Adenoids are an important part of the immune system during early childhood. However, at times, these lymphatic aggregates can become a liability due to increasing in size and causing a plethora of unpleasant symptoms. This blog is a detailed guide about adenoid hypertrophy, its causes, and effective ways to treat or prevent it.
What Is an Adenoid Gland?
The literal meaning of “adenoid” is glandular or gland-like. Anatomically, adenoids are two glands or lymphatic aggregates at the back of the nasal cavity. This area is also referred to as the upper airway or the nasopharynx. Nasal adenoids are part of the body’s lymphatic system and have an important role in defense against infections in the area. Adenoids start to decrease in size from age five and eventually regress completely.
Nasal adenoids augment the immune system during early childhood. These versatile glands reach full size by age five and start to shrink after that. These glands are not present in adult humans. The adenoids are a part of the Waldeyer’s Ring along with the tonsils. It is a group of lymphatic tissues that traps harmful pathogens (bacteria, viruses, etc.) and prevents infections.
Why Do Adenoid Glands Enlarge?
The size of the normal adenoid glands is approximately 6.2 mm. They can increase in size up to 11.6 mm due to multiple reasons. The causes for pathologically large adenoid glands are as follows:
Recurrent Infections
Frequent bacterial and viral infections trigger adenoid issues, leading to the enlargement of these glands.
Allergic Reactions
Allergies cause inflammation of the airways, which in turn leads to adenoid enlargement.
Chronic Sinus Inflammation
There are multiple ways in which chronic sinusitis leads to adenoid enlargement. Such as:
- Constant inflammation and irritation of the airways
- Making the airways prone to infections
- Overproduction and accumulation of mucus that leads to secondary blockage and infections
- By overstimulating the immune response of the body
Genetics and Anatomy
Some children are born with a predisposition for adenoid issues due to a positive family history, an overactive immune system, or a genetic disorder (Down’s syndrome, Turner’s syndrome). Structural issues of the airways, like a narrow passage, abnormalities of the face and skull (Cleft palate, facial hypoplasia), dental malocclusions, etc., may lead to larger adenoids as well.
What Happens Due to an Adenoid Enlargement?
A hypertrophic adenoid definition refers to the enlargement of an adenoid gland due to any reason. Larger than normal adenoid symptoms are as follows:
Obstruction of Nasal Packages
Enlarged adenoids may lead to physical obstruction of the nasal passages, causing difficulty in breathing through the nose and a tendency for mouth breathing.
Sleep Problems
Blocked nasal passages due to adenoid hypertrophy cause problems like snoring and difficulty sleeping peacefully.
Speech Issues
Enlarged adenoids cause nasal congestion, making it difficult for children to pronounce certain words clearly and leading to a nasal-sounding speech pattern.
Recurrent Ear Infections
Hypertrophic adenoids can block the Eustachian tubes, resulting in a build-up of fluid in the tubes. Chronic fluid in the Eustachian tubes predisposes to recurrent middle ear infections and may lead to a decrease in or complete loss of hearing.
Chronic Rhinorrhea And Post Nasal Drip
An adenoid enlargement causes a constant state of inflammation and irritation of the nasal passages. This results in excessive mucous secretion, cough, and a post-nasal drip.
Developmental Issues of Face/Teeth
Adenoid enlargement is an issue in the early childhood period when the face, teeth, nasal passages, etc., are all developing. Chronic mouth-breathing produces “Adenoid facies” (facial elongation, overcrowding of teeth, open mouth).
How to Diagnose Adenoid Enlargement?
An adenoid enlargement is suspected in children with chronic respiratory symptoms, sleep issues, and a tendency to breathe through the mouth. The investigative modalities to confirm a diagnosis of adenoid hypertrophy include:
Scans
Scans (X-rays, MRI, CT) of the nasal passages, including nasopharynx, vocal cords, etc., help confirm a diagnosis of adenoid enlargement.
Sleep Studies
A sleep study assists in diagnosis if the child has symptoms of sleep apnea or snoring.
Endoscopy
The adenoids can be directly visualized through a nasal endoscopy procedure to confirm any inflammation or infection.
Culture And Sensitivity
The culture and sensitivity of a throat swab sample confirm that adenoid hypertrophy is the result of a bacterial infection.
What Are The Treatment Options For Adenoid Enlargement?
There are two main avenues of treatment for adenoid enlargement: Medication and Surgical removal.
Medications
Medications primarily treat inflammation, infection, or allergies that are the underlying cause of adenoid hypertrophy. These usually include nasal sprays with steroids, antibiotics for bacterial infections, and anti-allergy treatments.
Surgical Options
If the adenoid enlargement is refractory to medication, then patients can undergo an adenoidectomy. It is the surgical removal of the adenoid glands in children aged 1 – 7 years. An adenoidectomy is one of the most common procedures during childhood. It is performed under general anesthesia, and the child can not eat or drink before the procedure.
An adenoidectomy approach is through the mouth; therefore, there are no incisions on the outside. At times, both adenoids and tonsils are removed during the surgery if deemed necessary by the surgeon. It is a short and straightforward surgery that takes approximately half an hour from start to finish. An adenoidectomy is a relatively safe and well-tolerated surgery. However, rarely, there may be some risk for side effects such as discomfort, infection, changes in voice, reactions to anesthesia, and excessive bleeding (very rare).
How to Avoid an Adenoid Enlargement?
Some steps can help avoid any future adenoid enlargements. These may include:
- Maintaining optimum hygiene
- Effectively treating allergies
- Maintaining a healthy diet and lifestyle
Frequently Asked Questions
Does a large adenoid always require treatment?
No, If enlarged adenoids are asymptomatic and are not causing any nasal obstruction, then they may be left untreated. Adenoids begin to shrink on their own after age five and disappear by the teenage years.
Do enlarged adenoid symptoms improve on their own?
Mild symptoms that do not impact the quality of life may disappear on their own as the adenoids begin to shrink naturally with age.
Is an adenoidectomy safe?
Yes, an adenoidectomy is a very common childhood surgery that has a high safety profile in the hands of a trained and certified pediatric surgeon.
Is an adenoidectomy painful?
The procedure itself is painless because it is performed under general anesthesia. There may be some mild pain and discomfort during the early postoperative period, which is treated with effective pain medications.
