Adenoidectomy, by a paediatric ENT surgeon.

Prices vary by unit, by which consultant does the case, and by whether grommets or tonsillectomy are added on the same anaesthetic. NHS pathways remain available for OSA, glue ear and recurrent infection.

1. 01

   Before

   You send us the symptoms

   A short, confidential form. Snoring, witnessed apnoea, mouth breathing, ear infections, glue ear, growth or behaviour concerns, and any prior audiology or oximetry.

2. 02

   Before

   We come back with a plan

   Within one working day: whether adenoidectomy alone fits, or whether tonsillectomy or grommets should go on the same list. Indicative price. An honest read either way.

3. 03

   Before

   Paediatric ENT clinic visit

   Examination of the adenoid pad and tonsils (Brodsky grade), tympanogram and audiology for glue ear, and home overnight oximetry if paediatric OSA is suspected.

4. 04

   On the day

   Arrival at the day unit

   A play-friendly paediatric ward. Consent, weight and pre-op checks with the ENT surgeon and paediatric anaesthetist. Parent to induction in most units.

5. 05

   On the day

   The adenoidectomy

   15 to 20 minutes under GA, supine with head extended and a Boyle-Davis retractor. No external scar. Suction diathermy is the modern standard.

6. 06

   On the day

   Home the same day

   Short paediatric recovery, written aftercare, and home within a few hours. Cool, soft food for 5 to 7 days. Back to school in 5 to 7 days.

7. 07

   After

   Two-week telephone review

   A nurse-led call to check bleeding, feeding, snoring resolution and hyponasal speech. Face-to-face follow-up if grommets were placed or hearing was borderline.

• Chronic mouth breathing and hyponasal voice

  A blocked nose that never clears, a permanently open mouth and a muffled, blocked-nose voice - classic adenoid hypertrophy.

• Snoring and paediatric OSA

  Loud nightly snoring, witnessed apnoeas, restless sleep and daytime tiredness or hyperactivity that can mimic ADHD.

• Recurrent glue ear (OME)

  Persistent middle-ear effusion causing conductive hearing loss, delayed speech and school difficulties, often better after the adenoids come out.

• Recurrent adenoiditis

  Repeated episodes of purulent post-nasal discharge, halitosis and low-grade fever failing medical therapy.

• Recurrent otitis media

  Repeated ear infections in a child under seven where the adenoid pad is acting as a bacterial reservoir.

• Failure to thrive and growth failure

  A child dropping across weight centiles because sleep-disordered breathing is disturbing growth-hormone secretion.

• Behaviour and school problems

  Poor sleep from adenoidal obstruction driving inattention, irritability and hyperactivity that resolve after surgery.

• Red flag: severe OSA with desaturations

  Documented severe paediatric OSA needs prompt paediatric ENT input and a unit with overnight paediatric observation, not a routine day list.

• A short, well-tolerated day case

  About 15 to 20 minutes under general anaesthetic with a paediatric anaesthetist. Home within a few hours. No external scar and no stitches to worry about.

• Postoperative bleeding

  Uncommon (under 2%), usually self-limiting. Primary bleeding within 24 hours, or secondary bleeding at 5 to 10 days. Any fresh red bleeding is an A&E trip.

• Temporary hyponasal speech

  For 2 to 4 weeks the voice can sound less blocked and slightly different as the palate adapts. Almost always settles without any speech therapy.

• Velopharyngeal insufficiency (VPI)

  Rare (about 1%) persistent hypernasal speech from poor palate closure. Higher risk in children with a submucous cleft or a bifid uvula - screened for pre-op.

• Dehydration if poor oral intake

  Some children eat little on day 1. Cool fluids, ice lollies and soft food (yoghurt, mashed potato, pasta) protect against dehydration.

• Recovery expectations

  Back to school in 5 to 7 days. Avoid contact sport, swimming and flying for 2 weeks. Soft cool diet for 5 to 7 days. Regular paracetamol and ibuprofen as directed.

• Grisel syndrome (very rare)

  Atlanto-axial subluxation after nasopharyngeal surgery. Extremely rare; presents with fever, neck pain and torticollis in the first 2 weeks and needs urgent review.

• Realistic outcomes

  Around 90 to 95% of children see clear resolution of snoring, OSA symptoms or glue ear where the adenoid was the driver. Recurrence 2 to 5% with modern suction diathermy versus 10 to 15% with cold curettage.

• Red flags after discharge

  Fresh red bleeding from the nose or mouth, a fever above 38.5C beyond day 3, refusing all fluids, or a stiff painful neck. Call the unit or attend A&E.