Adenoids in children

Dr. Pieter NaudéENT Specialist

MBChB (Stell), FCORL (SA), MMED (Stell)

What are adenoids and where are they?

The adenoids are lumps of gland tissue, similar to tonsils, situated at the back of the nose. They are only visible when looking through the nose with a camera or up the back of the throat with a mirror.

What do they do?

The tonsils and adenoids are part of a lymph node system that help fight bacteria and viruses.They also help build up an immune system, and that is why they are bigger in children and can get infected regularly.

Adenoid hypertrophy,or enlarged adenoids?

The adenoids are biggest between the ages of 3 and 5. From 7 years the adenoids begin to shrink,and around puberty they have almost disappeared. It is rare for adults to have enlarged adenoids.

The nose narrows down at the back, where the air starts to flow down. This is exactly where the adenoids grow. Another important structure here is the opening of the 2 Eustachian tubes.These tubes take air up into the middle ear and drains the normal slimy secretions from there. If the adenoids are abnormally enlarged they will block the airflow through the nose and prevent fluid to drain from the ear.

Symptoms of adenoid hypertrophy include:

  • Blocked nose
  • Runny nose
  • Recurrent’sinus’ infections
  • Reduced smell can reduce the appetite.
  • Snoring,sometimes with open mouth and head arched back.
  • Middle ear fluid (Otitis media with effusion) and sometimes ear infections.

These symptoms can resolve if the adenoids return back to normal size after and infection. But if they stay enlarged and the symptoms mentioned above persist it can have some nasty consequences!

  • If the snoring is so bad it causes apnoea, it will put stress on the lungs and heart.
  • Poor sleep can cause the child to be hyperactive during the day and have poor concentration.
  • Reduced growth hormone secretion can lead to poor development.
  • Constant fluid in the middle ears (“glue ear”) can cause a conductive hearing loss.The world will sound like it’s under water for the child, and can delay his/her speech development.This can lead to poor school performance and behavioural changes.

How will the doctor assess my child?

The symptoms and history are usually enough to make a diagnosis.

Your doctor might recommend referral to an ENT specialist. If the child will tolerate a small camera to slip into his/her nose it will allow visual confirmation of adenoid hypertrophy, but this is not essential.

What is the treatment?

An adenoidectomy is a small procedure performed under general anaesthetic in theatre. It is mostly done as day-case surgery,and might include grommet (tube) insertion in the ears if there is fluid.

The adenoids are removed through the mouth using mirrors and special equipment.

Children recover remarkably well and quick!

Most parents report an improvement in breathing within a week, and a long-term reduction in ear and sinus infections.

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