Adenoids are removed through the mouth in a procedure called an adenoidectomy, which takes about 20 to 30 minutes under general anesthesia. There are no external incisions or visible scars. The surgeon works through the open mouth to access the adenoid tissue sitting at the back of the nasal passages, above the roof of the mouth. It’s one of the most common childhood surgeries, and most kids go home the same day.
What Happens During the Surgery
Your child will be put under general anesthesia using a breathing tube placed through the mouth. Once they’re asleep, the surgeon inserts a mouth gag (a device that holds the mouth open) and retracts the soft palate to expose the adenoid tissue behind the nose. In many cases, a small angled camera is passed through the mouth or nose so the surgical team can see the adenoids on a monitor in real time. This visual guidance helps the surgeon remove tissue more completely and avoid damaging surrounding structures.
Once the adenoids are visible, the surgeon removes them using one of several techniques. The choice of technique depends on the surgeon’s training, the size of the adenoids, and the equipment available at the facility.
Removal Techniques Surgeons Use
Curettage (the traditional method): This is the oldest and simplest approach, first developed in the 19th century. The surgeon uses a curved metal instrument called a curette to scrape the adenoid tissue away. It’s fast and doesn’t require specialized equipment, but it’s essentially a blind procedure when done without a camera. That means it can leave behind residual tissue and, in rare cases, injure nearby structures.
Electrocautery (electrical heat): A suction-tipped device delivers electrical energy to cut through the tissue and seal blood vessels at the same time. This is commonly done under direct camera visualization, which gives the surgeon a clear, magnified view of what they’re removing. The combination of visual guidance and built-in bleeding control makes this a widely used modern approach.
Coblation (radiofrequency energy): This technique uses radiofrequency energy to break tissue down at the molecular level without generating the high heat of traditional cautery. It cuts and seals simultaneously. Studies show it achieves more complete removal than traditional curettage: in one comparative study, 75% of coblation cases had complete adenoid removal versus only 15% with conventional scraping. Patients also tend to experience less postoperative pain. The downsides are cost, since the handpieces are single-use, and a steeper learning curve for surgeons.
Microdebrider: This powered instrument uses a rotating blade with continuous suction to shave away tissue precisely. Some surgeons use a combined approach, removing the bulk of the adenoid with a curette first and then cleaning up residual tissue with the microdebrider.
Why Adenoids Need To Come Out
Adenoids are small pads of immune tissue behind the nose that help fight infections in young children. Sometimes they become chronically enlarged or infected, creating problems that outweigh their benefit. The American Academy of Otolaryngology lists several established reasons for removal, including:
- Obstructed breathing during sleep persisting for at least three months, including obstructive sleep apnea
- Recurrent sinus infections: four or more episodes of thick, discolored nasal drainage in a 12-month period in children under 12
- Persistent symptoms after antibiotics: adenoid-related symptoms that don’t resolve after two full courses of treatment
- Chronic ear problems: fluid behind the eardrum lasting more than three months, recurrent ear infections, or the need for repeat ear tube placement
- Speech or dental effects: a persistently nasal-sounding voice, or changes in jaw alignment or facial growth documented by a dentist or orthodontist
Current guidelines released in 2016 recommend against adenoidectomy as a first-line treatment for ear problems in children under four, unless there’s also a clear issue like nasal obstruction or chronic adenoid infection.
What Recovery Looks Like
Most children go home within a few hours of surgery. Pain is typically managed with over-the-counter medications, and your child may need them for up to two weeks. The pain often follows a surprising pattern: it can actually get worse around day four or five before improving. This is normal and happens as the surgical site goes through its healing stages.
Many children need about two weeks home from school or daycare. Full healing usually takes three weeks, and swimming should be avoided until that point. Physical activity should be limited during this period to reduce the risk of bleeding.
Eating and Drinking After Surgery
Staying hydrated is the single most important part of recovery. Adequate fluid intake helps manage pain, lowers bleeding risk, and prevents dehydration, which is one of the top reasons children get readmitted to the hospital after this surgery. Encourage frequent small sips throughout the day rather than big gulps every few hours. For the first few nights, it helps to wake your child once overnight to offer fluids and pain medication.
On surgery day and the day after, stick to clear liquids: water, ice chips, electrolyte drinks, and popsicles. By days one and two, if your child is ready for more, offer bland, soft foods like applesauce, yogurt, mashed potatoes, plain pasta, macaroni and cheese, smoothies, broth, or pudding. Around days three and four, cold foods may feel especially soothing. By the end of the first week and into week two, most children can eat a wider variety of foods based on what they can tolerate. Adding protein-rich options like Greek yogurt, nutritional shakes, and blended meals helps maintain their strength during healing.
Risks and Complications
Adenoidectomy is considered a low-risk surgery. A large population-based study found that bleeding requiring a return to the operating room occurred in about 1.1% of all cases, dropping to 0.7% when adenoidectomy was performed on its own (without tonsil removal at the same time). Bleeding can happen in two windows: immediately after surgery (primary bleeding, about 1% of cases) or in the days that follow as scabs form and shed (secondary bleeding, about 1.2%).
Other uncommon complications include temporary changes in voice quality, mild neck stiffness, and low-grade fever in the first day or two. Serious complications are rare.
Can Adenoids Grow Back?
They can, though significant regrowth is uncommon. One study using a camera to examine the area after surgery found some degree of adenoid regrowth in about 19% of cases, but only a small fraction of those had regrowth large enough to matter clinically. Two factors increase the likelihood: younger age at the time of surgery (particularly under five years old) and frequent antibiotic use after the procedure. Children who have adenoids removed very early may have enough remaining immune tissue in the area to regenerate, which is one reason surgeons sometimes recommend waiting when possible.