Definition

Adenoids are lymphoid tissue (lymph nodes) located in the respiratory tract, between the nose and the throat. Adenoids are composed of the same tissue as the tonsils. You can see your tonsils when looking at the back of your throat in a mirror, while adenoids are located in an area not visible. Both adenoids and tonsils are part of the body's immune system, which functions to prevent and fight infections.

Adenoid hypertrophy is the blockage of the airways, digestive tract, and ears due to the enlargement of the adenoids. Adenoid hypertrophy occurs in about 34.46% of children aged 5-14 years. Another report states that approximately 42% of cases of adenoid hypertrophy seek treatment from ENT specialists. Adenoid hypertrophy is the most common cause of snoring and pauses in breathing during sleep (obstructive sleep apnea/OSA) in children. Adenoid hypertrophy most commonly occurs at ages 3-6 because adenoids reach their largest size.

Causes

Adenoids are part of the lymphatic system in the form of a ring called Waldeyer's ring. This ring is part of the human immune system. Adenoids are located in the passage connecting the nasal cavity to the throat.

Adenoids begin to grow at birth and reach their largest size at ages 3-6. By ages 7-8, the size of the adenoids will decrease as the child matures. As adults, adenoids will completely disappear. Adenoids can produce antibodies to help the body fight infection. In toddlers, adenoids help fight infection by trapping bacteria and viruses that enter the body through the nose. Infected adenoids will enlarge and return to their original size after the infection subsides. However, in some conditions, adenoid enlargement persists even after the infection is gone. Adenoid enlargement can also be caused by infection. Some children have adenoids larger than normal since birth.

Risk Factor

Adenoids are part of the lymphatic system in the form of a ring called Waldeyer's ring. This ring is part of the human immune system. Adenoids are located in the passage connecting the nasal cavity to the throat.

Adenoids begin to grow at birth and reach their largest size at ages 3-6. By ages 7-8, the size of the adenoids will decrease as the child matures. As adults, adenoids will completely disappear. Adenoids can produce antibodies to help the body fight infection. In toddlers, adenoids help fight infection by trapping bacteria and viruses that enter the body through the nose. Infected adenoids will enlarge and return to their original size after the infection subsides. However, in some conditions, adenoid enlargement persists even after the infection is gone. Adenoid enlargement can also be caused by infection. Some children have adenoids larger than normal since birth.

Symptoms

Adenoid enlargement can cause several symptoms, including:

• Blocked nose
• Recurrent ear infections (otitis media with effusion - where fluid accumulates in the middle ear, causing hearing impairment)
• Difficulty sleeping
• Snoring
• Sore throat
• Difficulty swallowing
• Speech disturbances
• Breathing through the mouth can cause dry mouth, bad breath, and dry lips
• In chronic conditions, it can cause changes in facial structure and form adenoid facies (open mouth, lower jaw pulled back, upper lip pulled upward)

Diagnosis

Doctors can diagnose adenoid hypertrophy based on symptoms, physical examination, and diagnostic tests. Doctors will inquire about the child's complaints, such as snoring, recurrent ear infections, speech disturbances; duration of symptoms, and accompanying complaints. Doctors will also perform an examination of the child's ears, throat, mouth, and neck to look for lumps and sources of infection. Doctors need to identify risk factors in children, such as allergic rhinitis and complications that have occurred, such as otitis media with effusion (OME).

Because adenoids are located behind the throat, doctors cannot directly see adenoids, so additional examinations are needed to evaluate the shape of the adenoids. Examinations performed to assess adenoid conditions include:

• Using a mirror inserted into the mouth
• Plain X-rays to compare adenoid size and nasopharynx
• Nasoendoscopy, which involves inserting a small camera-shaped cable through the nose. This examination is recommended to evaluate the condition of the adenoids because it can directly visualize the adenoids. The doctor will measure the adenoids and compare them with surrounding structures.
• Polysomnography (PSG). This examination is performed on children with OSA. This examination assesses snoring, airflow from the nose and mouth, and body position. This examination can help assess the severity of OSA experienced by the child.

Management

Adenoid treatment depends on the cause of adenoid enlargement and the symptoms experienced. If the symptoms are not severe, your child may not need specific treatment. However, if the symptoms potentially interfere or can cause complications, treatment such as nasal spray to reduce swelling may be given by the doctor. If the doctor suspects an ongoing bacterial infection, antibiotics may be prescribed. In some cases with severe symptoms, your child may need an adenoidectomy.

Adenoidectomy is a surgical procedure to remove the adenoids. The doctor may recommend this procedure if:

• Your child experiences recurrent infections. If infections continue to occur, adenoids can enlarge and block the ear canal, causing otitis media with effusion (OME).
• The antibiotics given cannot fight bacterial infections in the adenoids.
• Enlarged adenoids can block the respiratory tract, which can be potentially dangerous.

If there are problems with the tonsils, your child may also need a tonsillectomy (tonsil removal) along with an adenoidectomy.

After surgery, your child may go home the same day. After surgery, your child may experience a sore throat, bad breath, and a runny nose. Symptoms will last for several days after surgery.

Complications

Complications of adenoid hypertrophy include:

• Otitis media with effusion (OME), where fluid accumulates in the middle ear. If left untreated, this can disrupt your child's hearing.
• Breathing difficulties during sleep
• Speech, language, and/or learning disorders due to hearing impairment and recurrent OME.
• Behavioral disorders due to poor sleep quality, such as bedwetting
• Pulmonary hypertension
• Psychological disorders, such as depression and ADHD

Adenoid hypertrophy is self-limiting (self-healing) as the child grows older. However, considering the impact of complications on the child's future life, doctors generally consider operative management.

Prevention

Adenoid hypertrophy is a common condition in children and rarely causes problems in adults. This condition can be prevented by maintaining personal hygiene to avoid easily contracting upper respiratory tract infections. Moreover, this condition cannot be completely prevented. Handling conditions that can be risk factors for adenoid hypertrophy, such as ear and throat infections quickly and accurately can prevent worsening and adenoid enlargement.

When to See a Doctor?

Consult your doctor if your child experiences breathing problems, cannot breathe normally through the nose, experiences recurrent ear infections, hearing impairment, and often snores during sleep. Prompt management can help prevent complications in the future.