What are adenoids

Adenoids also called the pharyngeal tonsil, are two small pads of tissues high in the back of the nose believed to play a role in immune system activity. Adenoids are part of the immune system, which helps fight infection and protects the body from bacteria and viruses.

Only children have adenoids. They start to grow from birth and are at their largest when a child is around three to five years of age.

Adenoids help fight infections in your body. This function may make them particularly vulnerable to infection, inflammation and swelling. Adenoids are the most helpful between birth and age 5. Adenoids are like a sponge. They catch the germs that make you sick. That’s what causes them to increase in size. They return to normal size when you are healthy. It is not normal for adenoids to remain swollen (enlarged).

Adenoids usually start to shrink after about age 5. By the teenage years, adenoids are almost completely gone and they no longer play a big role in your body’s health. By adulthood, adenoids have disappeared completely. By then, your body has other ways to fight germs.

Adenoids are not important unless they become enlarged. They rarely become enlarged as an adult.

Infection of the adenoids and enlarged adenoids, a condition especially common in children, can obstruct the flow of air through the nasopharynx. Because the nasal airway is blocked, breathing through the mouth becomes necessary. Because adenoids are near the opening of the eustachian tubes, inflammation or enlargement of the adenoids may block the eustachian tubes, thereby contributing to middle ear infection. Inflammation of adenoids is more likely to play a role in ear infections in children because children have relatively larger adenoids.

Symptoms of enlarged adenoids

Common symptoms include:

• Sore throat
• Runny or stuffy nose
• Feeling like your ears are blocked
• Difficulty sleeping
• Difficulty swallowing
• Swollen neck glands
• Sleep apnea (a condition that causes you to stop breathing for short periods while sleeping)
• Chapped lips/bad breath (due to having to breathe through your mouth)

The eustachian tubes are a pair of narrow tubes that run from each middle ear to high in the back of the throat, behind the nasal passages. The throat end of the tubes open and close to:

• Regulate air pressure in the middle ear
• Refresh air in the ear
• Drain normal secretions from the middle ear

Swelling, inflammation and mucus in the eustachian tubes from an upper respiratory infection or allergy can block them, causing the accumulation of fluids in the middle ear. A bacterial or viral infection of this fluid is usually what produces the symptoms of an ear infection.

Ear infections are more common in children, in part, because their eustachian tubes are narrower and more horizontal — factors that make them more difficult to drain and more likely to get clogged.

Figure 1. Adenoids

Tonsils and adenoids

The tonsils are patches of lymphatic tissue located at the entrance to the pharynx, where they guard against ingested and inhaled pathogens. Each is covered by an epithelium and has deep pits called tonsillar crypts lined by lymphatic nodules. In the tonsils, the underlying lamina propria consists of abundant mucosa associated lymphoid tissue (MALT) packed with lymphocytes and scattered lymphoid follicles. The overlying epithelium invaginates deep into the interior of the tonsil, forming blind-ended crypts that trap food debris, dead leukocytes, bacteria, and antigenic chemicals. The trapped bacteria work their way through the epithelium to the underlying lymphoid tissue, causing the activation of lymphocytes. Such trapping of bacteria leads to many tonsil infections during childhood, but it also generates a great variety of memory lymphocytes for long-term immunity. Below the crypts, the tonsils are partially separated from underlying connective tissue by an incomplete fibrous capsule.

There are four groups of tonsils:

1. The paired palatine tonsils lie directly posterior to the mouth and palate on the lateral sides of the pharyngeal wall. Palatine tonsils are the largest tonsils and the ones most often infected and removed during childhood, in a surgical procedure called tonsillectomy.
2. The lingual tonsil lies on the posterior surface of the tongue.
3. Adenoids also called the pharyngeal tonsil lies on the pharyngeal roof. You cannot see your adenoids.
4. The tubal tonsils are just behind the openings of the pharyngotympanic tubes into the pharynx. The four groups of tonsils are arranged in a ring around the entrance to the pharynx to gather and remove many pathogens that enter the pharynx in inspired air and swallowed food. The tonsils process the antigens and then initiate immune responses.

