Pediatric Otolaryngology
Adenoid Hypertrophy and Adenoiditis

What is the adenoid?
The adenoid is a single mass of tissue located way in the back of the nose in the passage that connects the nasal cavity to the throat.  Although most people say “adenoids” as if there is more than one, we really have just one adenoid.  This tissue like the tonsils in the throat help filter out bacteria and viruses and produce antibodies to help the body fight off infections.  In most children the adenoid enlarges normally during early childhood when most infections of the nose and throat are most common.  They usually shrink as the child gets older and tend to disappear by puberty. 

Will my child’s immune system be weaker if the adenoid is removed?
The adenoid is only a small part of our immune system.  It turns out that our immune system has many different ways of learning to recognize germs.  Children who have their adenoid and even their tonsils removed do not on average have any more illnesses than children who keep this tissue.  In fact, many children will have far less nasal, sinus and ear infections once the adenoid is removed. 

What are the symptoms of an enlarged adenoid?
There are several symptoms associated with an enlarged adenoid pad.  You may notice that your child:
complains of difficulty breathing through the nose
is breathing through the mouth
talks as if his or her nostrils are pinched
has noisy breathing
snores while sleeping
       stops breathing for a few seconds while sleeping (obstructive sleep apnea)

What is adenoiditis?
Unfortunately, sometimes the adenoid tissue gets infected and this infection can last for weeks or even months.  This is called adenoiditis.  This problem can lead to repeated nasal infections characterized by thick green or yellow drainage that seems to be present all the time.  If left untreated this can even lead to chronic inflammation of the sinuses.  Children with adenoiditis also seem to have more ear infections (otitis media) because of the close proximity of the adenoid tissue to the eustachian tubes in the back of the nose.  Usually adenoiditis responds to antibiotics taken by mouth.  If antibiotics fail to get rid of the infection or if things recur immediately after the antibiotics are stopped, the adenoid tissue may have to be removed. 

When is surgery necessary?
If enlarged or infected adenoid tissue keeps bothering your child and medicine does not seem to help, your doctor may recommend surgically removing the adenoid.  This is called an adenoidectomy.  The main reasons your doctor may suggest removing the adenoid tissue would be:
obstructive sleep apnea
difficulty breathing
recurrent infections
Having your child’s adenoid tissue removed is especially important when repeated infections lead to sinus and ear infections.  Badly swollen adenoid tissue can interfere with the function of the eustachian tubes causing middle ear fluid and hearing loss.  In this case it is possible your child may benefit from ear tubes as well.

Adenoid tissue can be taken out without removing the tonsils.  This is especially common for very young children.  If your child is having tonsil problems as well or has obstructive sleep apnea, a tonsillectomy can be performed at the same time.