Adenoids are small collections of immune tissue located at the very back of the nasal passage. While active in early childhood, they typically begin to shrink around age five and often become quite small or disappear by the teenage years as the body develops other immune defenses. However, these tissues can sometimes become enlarged, leading to health concerns. This article explores the reasons behind adenoid enlargement, its symptoms, diagnosis, and the removal procedure.
Understanding Adenoids
Adenoids are situated high in the throat, specifically behind the nose in an area called the nasopharynx. They are distinct from tonsils, which are visible at the back of the throat, but both are components of the lymphatic system.
The primary function of adenoids is to act as a first line of defense against inhaled pathogens. They trap bacteria and viruses, producing antibodies to help the immune system fight off infections. While present at birth, they often naturally increase in size until about ages five or six, then gradually decrease. They can also temporarily swell in response to infections or allergies, sometimes remaining enlarged even after the initial cause resolves.
Recognizing Enlarged Adenoid Symptoms
When adenoids become significantly enlarged, they can obstruct the nasal airway, leading to several noticeable symptoms. Children with enlarged adenoids often breathe through their mouth, especially at night, which can result in a dry mouth and cracked lips. This persistent mouth breathing can also cause noisy breathing and snoring.
Severe enlargement can contribute to obstructive sleep apnea, a condition where breathing repeatedly pauses for brief periods during sleep. Enlarged adenoids can also block the tubes connecting the middle ear, leading to fluid buildup and frequent ear infections. They may also contribute to chronic sinus infections and a distinct “nasal” voice, where the child sounds as if their nostrils are pinched. In infants, difficulty feeding might also be observed.
Diagnosis and When Removal is Recommended
A doctor typically diagnoses enlarged adenoids by discussing the child’s symptoms and conducting a physical examination. Sometimes, imaging such as X-rays or a small camera (endoscope) inserted through the nose may be used to get a clearer view of the adenoid tissue. This allows the healthcare provider to assess the size and extent of the enlargement.
Adenoidectomy, the surgical removal of the adenoids, is generally recommended when enlarged adenoids cause significant and persistent health problems that do not respond to other treatments. This includes severe breathing difficulties, especially during sleep, such as obstructive sleep apnea. Frequent or recurrent ear infections that are unresponsive to medical management are another common reason for considering removal, as enlarged adenoids can hinder proper ear drainage. Chronic sinus infections also warrant consideration for adenoidectomy. The decision to proceed with surgery is made when the adenoids are clearly impacting the child’s quality of life or pose a risk to their health.
What Happens During and After Adenoid Removal
Adenoidectomy is a common and generally safe outpatient surgical procedure performed under general anesthesia. The surgery typically takes 20 to 30 minutes. The surgeon usually accesses the adenoids through the mouth, so there are no external incisions. The adenoid tissue is removed, and the area heals naturally without stitches.
Immediately after the procedure, children will wake up in a recovery area. They may experience a sore throat, mild nasal congestion, or noisy breathing for a few days. Pain management typically involves over-the-counter pain relievers like acetaminophen or ibuprofen. While there are generally no specific dietary restrictions, soft foods like popsicles, Jell-O, ice cream, and smoothies are often preferred initially due to throat soreness.
Most children can return home the same day. Recovery is usually quick, with many symptoms improving within a week. Activity restrictions are typically minimal, focusing on avoiding strenuous activities for a few days. Successful removal can lead to improved breathing, reduced snoring, fewer ear and sinus infections, and better sleep quality. Removing the adenoids does not compromise the child’s immune system, as the body has numerous other ways to fight infections.