Episode 5: My Opinion about Whether Your Child Should get or not get an Adenoidectomy 

This episode of ‘My Opinion about…’ series is another slightly controversial one, but I will take a crack at it anyway… I have often joked that Kenya, or at least Nairobi must have the largest population of children living without their adenoids and sometimes both their adenoids and tonsils. I say it as a joke, but is it something in the water? Kidding. What is adenoidectomy? I’ll explain. Ever had a child who seems to always get blocked nose and is perhaps a noisy breather when asleep or simply more of a mouth-breather? Have you had your child assessed by the ENT and ‘surgery’ has been recommended? If that is the case, then the so-mentioned surgery would most likely be an ‘adenoidectomy’. What are adenoids Adenoids are part of the immune system- i.e. they help the body fight infections. They’re high up in the throat behind at the end of the nasal cavity. If you licked the roof of your mouth and dragged the tip of your tongue all the way back as far as it could go- that would be about where the adenoids are located. In order to keep you healthy, the adenoids catch any germs from the nose before they cause infection. But, over time, they can become swollen as they do their work causing the child to have difficulty with breathing and sleeping and they could also cause pain. When a child’s tube- referred to as Eustachian tube is not working well, this can cause a child to retain fluid in the ears and have temporary hearing loss- which is not good for speech and language development. So should your child have an adenoidectomy? Well, if it is indicated or called for, your child’s ENT doctor will advise. What are the symptoms for enlarged and/infected adenoids?

• Breathing through the mouth frequently
• The nose being stuffy or runny without illness
• A dry mouth and cracked lips
• Noisy breathing
• Frequent or persistent ear infections
• Snoring or poor quality sleep

If your child exhibits any of the above symptoms, have the ENT see them to determine what could be causing the symptoms- it may or may not be that their adenoids are swollen. An adenoidectomy or removal of the adenoids would be recommended if:

• Your child has difficulty breathing quietly during sleep- a condition referred to as Sleep apnea, due to enlarged adenoids.
• Repeated infection of the adenoids that does not resolve with antibiotics.
• Recurring ear infections that doesn’t respond to antibiotics.
• Fluid retention in the middle ear due to enlarged adenoids.

Very often, the ENT might decide to remove both the adenoids and tonsils. A procedure referred to as tonsilloadenoidectomy. The tonsils do the same job as the adenoids- i.e. prevent germs. The tonsils sit at the back of the throat. Not everyone who needs an adenoidectomy will require tonsil removal and vice versa. The procedure in itself is pretty fast and in most cases, it should take less than an hour. The child is given a general anaesthesia and so will be asleep for the duration of the procedure. And the ENT cuts away the adenoid tissue. The surgeon usually will show you the tissue they removed. If there are no other complications, the child is usually fit to go home on the same day Actually within a few hours of undergoing the surgery There are no adverse effects of an adenoidectomy (or tonsillectomy), but it is worth noting that:

• Adenoids can in rare occasions grow back
• Childhood is when adenoids are generally the largest then they shrink or disappear during teenage years.
• According to research, removing a child’s adenoids may increase their chance of developing respiratory or allergic conditions later on.

I am witnessing a high percentage of children who have either had their adenoids removed or the procedure has been recommended. And I often wonder whether all of these cases are indicated (necessary). My feelings are that parents need to be empowered about some of these conditions for which surgery is often the first call. As a parent, you need to make sure that everything has been exhausted before signing your child off to theatre or to any intrusive procedure for that matter. I do not dispute that there are cases for which an adenoidectomy is warranted, but why are there so many children in Nairobi who require this procedure? Is it possible to protect your child against frequent infections? Not always possible…I know, but a little possible perhaps? Well, there you have it. I hope this episode has been informative.