Where are the adenoids located

Adenoids (the pharyngeal tonsil) are located in the mucosa covering the roof of the nasopharynx – high up in the throat, above the roof of the mouth, just behind the nose. You can’t see a person’s adenoids by looking in their mouth. Enlargement of adenoids (the pharyngeal tonsil), can occlude the nasopharynx so that breathing is only possible through the oral cavity.

Figure 2. Adenoids location

What do adenoids do

Adenoids along with the tonsils, are part of the lymphatic system. The lymphatic system clears away infection and keeps body fluids in balance. The adenoids and tonsils work by trapping germs coming in through the mouth and nose.

Adenoids can be helpful in young children, but they’re not an essential part of an adult’s immune system. This is why they shrink and eventually disappear by teens or adulthood.

What are enlarged adenoids

Enlarged adenoids are adenoids that are swollen. Swollen adenoids is a common problem in children. Adenoids usually start to shrink after about age 5. By the teenage years, they are almost completely gone. By then, the body has other ways to fight germs.

Enlarged adenoids causes

Your child’s adenoids can be enlarged, or swollen, for different reasons. It may just be that your child had enlarged adenoids at birth. Adenoids can also become enlarged when they are trying to fight off an infection. Adenoids might stay enlarged even after the infection is gone. The adenoids may stay enlarged even when you are not sick.

Can enlarged adenoids be prevented or avoided?

Having enlarged adenoids is a common condition for children. It is less of an issue as people age. There is nothing you can do to prevent it. Prompt attention for a sore throat or ear infection can help your doctor monitor the size of your adenoids. This may reduce your discomfort.

Enlarged adenoids symptoms

Enlarged adenoids can make it hard to breathe through the nose. Your child might end up breathing only through the mouth. Mouth breathing occurs mostly at night, but may be present during the day.

Mouth breathing may lead to the following symptoms:

• A dry mouth, which can also lead to bad breath
• Cracked lips
• Persistent runny nose or nasal congestion
• Dry mouth

Other problems that enlarged adenoids can cause include:

• Loud breathing
• Snoring
• Restless sleep
• Sleep apnea, where you repeatedly stop breathing for a few seconds while sleeping

Children with enlarged adenoids may also have more frequent ear infections.

Enlarged adenoids diagnosis

Your child’s doctor will take a medical history, check your child’s ears, throat, and mouth, and feel your child’s neck.

Since the adenoids are higher up than the throat, the healthcare provider cannot see them just by looking through your child’s mouth. To check the size of your child’s adenoids, your child’s doctor may use:

• A special mirror in the mouth
• A long, flexible tube with a light (an endoscope). The scope is made of a thin, flexible material. He or she will insert the scope through your nose and down the back of your throat. It may be uncomfortable. It will not be painful.
• An x-ray

Your doctor may order a blood test to see if you have an infection. Your doctors may also order a sleep study to see if you have sleep apnea. This helps determine whether enlarged adenoids are the reason for your sleep problems.

What are the treatments for enlarged adenoids?

Treatment depends on your age, how long your adenoids have been enlarged and what is causing the problem. Many people with enlarged adenoids have few or no symptoms and do not need treatment. Adenoids shrink as a child grows older.

If your child’s symptoms are not too bad, he or she may not need treatment. Your doctor may monitor the adenoids’ size over time. Your child might get nasal spray to reduce the swelling, or antibiotics if your doctor thinks that your child has a bacterial infection.

In some cases your child may need an adenoidectomy. Surgery to remove your adenoids (adenoidectomy) and tonsils (tonsillectomy) at the same time is common. This is common if you have frequent ear and throat infections, trouble breathing, or sleep apnea.

Living with enlarged adenoids

Children with enlarged adenoids are treated with an antibiotic. This is to eliminate the infection that is causing enlarged adenoids. Be sure your child takes the full dose. A partial dose will allow the infection to return. If medicine is not effective after repeated illness, your doctor may discuss surgery.

What is an adenoidectomy and why might I my child need one?

An adenoidectomy is surgery to remove the adenoids. Your child might need it if:

• He or she has repeated infections of the adenoids. Sometimes the infections can also cause ear infections and fluid buildup in the middle ear.
• Antibiotics can’t get rid of a bacterial infection
• The enlarged adenoids block the airways

If your child also has problems with his or her tonsils, he or she will probably have a tonsillectomy (removal of the tonsils) at the same time that the adenoids are removed.

