wake up more calmly the second time around. Your child can go home after a few hours of observation, unless sleep apnoea is suspected, in which case the child can go home the following morning. Generally, there is little pain after surgery which can be controlled with paracetamol and ibuprofen liquid.
The operation is sometimes combined with tonsillectomy, if both the tonsils and adenoids are blocking. It is best to stay at home for 2 weeks after surgery, to allow recovery and to prevent infection. The risks of the operation are pain, bleeding, infection, general anaesthetic, damage to the lips, teeth and gums, regurgitation of food or fluid from the mouth into the nose, recurrent growth of adenoid tissue, and 20% risk of mortality if COVID positive during the general anaesthetic.
I would normally see your child a few weeks after surgery for a check up. It can take up to 8 weeks for all the swelling, in the back of the nose, to settle and for the child to benefit from the surgery with better breathing through the nose.