The adenoids are masses of lymphoid tissue located high in the throat, forming part of the body’s immune system. Also known as the pharyngeal tonsils, they defend against inhaled pathogens, especially in children. When healthy, they function without causing problems, but chronic swelling or infection can lead to significant health issues. The surgical removal of the adenoids, known as an adenoidectomy, is a common procedure performed to relieve symptoms caused by persistent enlargement.
Understanding the Adenoids
The adenoids are positioned in the nasopharynx, the upper part of the throat situated behind the nasal cavity and above the soft palate. Unlike the palatine tonsils, they are not visible through the mouth without specialized instruments. As components of Waldeyer’s ring, their primary function is to trap incoming germs, such as bacteria and viruses, breathed in through the nose.
They are composed of lymphoid tissue containing white blood cells that produce antibodies to fight off foreign invaders. This activity is important during infancy and early childhood, helping to prime the developing immune system. The adenoids grow to their maximum size between the ages of three and five years, then naturally begin to shrink around age five to seven, and are typically almost completely gone by adulthood.
Causes of Chronic Enlargement
Adenoids frequently become problematic due to their response to repeated exposure to pathogens. When they trap germs, they swell as part of the normal inflammatory process. In children who experience frequent upper respiratory infections, this repeated inflammation can lead to adenoiditis.
This chronic inflammation prevents the tissue from shrinking naturally, resulting in persistent enlargement, or hypertrophy. Both viral and bacterial infections, such as those caused by Streptococcus species, contribute to this cycle. Non-infectious factors, particularly allergies like allergic rhinitis, can also cause chronic irritation, maintaining the enlarged state. Exposure to environmental irritants, such as tobacco smoke or pollution, further contributes to this chronic inflammatory response.
Clinical Indications for Surgery
The need for an adenoidectomy arises when chronic tissue enlargement leads to health problems that cannot be managed with medication. Indications generally fall into two primary categories: obstruction and infection.
Obstructive Symptoms
The primary reason for removal is obstruction of the nasal airway, which can lead to sleep-disordered breathing. When enlarged adenoids block airflow through the nasopharynx, a child may be forced to breathe through their mouth constantly. This chronic mouth breathing can cause speech problems, sometimes resulting in a hyponasal or “stuffy” voice.
The physical blockage can also cause or worsen Obstructive Sleep Apnea (OSA), where breathing is repeatedly paused or interrupted during sleep. Untreated OSA in children can have serious consequences, including developmental and behavioral problems, and strain on the cardiovascular system. Surgery is performed to eliminate this physical barrier to normal nighttime breathing.
Infectious Symptoms
Adenoidectomy is indicated for managing recurrent or chronic infectious diseases made worse by the adenoid tissue. The enlarged tissue can block the opening of the Eustachian tubes, which connect the middle ear to the back of the throat. This blockage impairs ventilation and drainage of the middle ear, contributing to recurrent acute otitis media (ear infections) or chronic otitis media with effusion (fluid behind the eardrum).
Surgical removal is considered when a child experiences four or more episodes of acute otitis media within a year, or if chronic middle ear fluid persists despite antibiotic therapy or the placement of ear tubes. The adenoids can also harbor bacteria, leading to chronic adenoiditis and persistent rhinosinusitis (sinus infection) that does not respond to antibiotics. Removing the tissue eliminates this persistent source of infection and inflammation.
Overview of the Removal Procedure
An adenoidectomy is a routine surgical procedure typically performed on an outpatient basis under general anesthesia. The surgeon accesses the adenoids through the patient’s mouth and removes the tissue from the back of the nasal cavity. The procedure is quick, usually lasting 20 to 30 minutes.
Most children are monitored in a recovery room for an hour or two after the operation and return home the same day. Post-operative care involves pain management, typically with liquid pain relievers, to address throat discomfort. Patients are encouraged to drink clear liquids immediately after surgery and then progress to a soft diet, avoiding hard or scratchy foods for several days. Full recovery generally takes between one and two weeks.