After having the surgery, your child usually goes home the same day. He or she will probably have some throat pain, bad breath, and a runny nose. It can take several days to feel all better.

Tonsils and adenoids removed

Adenoid removal is also called adenoidectomy. The procedure is most often done in children. The adenoids are often taken out at the same time as the tonsils (tonsillectomy). If your child has large tonsils, or has had severe or frequent bouts of tonsillitis, removing the tonsils and adenoids at the same time may be recommended. This procedure is called an adenotonsillectomy.

Tonsillitis is an acute inflammation of the palatine tonsils, usually caused by a Streptococcus infection. Their surgical removal, called tonsillectomy, used to be one of the most common surgical procedures performed on children, but is less common today. Tonsillitis is now usually treated with antibiotics.

Enlarged tonsils and adenoids are a common cause of snoring and sleep disruption in children. Although less enlarged in adults, some adults can receive excellent resolution of snoring through removal of tonsils and/or adenoids.

Tonsillectomy/adenoidectomy is an outpatient surgery performed in the operating room under general anesthesia. Most patients require a recovery time at home of approximately one week but may continue to experience a sore throat for two weeks. The most common complication is bleeding, often occurring over a week after the surgery. Serious bleeding is rare.

When do adenoids need to be removed?

A child’s adenoids can sometimes become swollen or enlarged. This can happen after a bacterial or viral infection, or after a substance triggers an allergic reaction.

In most cases, swollen adenoids only cause mild discomfort and treatment isn’t needed. However, for some children, it can cause severe discomfort and interfere with their daily life.

Adenoids may need to be removed if your child has:

• breathing problems – your child may have difficulty breathing through their nose and may have to breathe through their mouth instead, which can cause problems such as cracked lips and a dry mouth
• difficulty sleeping – your child may have problems sleeping and may start to snore; in severe cases, some children may develop sleep apnea (irregular breathing during sleep and excessive sleepiness during the day)
• recurrent or persistent problems with the ears – such as middle ear infections (otitis media) or glue ear (where the middle ear becomes filled with fluid)
• recurrent or persistent sinusitis – leading to symptoms such as a constantly runny nose, facial pain and nasal-sounding speech.

Adenoidectomy may also be recommended if your child has tonsillitis that keeps coming back.

The adenoids normally shrink as children grow older. Adults rarely need to have them removed.

How an adenoidectomy is carried out

The adenoids can be removed during an adenoidectomy.

The operation is usually carried out by an ear, nose and throat (ENT) surgeon and takes around 30 minutes. Afterwards, your child will need to stay in the recovery ward for up to an hour until the anaesthetic has worn off.

Adenoidectomies are sometimes day cases if carried out in the morning, in which case your child may be able to go home on the same day. However, if the procedure is carried out in the afternoon, your child may need to stay in hospital overnight.

Before the operation

Tell your ENT surgeon if your child has had a cold or sore throat in the week before the operation.

If your child has a high temperature and cough, the operation may have to be postponed for a few weeks to ensure they’ve fully recovered and to reduce their risk of developing complications as a result of the surgery.

The adenoidectomy procedure

An adenoidectomy is carried out under general anaesthetic, so your child will be unconscious during the procedure and won’t feel any pain.

Your child’s mouth will be propped open and after the adenoids have been located, the surgeon will remove them by scraping them away with an instrument called a curette, or by applying heat using a diathermy instrument. A diathermy instrument produces high-frequency electrical currents that burn the adenoids.

After the adenoids have been removed, the diathermy instrument may be used to stop the bleeding (cauterisation), or an absorbent material called packing material may also be used to control bleeding. When this is removed, the operation is complete.

Your child will stay in the recovery room after surgery. You will be allowed to take your child home when your child is awake and can breathe easily, cough, and swallow. In most cases, this will be a few hours after surgery.

Note: Some surgeons use electricity to heat the tissue, remove it, and stop bleeding. This is called electrocautery. Another method uses radiofrequency (RF) energy to do the same thing. This is called coblation. A cutting tool called a debrider can also be used to remove the adenoid tissue.

Tonsillectomy

Tonsillectomy is a surgery to remove the tonsils.

