Toddler Adenoidectomy

Alternately Titled - "Adenoids: The ENT's Best Kept Secret"

Back in January (when Sam was 18 months old), after almost a year of on and off ear infections and constant antibiotics, we opted for Sam to have tubes put in his ears.  This is a pretty routine procedure (in fact, our doctor said that when adults get tubes they just do it in the office with no medicine or anything); but, because he is little (and wiggly) it requires anesthesia.  Since he was going to have to be put under anyway - and for a number of other reasons I'll talk about below - we decided to have the surgeon remove his adenoid at the same time.

I am writing about this now because I wanted to let some time pass and see what kind of change we really saw after the surgery...  It has been four months now (almost to the day), and the improvement has been dramatic.  Just this week, in fact, Sam has had an ear infection (his first one since then) and a bad cold, and I've been reminded how far we have come... 

Since I know chronic ear infections, stuffiness, and trouble breathing at night are very common problems for babies and toddlers, I thought some of you might benefit from hearing a little more about our experience before, during, and after the surgery.  For the most part, I'm going to avoid a lot of "technical" talk because, honestly, you can just search Web MD for that.  This is, obviously, not professional medical advice.  In addition,  although it is difficult to separate the two since Sam had both procedures at the same time, most of these thoughts are specifically related to the adenoids (as opposed to the tubes) - since that seems to be what most people are unfamiliar with. 

So... What is the adenoid?  That's probably a good place to start...

from Web MD - see, I told you

Put simply, the adenoid is a clump of tissue found way up behind the tonsils (actually at the back of the nasal cavity) that is meant to trap germs that get in through the nose and mouth of babies and children.  (Interestingly, the adenoid shrinks significantly after age five and is almost gone by the time you are a teenager.)  Like the tonsils, the adenoid can become swollen or infected and block the airway causing trouble breathing, a stuffy/runny nose, and even ear infections. Aha!

Before: 

Beginning around the time I stopped breastfeeding exclusively at six months (which may or may not be related) Sam began to have a constant runny nose and ear infections.  (We estimate that he had about eight infections in nine months.)  In addition, his breathing was pretty much entirely out of the mouth (tricky for a pacifier lover like Sam), and almost everyone he was around commented on his nasally and labored breathing - at the time, I called him "my little pig" because he sounded just like one!  His breathing problems were particularly obvious at night when he would snore loudly (Jeff and I grew accustomed to sleeping with the sound of his snoring in the background on the monitor) and often wake up several times because he couldn't catch his breath (scary)!  When, finally, at 18 months the pediatrician finally recommended that we have tubes put in his ears because of recurring infection and lack of speech (he had zero words at the point), Jeff and I actually were the ones that suggested the adenoid removal too.

*It is worth noting that neither the pediatrician nor the ENT ever mentioned the adenoid.  The only reason we knew anything about it was because one of our neighbor's little boy had just recently had his removed.  I think our experience would have been vastly different if we had only had tubes put in, which is why I think it is SO important to know about it and research it on your own!!

The main problem with adenoid removal is that, because of it's location, the doctor can't just look in your little one's mouth to see if it is enlarged.  Seeing the adenoid actually requires the use of a tiny little mirror in the very back of the throat and/or an x-ray - both of which require additional anesthesia for a baby/toddler.  We had the option of doing this ahead of time, but we didn't want to have Sam put to sleep any more than we had to.  SO, we actually went in to our surgery with the plan of "bilateral tubes with possible adenoidectomy."  Basically, once Sam was fully asleep and the tubes were inserted into both ears, the surgeon would look at the adenoid.  If it was enlarged, he would remove it (basically by cutting and burning it out of the back of the throat); and, if not, he would leave it as is.  (Yes, this wasn't an ideal situation for a Type-A/Planner Momma... But, we do what we have to do.  Plus... Based on his symptoms, Jeff and I were pretty confident that it would be enlarged, so we prepared ourselves for that.)

During:

On the morning of the surgery, we were told to arrive around 7AM and no let Sam have anything to eat or drink beforehand. (Lovely.)  Bless his little heart, he was in such a good mood that morning and just happily played in the waiting room for the almost hour before we were called back to meet with the surgeon.  Both Jeff and I went back with him initially as he got dressed in his adorable little hospital gown and the nurses prepped us for what was going to happen.  Then, the surgeon came back and talked to us a little more.  (He seemed to want a good idea of whether or not he would be removing the adenoid before going in to surgery so he pressed us a lot on his "symptoms" - his main concern being snoring.  Thinking back on it now, I remember being nervous that I was being too pushy about the adenoid and feeling like we had to beg him to take it out; but, I'm so glad that we did.)

