What are the Adenoids?
The adenoids "are a single clump of tissue in the back of the nose (nasopharynx), on the back wall of the throat (pharynx) about one inch above the uvula (the little teardrop shaped piece of tissue that hangs down the middle of the soft palate)" (www.pedisurg.com).
The adenoids (and tonsils) are made up of lymphoid tissues, which is in turn made up of lymphocytes, which help the body create antibodies. This kind of tissue is found throughout the gastrointestinal tract and on the base of the tongue. The adenoids trap bacteria and viruses in babies and young children. After the age of five, the adenoids start to shrink (regress) and by the thirteenth birthday are usually gone completely. Unfortunately for some, the swollen adenoids have already done irreparable harm by the time they start regressing.
Problems with the Adenoids
When the adenoids trap germs and bacteria and attempts to fight off the infection, the tissue will swell. Usually the tonsils will swell too. Swollen adenoids can make it difficult for children to breathe through their nose and so they will breathe through their mouth. Chronic mouth breathing during these early years when the facial bones are developing into their adult formation results in a "high arched palate, the pinching in of the nose, and a shortened upper lip, with a staring expression of the eyes. The face becomes slightly elongated and the upper teeth may be prominent. These changes are called adenoid facies" (www.ghorayeb.com) and can result in breathing problems such as sleep apnea later on in life because the palate and other structures have formed abnormally.
Mouth breathing is a classic sign of swollen adenoids, and if it persists, a doctor may recommend the adenoids (and usually the tonsils as well) be removed.
The most common reason for removing adenoids is that they become so big that they block the back of the nose. This causes snoring, mouth breathing, and even sleep apnea. The degree of enlargement is related to chronic fluid build up or infection in the ears. The inability to breathe through the nose also affects being able to smell and taste foods.
If an infant experiences chronic and recurring fluid or ear infections, adenoids may be recommended for removal if problems persist after tubes are placed for the first time.
Chronic or recurrent sinus infections (rhinosinusitis) may also lead to adenoid removal. "Similar to the problem with the middle ear, enlarged or infected adenoids may cause accumulation of nasal secretions or recurrent sinus infections" (www.pedisurg.com)
Swollen adenoids can also obstruct the eustachian tubes and contribute to middle ear infections.
Symptoms that may be related to enlarged (hypertrophied) adenoids include:
- mouth breathing
- snoring and trouble getting a good night's sleep
- sore throat and difficulty swallowing
- swollen nodes in the neck
- ear problems
Treatment of Adenoid Swelling
Bacterial infections that cause the swelling of the adenoids and tonsils are usually treated with antibiotics.
Removal of either the adenoids or the tonsils are only recommended if there are recurring illnesses as listed above. Those procedures (the tonsillectomy and adenoidectomy) are usually carried out under general anesthetic in the hospital.
Unlike the tonsils, the adenoids are not visible through the mouth, so the surgeon will use mirrors to help him/her visualize the area. Then, the adenoid tissue will be "shaved" (or curetted). Some surgeons use electocautery instruments which seals the blood vessels to the adenoids and prevents post-operative bleeding.
An adenoidectomy is less painful than a tonsillectomy and children usually recover more quickly. It is common for patients to experience 7-10 days of bad breath and a stiff or sore neck.
An adenoidectomy should be decided after very careful consideration of each particular patient's anatomy. Some children's anatomy contraindicates surgery. In these cases, removal of the adenoids may result in velopharyngeal insufficiency where sound or liquids can escape up the back of the nose affecting speech and swallowing (www.pediosurg.com).
Sources: http://kidshealth.org; www.medicinenet.com; www.pedisurg.com; www.ghorayeb.com