Removing the adenoids and tonsils in a single procedure reduces the risk of complications. However, adenoidectomies, tonsillectomies and adenotonsillectomies are quick and straightforward procedures with few associated risks.

Grommets

Grommets may be inserted at the same time as an adenoidectomy if your child has had persistent glue ear which affects their hearing.

Grommets are tiny tubes that are inserted into the ear through a small incision in the eardrum. They drain fluid away from the middle ear and help maintain air pressure.

Can adenoids grow back?

In rare cases, adenoid tissue may grow back. This does not cause problems most of the time. However, it can be removed again if necessary.

Prognosis after adenoidectomy

After adenoidectomy procedure, most children:

• Breathe better through the nose
• Have fewer and milder sore throats
• Have fewer ear infections

Adenoids removed side effects

An adenoidectomy is a low-risk procedure and complications following surgery are rare. However, as with all types of surgery, there are some associated risks.

When to seek medical advice

Contact your doctor immediately or go to your nearest accident and emergency (A&E) department if your child experiences the following symptoms shortly after surgery:

• bright red bleeding from their mouth (for more than two minutes)
• a fever
• intense pain that isn’t reduced by painkillers

Some of the possible problems after having an adenoidectomy are outlined below.

Minor problems after surgery

After an adenoidectomy, some children experience minor health problems. However, most of these are temporary and rarely require further treatment. They can include:

• sore throat
• earache
• stiff jaw
• blocked nose or nasal discharge
• bad breath (halitosis)
• a change in voice (your child may sound like they’re speaking through their nose)

Most of these symptoms will pass within one to two weeks, and shouldn’t last longer than four weeks. Contact your doctor if your child is still experiencing side effects after this time.

Infection

All surgery carries the risk of infection. The tissue in the area where the adenoids were removed may become infected with bacteria.

Therefore, after the procedure, your child may be prescribed antibiotics to help prevent infection.

Allergy to the anaesthetic

With any surgery where an anaesthetic is required, there’s a risk of the person having an allergic reaction to the anaesthetic.

If your child’s general health is good, their risk of having a serious allergic reaction (anaphylaxis) to the anaesthetic is extremely small (1 in 20,000).

Around 1 in 10 children may experience some temporary symptoms, such as a headache, sickness or dizziness.

Bleeding

In rare cases, excessive bleeding can occur after the adenoids have been removed. This is known as a hemorrhage.

Further surgery will be needed for cauterisation (where heat is applied to stop the bleeding) or to insert a dressing.

Less than 1 in 100 children need emergency treatment to stop a hemorrhage. However, if it occurs, a hemorrhage needs to be dealt with quickly to prevent excessive blood loss.

Recovery

It’s normal to have a sore throat after an adenoidectomy. Your child will usually be given painkillers while in hospital to help ease discomfort.

Your child may also feel groggy and sleepy after having an anaesthetic. After the operation, they’ll be observed for several hours to make sure they’re recovering normally. Once the doctor is satisfied, you’ll be able to take your child home.

Pain relief

Your child may still have a sore throat, earache or stiff jaw after returning home, and they may need painkillers in the days after the operation.

Over-the-counter painkillers, such as acetaminophen (paracetamol), are usually suitable. Younger children may find it easier to take liquid or soluble paracetamol, particularly if they have a sore throat.

Always make sure you follow the dosage instructions on the packet, and never give aspirin to a child who’s under the age of 16.

Eating and drinking

Your child should be able to drink liquids two to three hours after having an adenoidectomy. They can begin eating several hours after that.

To start with, eating normally may be difficult because of the sore throat. Encourage your child to eat soft or liquid foods, such as soups or yoghurts, which are easier to swallow.

Giving your child a dose of painkillers about an hour or so before they eat may make swallowing food easier.

It’s also important for them to drink plenty of fluids to avoid dehydration.

Returning to school

Your child will need to rest for several days after an adenoidectomy and should be kept off school for a week. This is to reduce their risk of getting an infection.

The skin and tissue where the adenoids used to be will take a while to heal. It’s important to try to prevent the wound becoming infected because an infection could cause complications.

Keep your child away from people with coughs or colds, and from smoky environments. They should also avoid swimming for three weeks after the operation.