I was able to go back into the operating room with Sam and hold him while they administered the general anesthesia.  I had been warned that this was "the hardest part" and would be "harder on me than on him."  SO TRUE.  At least in our case, the anesthesiologist starts by just letting some gasses into the air and then, when he starts getting sleepy and relaxes, puts a mask over his face to help him go all the way to sleep.  Apparently, we have a little fighter because he screamed and kicked and threw a total fit and DID NOT go to sleep.  It was miserable to watch, but I was so glad I was with him.  Finally, the nurses had to actually hold him down and hold the mask over his face until he finally went limp in my arms.  I don't want to over-dramatize this; but, you should be warned that this part is not for the weak.  I hadn't been too upset or scared at all going into the surgery, but this part made me leave the operating room in tears.     

We had been told that the surgery would take a little longer (and the recovery, likewise) if they decided to take out the adenoid.  I would estimate that, in total, we were in the waiting room alone for about an hour (although I honestly don't remember now).  When the surgery was complete, the surgeon came to talk to us and reported that the adenoid had been "very enlarged," and that we had made the right decision in having it removed. (Whew.)

A little later, once Sam was awake and in recovery, the nurses came for us and took us to our very angry, screaming boy.  (Another thing I had heard and definitely experienced first hand - some kids get very MAD after anesthesia.  Sam is one of them.  He cried and screamed for another hour and, at one point, ripped the IV out of his little hand in rage.  Let's just say he was no one's favorite patient that day.  BUT, everyone was very nice and helpful and accommodating.)  Once they could get him to drink a little juice (he had never had juice before and wasn't quite sure what to think of it) and keep down some food without throwing up, we were released.

From what I can remember, that day was not bad at all.  I had expected (hoped?) that he would be tired and want to sleep a lot; but, for the most part, he ate up all the attention he was receiving.

These photos were taken throughout that first day:

So, I made this cute little collage and THEN realized that he is wearing two different outfits... Obviously, my times are off.  You get the idea... ;)

We had the surgery on a Thursday morning and I took off work Thursday and Friday.  We treated minor pain with Motrin and, by Monday, he was 100% back to his normal (MUCH less stuffy) self. :)

After:

Immediately after the surgery (as in, that afternoon) we could tell a drastic difference in Sam's breathing.  I had actually taken a video a few days earlier of his sleeping to record his breathing and he slept almost silently right after surgery.  (Admittedly, Jeff and I had to get used to our now quiet sleeping environment.)  Sam's stuffiness and runny nose also cleared up right away.  He sleeps much better now and we don't worry that he will quit breathing at night! Honestly, that alone was worth the surgery!!! We saw a HUGE improvement and have continued to be impressed with the results now four months later.

YES, he still has colds and gets a runny nose from time to time - but it is NOTHING like it used to be.

YES, even with tubes, he recently had an ear infection.  But, treatment has been much easier and (we think) recovery much quicker.

NO, he did not immediately start talking.  (More on that later.)  BUT, we have seen a slow and steady improvement.

A few other "side effects" worth mentioning:

- Around day three a scab formed in the back of Sam's throat.  We couldn't see this, but we could SMELL it.  Apparently this is common, but the smell of that burned skin healing was NO JOKE.  For about a week, his breath smelled absolutely ROTTEN and there was nothing we could do about it.  As soon as the scab healed, it went away.  But, prepare yourself.  Seriously.

- We have also found that with the adenoid removed, a basic cold can be a little stranger now.  I guess because this "blocker" is no longer in place, when he does have a cold a snot like substance comes out of not only his nose, but also out of his eyes, ears, etc.  It is not pretty.  Be warned.

As a side note: I told my students this, and they freaked out.  Within a matter of minutes they had me convinced I was the worst mother ever because poor Sam would be scarred for life and no one would be his friend because he had snot ears and eyes.  BUT, alas, two of my students assured me that they too had had their adenoid removed as a little kid and did not have this problem currently. Fingers crossed...

In conclusion, I am SO glad that we knew about the adenoid and chose to have Sam's removed when we did.  Since he was going to have to be put to sleep for the tubes anyway (which seemed non-negotiable given the sheer volume of infections), it was really very little added risk, and the pay-off was well worth it.  If your child is experiencing any of the same symptoms, please consider looking into this!! 

Note: I've heard of several doctors that recommend a tonsillectomy and an adenoidectomy at the same time.  Obviously, I can't speak to this from experience; but, I have heard that the procedure and the recovery for a tonsillectomy is much more serious.  If your problems aren't directly related to the tonsils/sore throat, I would definitely recommend considering just having the adenoid removed first.  For what it's worth...

Ok, so sorry for the novel.  I hope this was useful for some of you.  Back to regularly scheduled "fluff" tomorrow!