Adenoids are collections of lymphatic tissue located high in the throat, behind the nasal cavity in the nasopharynx. As part of the immune system, this tissue traps inhaled germs and is most active during early childhood. The tissue typically begins to shrink around age seven and often significantly reduces in size by late adolescence or early adulthood (ages 16 to 20). When adenoids remain enlarged or re-enlarge in adults, the condition is known as adenoid hypertrophy. This condition is uncommon but can cause respiratory issues, and symptoms are often mistakenly attributed to other conditions, sometimes leading to misdiagnosis.
Recognizing the Indicators of Enlargement
Enlarged adenoids in an adult cause obstruction of the nasal passages. This obstruction often forces individuals to rely on mouth breathing, especially during sleep, which can result in dry mouth, bad breath, and chapped lips. Persistent snoring or the development of obstructive sleep apnea is a noticeable indicator.
The adenoids are located near the opening of the Eustachian tubes, and enlargement can block these passages. This blockage leads to muffled hearing, ear pressure, or recurrent middle ear infections. The obstruction in the nasopharynx can also change the voice quality, causing hyponasal speech—a voice that sounds “stuffy” or as if the person has a persistent cold.
Underlying Reasons for Adult Adenoid Enlargement
Unlike in children, where enlargement is often a temporary response to viral infections, adult adenoid hypertrophy is driven by chronic inflammatory processes. Recurring or long-term infections and chronic allergies are common causes for the tissue to remain active and enlarged.
Environmental factors also play a role, as exposure to air pollution and tobacco smoke act as chronic irritants that stimulate the lymphoid tissue. Gastroesophageal reflux disease (GERD) is another contributing factor, as stomach acid vapor can irritate the upper respiratory tract, including the adenoids. In rare instances, adult enlargement may signal a more serious underlying condition, such as lymphoma, sinonasal tumors, or an HIV infection.
Clinical Diagnostic Procedures
A healthcare provider begins the diagnosis by taking a detailed medical history and performing a physical examination.
Diagnostic Nasal Endoscopy
The gold standard for confirming adenoid hypertrophy is Diagnostic Nasal Endoscopy (DNE). During this procedure, a thin, flexible tube equipped with a light and camera is gently passed through the nasal passage for direct visualization of the nasopharynx. The endoscope permits the physician to accurately grade the size of the adenoid tissue and observe its obstruction of the nasal airway and the opening of the Eustachian tubes.
Imaging Studies
Imaging studies are often used as supplementary tools to confirm the diagnosis and rule out other potential masses. A lateral neck X-ray can provide a quick assessment of the adenoid pad’s thickness relative to the airway space. Computed tomography (CT) scans or magnetic resonance imaging (MRI) offer a more detailed view, which is particularly useful if malignancy is suspected. Imaging helps to definitively measure the degree of hypertrophy.
Management and Treatment Options
Treatment for enlarged adenoids in adults depends on the severity of symptoms and the underlying cause identified during diagnosis. For mild to moderate cases, medical management is the first approach, aiming to reduce the inflammation driving the enlargement.
Medical treatments often include:
- Intranasal corticosteroid sprays, which help shrink the tissue by decreasing localized swelling.
- Antihistamines or other anti-allergic therapies if chronic allergies are a factor.
- A course of appropriate antibiotics if the enlargement is due to a bacterial infection.
When medical treatments fail to resolve severe symptoms like persistent sleep apnea or significant nasal obstruction, surgical intervention is considered the definitive treatment. The procedure, known as an adenoidectomy, involves the surgical removal of the enlarged tissue. In adults, this procedure is often performed endoscopically, allowing for complete removal under direct visualization and minimizing the chance of recurrence.