Adenoids are patches of tissue high in the throat, just behind the nasal cavity, and cannot be seen by looking in the mouth. As part of the immune system, they trap germs that enter through the nose and mouth to help fight infections. This role is active during the first few years of life while a child’s immune system is developing.
Adenoid Size Throughout Childhood
There is no single “normal” size for adenoids; their size is understood relative to a child’s age and airway space. Adenoids are present at birth and undergo a predictable cycle of growth and regression. They reach their largest size when a child is between three and five years old, a period of frequent exposure to new germs.
After about age five, as the child’s body develops other methods for fighting infection, the adenoids naturally begin to shrink. This process, known as involution, continues through middle childhood. By the time a child reaches their teenage years, the adenoid tissue has often shrunk until it has almost completely disappeared.
Signs of Enlarged Adenoids
When adenoids become enlarged (adenoid hypertrophy), they can obstruct the airway and lead to observable signs. One of the most common is chronic mouth breathing because the child cannot breathe comfortably through their nose. This can be accompanied by persistent nasal congestion, even without a cold or allergies.
A child’s breathing may be consistently loud or noisy. Snoring during sleep is a frequent symptom and can be accompanied by brief pauses in breathing, a condition known as obstructive sleep apnea. Another sign is a change in the child’s voice, causing them to sound pinched. Recurrent middle ear infections can also be linked to enlarged adenoids, as the tissue can block the Eustachian tubes.
Medical Evaluation and Diagnosis
When enlarged adenoids are suspected, a physician will review the child’s medical history and discuss the symptoms being observed. This initial conversation helps establish the duration and severity of the issues. A physical examination of the head and neck area is also performed.
To confirm a diagnosis, direct visualization of the adenoids is often necessary. The most common method is a nasal endoscopy, which involves inserting a thin, flexible tube with a camera through the nose for a clear view. An alternative is a lateral neck X-ray, which can provide an image showing the size of the adenoids and how much space they occupy.
Management of Enlarged Adenoids
The approach to managing enlarged adenoids depends on the severity of symptoms and their impact on a child’s health. If symptoms are mild, a doctor may recommend “watchful waiting” to see if the adenoids shrink naturally. For symptoms related to inflammation, a nasal steroid spray may be prescribed to reduce swelling.
If conservative measures are not effective, surgery to remove the adenoids (an adenoidectomy) may be recommended. The primary reasons for surgery include obstructive sleep apnea, chronic sinus infections, or recurrent middle ear infections that affect hearing. The procedure is often performed using endoscopic techniques for minimal bleeding and a quicker recovery. Removing the adenoids does not negatively impact the body’s long-term ability to fight infection.