Adenoids & Tonsils
The adenoids are a single clump of tissue in the back of the nose (nasopharynx).
They are located (in the adult) on the back wall of the throat (pharynx)…
about one inch above the uvula (the little teardrop shaped piece of tissue
that hangs down in the middle of the soft palate). The tonsils are two
clumps of tissue, on either side of the throat, embedded in a pocket at
the side of the palate (roof of the mouth). The lower edge of each tonsil
is beside the tongue… way in the back of the throat.
What function do they serve? Aren’t they important?
The tonsils and the adenoids are mostly composed of lymphoid tissue, which
is found though out the gastrointestinal tract and on the base of the
tongue. Lymphoid tissue is composed of lymphocytes…which are mostly
involved in antibody production. Since we generally consider antibody
production to be a good thing, many studies have been performed to try
to clarify the importance of the tonsils. To date, there seems to be no
adverse effect on the immune status or health of patients who have had
them removed. Any noticeable effect has generally been positive. It appears
that the tonsils and adenoids were not “designed” to effectively
handle the multitude of viral infections that occur in children in an
urban population. Rather, the immune system, including the tonsils and
adenoids, developed during a era where the child was rarely exposed to
a large number of other people and the germs they carried. It may also
be that these organs are relatively more important in dealing with certain
types of infections, such as worms or other parasites, that are relatively
uncommon in today’s society. It is clear that in many cases, the
tonsils and/or the adenoids become “dysfunctional” and are
more of a liability than an asset.
Why are the adenoids removed?
There are a number of well-established valid reasons for removal (called
an adenoidectomy). Some patients will have more the one reason. The most
common are listed below.
Blockage of the back of the nose…they are too big
This is now one of the more common reasons for removal. The adenoids may
be large enough to cause “mouth breathing”, snoring, or even
sleep apnea (blockage of breathing during sleep). This degree of enlargement
may be associated with chronic fluid or infection in ears. Inability to
breathe thought the nose causes a reduction in smell (and therefore taste).
This is most commonly seen in preschool children but can exist as early
as several months of age.
Chronic and recurrent fluid or infections of the ears
The adenoids may be enlarged or chronically infected to the extent that
they cause ear problems… either recurrent infections or chronic
fluid. The infection or blockage may affect eustachian tube function.
An adenoidectomy is often recommended for children who continue to have
ear problems after the first set of tubes. We will occasionally recommend
an adenoidectomy with the first set of tubes if some of the other problems exist.
Chronic or recurrent sinus infections… or “rhinosinusitis”
Similar to the problem with the middle ear, enlarged or infected adenoids
may cause accumulation of nasal secretions or recurrent sinus infections.
Many surgeons feel that an adenoidectomy is the most appropriate surgical
procedure for young children with severe sinus problems.
Should the tonsils be removed also?
In general, only if they are enlarged, or otherwise have been causing problems
themselves. The tonsils rarely, if ever, are associated with ear disease.
However, if we are removing adenoids because they are enlarged or obstructed,
we tend to be relatively aggressive with borderline enlarged tonsils.
Too often, several months later, when we left such tonsils, they became
enough of a problem to warrant removal.
Will the child outgrow the problem?
In general, yes… the adenoids usually shrink (regress) in the second
decade of life. However, years of any of the problems above may be too
high of a price to pay for waiting. In particular, blockage and sleep
apnea may result in permanent adverse changes in facial or dental development…
in addition to the adverse effects on growth and learning caused by chronic
How are adenoids removed?
General anesthesia is the norm. Most often, with the assistance of a small
mirror, adenoid tissue is “shaved” or curetted from the back
of the nose. Occasionally, some other devices or electocautery is used.
With the advent of special cautery devices, we almost always completely
dry the surgical site before the patient wakes up, eliminating the low-grade
bleeding that used to be associated with adenoidectomies. The procedure
typically takes 5-15 minutes to complete.
What are the complications of adenoidectomy?
Complications are rare, and usually minor. Anesthetic risk is usually related
to the health of the patient… serious anesthetic complications
can occur, but are very unusual. Bleeding is rare… we have had
no serious bleeding in over 3000 patients, and only a few minor bleeding
episodes. The adenoid “bed” usually becomes superficially
infected, and can cause 7-10 days of bad breath, but serious infections
are very rare. If adenoids are routinely removed in all children, without
careful consideration and examination, a few children will have “velopharyngeal
insufficiency”… meaning that sounds or liquids can escape
up the back of the nose…affecting speech and/or swallowing. We
have never encountered that complication, but it has been reported by
other surgeons. In other words, some children should not undergo adenoidectomy
– because of their special anatomy.
What should we expect post-operatively?
Adenoidectomy typically is much less painful than a tonsillectomy. Most
children need no pain medications…a few benefit from acetaminophen
(Tylenol). Bad breath is common…for 7-10 days. A few children will
complain of a stiff or sore neck (from irritation of the neck muscles
underneath the adenoid bed). We do not limit activity (playing or swimming)…although
some surgeons do so. The patient may consume a normal diet. We usually
see patients 2-4 weeks post-operatively – to ensure normal function
If you are considering
Tonsillectomy and/or Adenoidectomy, please contact your doctor at to schedule a consultation.