Enlarged Adenoids

Adenoids (or nasopharyngeal tonsils) are two areas of collection of lymphatic tissue located at the back of the nasal cavity. These form a part of body’s defense mechanism against infections.

In children below 7 years of age (more commonly between 3-6 years), the adenoids become enlarged (hypertrophied) and may then lead to difficulty in breathing and speech.

The cause of enlarged adenoids may be genetic, recurrent respiratory tract infections, allergies or even unknown.

The common symptoms, which appear with enlarged adenoids, are categorized as nasal, aural and general. These include breathing through the mouth, snoring during sleep, blocked or running nose, nasal voice, loss of appetite, nocturnal cough (due to post nasal discharge) and mental dullness. The difficulty in breathing may disturb the child while sleeping leading to inability in concentration and easy fatigue. The child may complain of earache due to obstruction in the eustachian tube and also experiences frequent attacks of cold. In severe cases, ear discharge and reduced hearing or deafness (conductive) may also result.

The typical appearance of a child is termed ‘adenoid facies’ in which the child looks dull with pinched nostrils, open mouth, retracted upper lip and protruded teeth. On examination, there is purulent discharge from the nose and post-nasal discharge in the throat. On nasopharynx palpation, adenoids are felt as a bag of worms. In the x-ray of nasopharynx, adenoid mass is easily visible.

If the symptoms are mild, then no treatment is required because the enlarged adenoids shrink spontaneously with age. The symptoms tend to disappear, as the child gets older and completely disappear by the time adolescence is attained. Local decongestants and antibiotics may be prescribed to control the infection.

However, if the symptoms get severe and include disturbance of sleep, recurrent ear infections and otitis media, surgical removal of adenoids (adenoidectomy) is the choice of treatment.