Adenoidectomy: surgery to remove adenoids

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Definition of adenoidectomy: what is it?

Adenoidectomy is a surgical procedure to remove the adenoids—small masses of lymphatic tissue located at the back of the nasal passage, just above the throat. The medical term "adenoidectomy" comes from "adenoid," referring to the gland-like tissue, and the suffix "-ectomy," meaning surgical removal. This procedure is most commonly performed in children whose enlarged or infected adenoids cause problems such as chronic nasal blockage, frequent ear infections, or breathing issues. One of the most common indications for adenoidectomy is its use in treating sleep apnea, a condition where blocked airways disrupt normal breathing during sleep. In such cases, removing the adenoids can significantly improve breathing, sleep quality, and overall health.

CPT and ICD-10 codes for adenoidectomy

In medical billing, adenoidectomy is identified using specific codes. The CPT code for a standalone adenoidectomy is 42830, while 42831 is used when it's performed with a tonsillectomy. For diagnosis purposes, the ICD-10 code commonly used is J35.2, which refers to chronic diseases of the adenoids. These codes help standardize documentation and ensure proper insurance processing.
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Who needs adenoidectomy?

Adenoidectomy is most commonly performed in children, especially those experiencing recurrent infections, chronic nasal obstruction, or sleep-disordered breathing caused by enlarged adenoids. While there is no strict minimum age, the procedure is typically recommended for children over the age of two, as adenoids tend to shrink naturally after early childhood. However, in some cases, younger children may require surgery if symptoms are severe. Although less common, adults may also need adenoidectomy if they suffer from chronic infections or nasal blockages that do not respond to other treatments. Ultimately, the decision to perform adenoidectomy depends on the severity of symptoms and the impact on a person’s quality of life, regardless of age.

Indications for adenoidectomy

Adenoidectomy is generally recommended when the adenoids cause significant health issues. Common indications include:

  • Chronic nasal obstruction causing difficulty breathing through the nose
  • Recurrent or persistent ear infections (otitis media)
  • Frequent sinus infections
  • Obstructive sleep apnea, where enlarged adenoids block the airway during sleep
  • Failure of medical treatments like antibiotics or nasal sprays to improve symptoms
  • Speech or swallowing difficulties related to enlarged adenoids
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Procedure of the adenoidectomy surgery

Adenoidectomy is a relatively quick surgical procedure usually performed under general anesthesia. During the surgery, the surgeon accesses the adenoids through the mouth—meaning no external incisions are made—and removes the enlarged tissue at the back of the nasal passage. In many cases, especially when children have frequent ear infections or fluid buildup, tympanostomy tubes (ear tubes) are inserted into the eardrums during the same operation to help drain fluid and prevent future infections. The entire procedure typically lasts about 20 to 30 minutes, and patients usually go home the same day

Adenoidectomy: primary vs. secondary

A primary adenoidectomy refers to the initial surgical removal of the adenoids, usually performed when a child first develops symptoms like chronic infections or breathing issues. In contrast, a secondary adenoidectomy is a repeat surgery done when symptoms persist or return after the first procedure, often due to regrowth of adenoid tissue. Secondary adenoidectomy is less common but may be necessary to fully resolve ongoing problems.

Before and after adenoidectomy

Before

Before an adenoidectomy, patients typically undergo a thorough evaluation that may include a physical exam, medical history review, and sometimes imaging or sleep studies to determine the severity of symptoms. It’s important to follow all preoperative instructions provided by the surgeon, such as fasting for a specified period before surgery, to ensure safety during anesthesia. Preparing emotionally, especially for children, can also help ease anxiety about the procedure.

After

After the surgery, patients may experience mild throat soreness, nasal congestion, or a low-grade fever, which usually improve within a few days. Pain can generally be managed with over-the-counter medications. Most children return to normal activities within a week but should avoid strenuous exercise or swimming for about two weeks to allow proper healing. Follow-up appointments with the healthcare provider ensure the recovery is progressing well and address any concerns.

Adenoidectomy recovery

The recovery time after an adenoidectomy is generally short and uncomplicated. In the post adenoidectomy period, patients might have mild throat pain, nasal stuffinessand a slight decrease in appetite, but these symptoms generally resolve within a few days. Managing discomfort with over-the-counter pain medications and ensuring plenty of rest and hydration can help speed healingMonitoring for any signs of complications during the post-operative phase is important, and contacting a healthcare provider if symptoms like excessive bleeding, high fever, or severe pain arise is essential.

Common post adenoidectomy symptoms

After an adenoidectomy, patients may experience several symptoms as part of the healing process, including:

  • Bad or stinky breath, caused by healing tissue or dried blood in the throat
  • Low-grade fever, which is normal shortly after surgery but should be monitored
  • Snoring, which may persist or temporarily worsen due to swelling
  • Coughing, often from throat irritation or mucus drainage
  • Throat pain or discomfort, common for several days after the procedure
  • Ear pain, caused by referred pain or irritation of the Eustachian tubes
  • Vomiting, sometimes related to anesthesia effects or swallowing blood during surgery
  • Temporary hearing changes, especially if ear tubes are placed during the procedure

How long does bad breath last after adenoidectomy?

Bad breath is a common temporary side effect following an adenoidectomy and typically results from healing tissues, dried blood, and mucus buildup in the throat and nasal passages. For most patients, this unpleasant odor lasts for about 5 to 7 days after surgery as the area heals.
 
