Specialties · Paediatric ENT
Adenoid and tonsil surgery in children
Surgery on the adenoids and tonsils is indicated when these structures obstruct breathing during sleep or when infections recur at high frequency. It is not the first step: it follows assessment and medical treatment. At Clínica Rhinus, the procedure is performed using coblation technology.
Medically reviewed by Prof. Aline Bittencourt, MD, PhD, CRM-MA 7562 · RQE 1832 Updated on
When surgery comes in
Enlarged adenoids and tonsils are common in childhood and, in most cases, do not call for surgery. Treatment starts with control of rhinitis, nasal irrigation and attention to environmental factors — the subject of the page on snoring and mouth breathing in children.
Surgery is considered when:
- Airway obstruction during sleep is significant and persistent.
- Sleep apnoea has been documented.
- Throat infections recur at high frequency, despite treatment.
- There is otitis media with effusion that will not settle and affects hearing.
There is no adenoid measurement that, on its own, indicates surgery. What weighs is the whole picture: how the child breathes, how she sleeps, how often she falls ill, and how her hearing is.
Adenoids, tonsils, or both?
They are different structures, in different places, and both do not always need to be removed.
| Procedure | What is removed | Typical indication |
|---|---|---|
| Adenoidectomy | The adenoid, at the back of the nose | Nasal obstruction, nasal voice, recurrent ear infections |
| Tonsillectomy | The palatine tonsils, in the throat | Recurrent infections, obstruction during sleep |
| Adenotonsillectomy | Both, in the same procedure | Where both contribute to obstruction |
Assessment with nasal endoscopy shows the true size of the adenoid and how much it obstructs airflow, information that examination through the mouth cannot provide.
Coblation technology
At Clínica Rhinus, these procedures are performed using coblation.
The name comes from controlled ablation. The technique applies radiofrequency in a saline medium, generating a field capable of dissolving tissue at a lower temperature than conventional electrocautery — in the range of tens of degrees rather than hundreds.
In practice, this allows the surgeon to remove or reduce tissue with better delineation of the treated area. The choice of technique is made by the surgeon, considering the case, the child’s age and the aim of the procedure. It is discussed beforehand, at the pre-operative consultation.
What recovery usually involves
Recovery varies with the child and with the extent of the procedure. Some points are common:
- A sore throat in the first days, with guidance on pain relief.
- Light, cold food, as advised by the team.
- Increased fluid intake — drinking helps recovery.
- Relative rest, with a gradual return to normal activities.
- Post-operative visits to monitor healing.
Bad breath and a whitish patch in the throat during the first days are part of the normal healing process.
Where it is carried out
Assessment, tests and pre- and post-operative follow-up take place at Clínica Rhinus, in the Renascença district of São Luís. Surgery is carried out in a hospital setting.
Sources: Brazilian Association of Otorhinolaryngology and Cervico-Facial Surgery (ABORL-CCF) · Flint PW, Francis HW, Haughey BH, et al. Cummings Otolaryngology: Head and Neck Surgery. 7th ed. Elsevier; 2020. · Bento RF, Bittencourt AG, Voegels RL. Seminários em Otorrinolaringologia. Fundação Otorrinolaringologia.
Frequently asked questions
Questions about paediatric ent
When is surgery indicated?
When airway obstruction during sleep is significant and persistent, when sleep apnoea has been documented, when throat infections recur at high frequency despite treatment, or when there is otitis media with effusion that will not settle. The decision considers the whole picture, not an isolated measurement of the adenoid.
What is coblation technology?
It is a technique that applies radiofrequency in a saline medium to dissolve tissue, working at a lower temperature than conventional electrocautery. This allows tissue to be removed with better delineation of the treated area. The choice of technique is made by the surgeon, case by case.
Does removing the tonsils weaken immunity?
No. The tonsils form part of the defence system, but they are not its central component, and the body maintains protection through other routes. Surgery is indicated when they impair breathing during sleep or cause recurrent infections, and the decision is always individual.
What does recovery usually involve?
It involves a sore throat in the first days, light and cold food as advised, good hydration and relative rest. The time to return to normal activities varies with the child and with the extent of the procedure, and is advised individually at post-operative visits.
Can the adenoid grow back?
It is uncommon, but it can happen, particularly in children operated on at a very young age. When obstructive symptoms return after a period of improvement, assessment is repeated with nasal endoscopy to see what is going on.