What are Adenoids?

• Tonsils and adenoids are similar to lymph nodes found in the other part of the body. Tonsils can be seen as small lumps in the throat (as in the figure). Adenoids are similar to the tonsils but at the back of the throat and high up. Adenoids cannot be seen through the nose or the mouth.
• Normally the adenoids are small in size but sometimes they can be enlarged and can block the breathing airway (as shown in the accompanying figure).

What symptoms will we find if adenoids are increased in size? If adenoids are enlarged they would make breathing through the nose difficult. They can also lead to breathing difficulty during sleep.

Other signs could be:

• Chronic mouth breathing (due to nasal block)
• Unclear speech (more nasal sounds)
• Regularly runny nose
• Frequent ear infections
• Snoring during sleep
• Pauses in breathing & occasionally stoppage of breathing for a few seconds at night during sleep. This condition is called as obstructive sleep apnea (OSA).

Which investigation would help us to diagnose Adenoids?

• Xray of the neck is a useful investigation to pick up an adenoid hypertrophy. It also helps us to assess the size of the adenoid.
• Some children might need additional tests like a nasal endoscopy for diagnosis.

What are the problems associated with enlarged adenoids?

• Adenoid Facies: Children with adenoids can have persistent mouth breathing leading to changes in the facial appearance. Children develop a open-mouthed appearance associated with a narrow nose, shortened upper lip, narrow high palate and dental crowding. These are described as Adenoid Facies.
• Glue Ear: Enlarged adenoids can obstruct the Eustachian tube (a tube connecting the ear & nose) which predisposes children to ear infections. Sometimes sticky fluid get accumulated in the ear known as “Glue Ear” or serous otitis media. “Glue Ear” or serous otitis media leads to hearing impairment.
• Obstructive Sleep Apnea: The most common cause of obstructive sleep apnea (OSA) in children is enlarged adenoids and tonsils. Obstructive Sleep Apnea (OSA) is a highly under-recognized problem with adenoid enlargement which can have many sleep related problems like snoring, pauses in breathing etc and daytime issues like excessive sleepiness, hyperactivity etc.

How does a sleep study help? Children with snoring and symptoms suggestive of adenoid hypertrophy require a sleep study or a polysomnography for diagnosis of obstructive sleep apnea (OSA). The severity of obstructive sleep apnea (OSA) decides further management of the child.