Adenoids are lymphatic tissues at the back of the nasal cavity, above the roof of the mouth. They are part of the immune system, primarily trapping germs entering through the nose and mouth. While most active in childhood, adenoids typically shrink with age, often becoming undetectable in healthy adults. However, these tissues can re-emerge or enlarge in adulthood.
Adenoid Presence in Adulthood
Adenoids are composed of lymphoid tissue, similar to tonsils, and are part of Waldeyer’s Ring, a protective ring of lymphatic tissue in the throat. In children, these glands play a significant role in developing immunological memory by trapping bacteria and viruses. Adenoids typically grow until age 6, then begin to shrink by adolescence, often disappearing by age 16. This reduction in size is a normal physiological process; in most adults, adenoid tissue appears only in a residual form, though it rarely disappears completely.
Why Adenoids Might Regrow or Enlarge
While adenoid enlargement is less common in adults than in children, it can occur. In adults, “regrowth” refers to the re-enlargement of existing residual lymphoid tissue, not new tissue formation. Chronic infections, whether bacterial or viral, are common causes of adenoid enlargement in adults. Persistent allergies can also contribute to their increase in size.
Environmental factors like pollution and smoking are predisposing factors. Gastroesophageal reflux disease (GERD) and chronic nasal secretions have also been linked to adenoid enlargement. Adult adenoid hypertrophy may also be associated with compromised immunity (e.g., HIV infection), or, rarely, with sinonasal malignancy or lymphoma.
Recognizing Symptoms in Adults
Enlarged adenoids in adults can cause various symptoms, sometimes mistaken for other conditions. A primary symptom is chronic nasal obstruction, making it difficult to breathe through the nose. This can result in persistent mouth breathing, leading to dry lips and a dry mouth. Snoring and sleep apnea, characterized by pauses in breathing during sleep, are also frequently reported.
Recurrent ear infections or fluid buildup (otitis media with effusion) due to blocked Eustachian tubes are also possible. Changes in voice quality, often described as hyponasal speech, can occur. Other symptoms include persistent post-nasal drip, chronic sinusitis, and occasionally, a sore throat or swollen glands in the neck.
Treatment Approaches
Diagnosis typically involves reviewing symptoms and a physical examination of the nasal passages and throat. A doctor may use a flexible fiber-optic scope (nasal endoscopy) to visualize the adenoids directly. Imaging tests like X-rays or CT scans can assess adenoid size and surrounding structures.
Medical management often serves as the initial approach, addressing underlying causes. This may include antibiotics for bacterial infections, antihistamines or nasal steroid sprays for allergies, and medications for GERD. Intranasal corticosteroids are often recommended as a first-line treatment for mild to moderate cases, aiming to reduce inflammation and adenoid size. If medical treatments do not alleviate symptoms, surgical removal of the adenoids (adenoidectomy) may be considered. This procedure, typically performed under general anesthesia, involves removing the adenoids through the mouth, usually as a day-case surgery. Endoscopic adenoidectomy is often preferred in adults for better visualization and more precise removal.