Adenoidectomy in Children — Indications, Preparation and Recovery

What is adenoidectomy?

Adenoidectomy is the surgical procedure through which the adenoid vegetations (adenoids) are removed — formations of lymphoid tissue located in the nasopharynx, behind the nasal cavity. In children, the adenoids are part of the immune system, but when they become excessively hypertrophied, they can obstruct the upper airways and promote the occurrence of recurrent middle ear infections.

The procedure is performed under general anesthesia, lasts approximately 15–30 minutes, and is considered one of the safest pediatric surgical procedures. Dr. Vlad Postelnicu performs adenoidectomy using modern techniques, including radiofrequency ablation and endoscopic-guided curettage, ensuring maximum precision and minimal bleeding risk.

When is adenoidectomy necessary?

The main indications for adenoidectomy in children include:

• Chronic nasal obstruction — the child breathes predominantly through the mouth, snores during sleep, and may develop obstructive sleep apnea.
• Recurrent or chronic middle ear infections — hypertrophied adenoid vegetations block the Eustachian tubes, causing fluid accumulation in the middle ear and repeated infections.
• Recurrent rhinosinusitis — chronic inflammation of the paranasal sinuses, sustained by the presence of an adenoid infectious focus.
• Adenoid facies — changes in facial and dental development caused by prolonged mouth breathing.
• Speech disorders — nasal voice (closed rhinolalia) due to nasopharyngeal obstruction.

Recommendation: If your child snores frequently, breathes through the mouth, or has repeated ear infections, an ENT evaluation can determine whether adenoidectomy is indicated.

Preoperative preparation

Before the procedure, the ENT specialist will request:

• Complete ENT consultation — nasal endoscopic examination to evaluate the size of the adenoid vegetations and the general condition of the nasal cavity.
• Blood tests — complete blood count, coagulation tests (PT, APTT, INR), blood type.
• Anesthesia consultation — standard preoperative evaluation, including medical history regarding drug allergies.
• Fasting — the child must not eat or drink for a minimum of 6 hours before surgery.

It is recommended to discontinue aspirin, ibuprofen, or other non-steroidal anti-inflammatory drugs at least 7 days before the procedure, as they increase the risk of bleeding.

How is the procedure performed?

Adenoidectomy is performed under general anesthesia. The child is positioned supine with the head slightly hyperextended. The surgeon accesses the adenoid vegetations through the oral cavity, without external incisions.

Techniques used

• Classic adenoidectomy with curettage — using a special instrument (adenotome) to remove the tissue.
• Radiofrequency ablation — a modern method that provides precise hemostasis control and minimizes bleeding.
• Endoscopic-guided adenoidectomy — direct visualization of the surgical field, ensuring complete removal of hypertrophied tissue.

The procedure lasts 15–30 minutes. In most cases, the child can be discharged on the same day (one-day surgery).

Postoperative recovery

The recovery period after adenoidectomy is generally short and well-tolerated:

• First 24 hours — the child may experience mild throat discomfort, nasal voice, and minor nasal discharge. A diet of liquids and soft foods at room temperature is recommended.
• Days 2–5 — pain is usually minimal and can be managed with paracetamol. Hard, spicy, or acidic foods should be avoided.
• Days 5–10 — gradual return to normal diet. The child may resume light physical activities.
• After 2 weeks — complete healing of the surgical wound. Full resumption of sports activities.

An ENT follow-up at 7–10 days postoperatively is recommended to verify healing. Throughout the recovery period, the child should avoid contact with sick individuals and crowded environments (nursery, kindergarten). Return to group settings is usually at 7–10 days postoperatively, with the doctor's approval.

Risks and possible complications

Adenoidectomy is a low-risk procedure. However, the following may occur:

• Postoperative bleeding — rare (less than 2% of cases), usually occurs within the first 24 hours.
• Transient velopharyngeal insufficiency — temporary voice change that resolves spontaneously within a few weeks.
• Adenoid regrowth — possible, especially in very young children (under 2 years), but uncommon.
• Risks related to general anesthesia — extremely rare in pediatric settings, minimized through careful preanesthetic consultation.

Results and benefits

Adenoidectomy provides excellent results in most cases:

• Significant improvement of nasal breathing and disappearance of snoring.
• Reduction in the frequency of middle ear infections and rhinosinusitis episodes.
• Improvement of sleep quality and, consequently, attention and school performance.
• Prevention of dental and facial changes associated with chronic mouth breathing.

Studies show that over 80% of parents report a significant improvement in their child's health after adenoidectomy. The improvement in breathing and sleep also has positive effects on appetite, weight gain, and the child's overall behavior.

Dr. Vlad Postelnicu recommends a personalized approach, adapted to each patient, taking into account the child's age, symptom severity, and any associated conditions, to achieve the best possible results.