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Ear, Nose, Throat, Head & Neck Surgery

What are adenoids?

The adenoid (or “adenoids”) is a pad of tonsil-like or lymph node-like tissue located in the back of the nose. These tissues can get large with an sudden infection, like the Epstein-Barr virus (the virus that causes “mono” or infectious mononucleosis) or they can become repeatedly infected with Streptococcus pyogenes (the “strep throat” organism).

As we grow from babies through childhood, the adenoid tissue should shrink away, but sometimes this fails to happen and it remains large, causing snoring with or without sleep apnea, frequent mouth-breathing, a nasal voice, or recurring ear infections.

For any of these reasons, the adenoid may be removed under general anesthesia as an inpatient or an outpatient, depending upon the patient.

How is it removed?

The adenoid is removed through the mouth. Using a mirror, we can see the back of the nose through the open mouth. An electrocautery knife is used to create a small burn at the raw edge of the tissue and seal the blood vessels closed to prevent bleeding.

Does it hurt?

Yes, for a few days after surgery the throat can be sore, but not nearly as sore as when we remove the tonsils too.

This is why we recommend acetaminophen (Tylenol™) for the pain. You should never use aspirin or an aspirin-like non-steroidal anti-inflammatory drug (NSAID) such as Motrin™, Advil™, Alleve™, ibuprofen, or naprosyn, because these medications can thin the blood and make it difficult to control bleeding when the scabs start to fall off.

In addition to the sore throat, your child may complain of ear pain or neck pain. Ear pain is quite common and is called “referred pain.” The ears are not usually infected, but the nerves that transmit pain sensations in the throat and the ears overlap some, causing the pain to feel like it is in the ears.

Neck pain may be from the position in the operating room, but it should be reported to the doctor’s office if your child has any trouble turning his or her head.

What else makes it feel better?

An ice pack on the neck may help. Most importantly, taking in plenty of fluids and regularly using the pain medication for the first few days will make it easier to recover.

What should I expect during my child’s recovery?

• Nausea/vomiting: There are several factors that can each contribute to nausea and vomiting. Some children are sensitive to the anesthesia medicines and this can last for 24 hours after surgery. Sometimes swallowed blood may make your child sick to his or her stomach. If he or she vomits blood, note if it is clumpy and purple or brown, or if it is bright red. Please report this to the doctor’s office. Some children get sick from the pain medicine or from the antibiotics. It is important to note the time between the last medicine dose and the vomiting. Report the time to the doctor’s office.

• Stinky breath: All children will have foul smelling breath after this surgery. The scabs in the back of the nose serve as home base for bacteria living in the mouth and throat. They are full of nutrients that the bacteria live off of. The antibiotics prescription that we usually give after surgery helps to reduce the number of organisms living in the scabs. If the foul smell becomes totally repulsive, please call the doctor’s office.

• Fever: Most children will have a low-grade temperature (up to 100°F) after this surgery and some will even have a fever (up to 101.5°F). If your child has a fever of 102 degrees F or more, please report this to the doctor’s office.

• Diet: Your child can eat anything that he or she wants, but please make sure that he or she is drinking plenty of liquids. Some thickened foods like Jell-O™, apple sauce, pudding, yogurt, ice cream, popsicles, Flavor-ice™, Italian ice, and fruits like watermelon have a lot of water in them and are easier to swallow with a painful throat than plain water.

• Activity: When your child feels well enough to return to daily activities, then he or she is permitted. Some children are ready in a few days. Others may need a whole week. It is recommended that they avoid heavy playground activities, physical education class, or sports teams for two weeks.

What problems should I report to the doctor’s office?

• Report any bleeding immediately. Bleeding usually happens between seven to 10 days after surgery when the wet scabs in the back of the throat are sloughing off. Ninety-eight percent of the time this is a brief bleed that is not significant.
• Report a temperature of more than 102°F.
• Report ear pain that lasts more than three days or severe ear pain.
• Report neck pain associated with a stiff neck or fixed head position.

Who do I call?

Monday – Friday, 8:30 a.m. to 4:30 p.m., call the doctor’s office at: 919-684-3220.

After 4:30 p.m. on weekdays and on weekends or holidays, page the on-call doctor at: 919-684-8111.