Maintaining good oral hygiene, staying well-hydrated, and following post-operative care instructions can help reduce the duration and intensity of bad breath. If bad breath persists beyond two weeks or is accompanied by other symptoms like fever or pain, it’s important to consult a healthcare provider to rule out infection or other complications.
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Benefits of adenoidectomy surgery

The benefits of adenoidectomy include:

  • Improved breathing by removing nasal obstructions
  • Better sleep quality and reduction of obstructive sleep apnea symptoms
  • Decreased frequency of ear and sinus infections
  • Improved hearing due to fewer ear infections
  • Reduced need for repeated antibiotic treatments
  • Relief from chronic mouth breathing and associated issues like dry mouth

Overall enhancement in quality of life, including better breathing, sleep, and fewer infections.

Cost of adenoidectomy

The cost of an adenoidectomy can vary widely depending on factors such as the healthcare provider, geographic location, whether the procedure is performed in a hospital or outpatient surgery center, and if it’s combined with other surgeries like tonsillectomy. In the United States, the total cost—including surgeon fees, anesthesia, facility charges, and follow-up visits—can range from approximately $3,000 to $10,000 or more. Insurance coverage often helps reduce out-of-pocket expenses, but it’s important for patients and families to check with their insurance providers about coverage details, copayments, and deductibles. Additionally, some facilities offer payment plans or financial assistance to help manage the cost.

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Complications and risks of adenoidectomy

Although adenoidectomy is generally considered a safe procedure, like any surgery, it carries some risks and potential complications. Common risks include bleeding during or after surgery, infection at the surgical site, and reactions to anesthesia. Some patients may experience temporary side effects such as nasal dryness, a sore throat, or changes in voice quality. Rare but more serious complications can include damage to surrounding tissues, persistent nasal regurgitation, or airway obstruction. It’s important for patients and caregivers to discuss these risks with their healthcare provider and follow all pre- and post-operative instructions to minimize complications.

Signs of infection after adenoidectomy

It’s important to monitor for signs of infection following an adenoidectomy, including:

  • High fever (above 101°F or 38.3°C) that doesn’t improve with medication
  • Increased or worsening throat pain
  • Redness, swelling, or discharge around the surgical site
  • Persistent or worsening nasal discharge, especially if thick, yellow, or foul-smelling
  • Excessive or continuous bleeding
  • Difficulty swallowing
  • Unusual fatigue or weakness
  • Swollen glands in the neck

If any of these symptoms appear, contacting a healthcare provider promptly is essential to prevent complications.

What to eat after adenoidectomy

After an adenoidectomy, it’s best to focus on foods that are soft and easy on the throat, such as:

  • Yogurt
  • Applesauce
  • Mashed potatoes
  • Smoothies
  • Soups (not too hot)
  • Soft cooked cereals (like oatmeal)
  • Ice cream or popsicles (for soothing the throat)

It’s also important to:

  • Stay well-hydrated with water, clear broths, and non-citrus juices
  • Avoid spicy, acidic, or rough-textured foods that can irritate the throat
  • Gradually return to a normal diet as comfort allows, usually within a week
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Behavior changes after adenoidectomy

It’s common for children to experience temporary behavior changes following an adenoidectomy due to discomfort, anesthesia effects, and the overall recovery process. They may become more irritable, tired, or clingy than usual, and their appetite might decrease for a few days. Some children might also have trouble sleeping or seem restless as their body heals. These changes are usually short-lived and improve as pain subsides and normal routines resume. Parents and caregivers should offer extra comfort and patience during this time and consult a healthcare provider if unusual or prolonged behavior changes occur.

Adenoidectomy vs. Tonsillectomy

Adenoidectomy and tonsillectomy are both common surgical procedures that involve the removal of lymphoid tissues in the throat but serve different purposes. An adenoidectomy removes the adenoids, which are located higher up behind the nasal cavity, and is typically done to relieve nasal obstruction, chronic ear infections, or sleep apnea caused by enlarged adenoids.

In contrast, a tonsillectomy involves removing the tonsils, which sit on either side of the back of the throat, and is often performed to treat recurrent tonsillitis or severe tonsil-related breathing problems.

Sometimes, both procedures are done together, especially in children who experience multiple throat and airway issues. The recovery and risks for each surgery can vary, so doctors decide based on the specific symptoms and needs of the patient.

FAQs about adenoidectomy

Is adenoidectomy a minor or major surgery?

Adenoidectomy is generally considered a minor surgical procedure, especially when compared to more invasive operations. It is usually performed on an outpatient basis under general anesthesia, meaning patients can go home the same day. The surgery itself is relatively quick—typically lasting 15 to 30 minutesand involves minimal external incisions, as the adenoids are accessed through the mouth. 

What is coblation adenoidectomy?

Coblation adenoidectomy is a minimally invasive surgical technique used to remove enlarged or infected adenoid tissue using low-temperature radiofrequency energy.
 
Unlike traditional methods that cut or burn the tissue, coblation gently dissolves it with a combination of radiofrequency and saline, resulting in less heat damage to surrounding areas. This technique often leads to reduced bleeding during the procedure, less post-operative pain, and a faster recovery time—making it especially beneficial for children.
 
Because of its precision and lower risk of complications, coblation has become a preferred option for many ENT specialists when treating chronic nasal obstruction, ear infections, or sleep-related breathing issues caused by enlarged adenoids.

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