Enlarged Adenoids

Often, tonsils and adenoids are surgically removed at the same time. Although you can see the tonsils at the back of the throat, adenoids aren't directly visible. A doctor has to use a telescope to get a peek at them. As an alternative, an X-ray of the head can give the doctor an idea of the size of someone's adenoids.

So, what are adenoids anyway? They're a mass of tissue in the passage that connects the back of the nasal cavity to the throat. By producing antibodies to help the body fight infections, adenoids help to control bacteria and viruses that enter through the nose.

In kids, adenoids usually shrink after about 5 years of age and often practically disappear by the teen years.

Symptoms of Enlarged Adenoids

Because adenoids trap germs that enter the body, adenoid tissue can temporarily swell as it tries to fight off an infection. These symptoms are often associated with enlarged adenoids:

• difficulty breathing through the nose
• breathing through the mouth
• talking as if the nostrils are pinched
• noisy breathing
• snoring
• stopped breathing for a few seconds during sleep (sleep apnea)
• frequent "sinus" symptoms
• ongoing ear middle ear infections or middle ear fluid in a school-aged child

If enlarged adenoids are suspected, the doctor may ask about and then check your child's ears, nose, and throat, and feel the neck along the jaw. To get a really close look, the doctor might order one or more X-rays. For a suspected infection, the doctor may prescribe oral antibiotics.

When Is Surgery Necessary?

If enlarged or infected adenoids keep bothering your child and are not controlled by medication, the doctor may recommend surgically removing them with an adenoidectomy. This may be recommended if your child has one or more of the following:

• difficulty breathing
• sleep apnea
• recurrent infections
• ear infections, middle ear fluid, and hearing loss requiring a second or third set of ear tubes

Having your child's adenoids removed is especially important when repeated infections lead to sinus and ear infections. Badly swollen adenoids can interfere with the ability of the middle ear space to stay ventilated. This can sometimes lead to infections or middle ear fluid causing a temporary hearing loss. So kids whose infected adenoids cause frequent earaches and fluid buildup might also need an adenoidectomy at the time of their ear tube surgery.

And although adenoids can be taken out without the tonsils, if your child is having tonsil problems, they may be removed at the same time. A tonsillectomy with an adenoidectomy is the most common pediatric operation.

What Happens During Surgery

Surgery, no matter how common or simple the procedure, can be frightening for both kids and parents. You can help prepare your child for surgery by talking about what to expect. During the adenoidectomy:

• Your child will receive general anesthesia. This means the surgery will be performed in an operating room so that an anesthesiologist can monitor your child.
• Your child will be asleep for about 20 minutes.
• The surgeon can get to the tonsils and/or the adenoids through your child's open mouth — there's no need to cut through skin.
• The surgeon removes the adenoids and then cauterizes (or seals) the blood vessels.

Your child will wake up in the recovery area. In most cases, the total time in the hospital is less than 5 hours. Very young children and those who are significantly overweight, or have a chronic disease such as seizure disorders or cerebral palsy, may need to stay overnight for observation.

The typical recuperation after an adenoidectomy often involves several days of moderate pain and discomfort.

In less than a week after surgery, everything should return to normal. The adenoid area will heal naturally, which means there are no stitches to worry about. There's a small chance any tissue that's left behind can swell, but it rarely causes new problems.

After surgery, a child's symptoms usually disappear immediately, unless there's a lot of swelling that could lead to some temporary symptoms.

Even though some kids need surgery, remember that enlarged adenoids are normal in others. If your child's adenoids aren't infected, the doctor may choose to wait to operate because the adenoids may eventually shrink on their own as adolescence approaches.

Reviewed by: Steven P. Cook, MD
Date reviewed: November 2010
Originally reviewed by: Aaron S. Chidekel, MD