What Are the Symptoms of Adenoid Problems, and How Is Adenoid Surgery Performed?

The adenoid is a lymphatic tissue located in the upper respiratory tract, between the nose and throat.

The adenoid is a lymphatic tissue situated in the upper respiratory tract, between the nose and throat. Every healthy person has adenoids. They are small glands with a big job, responsible for the body's defense mechanism. This soft, typically reddish tissue cannot be seen with the naked eye. Along with the tonsils, the adenoid is a part of our immune system, helping to defend the body by trapping germs that enter through the mouth and nose.

The adenoid primarily helps children and infants fight infections and bacteria. Generally, the adenoid (adenoid tissue) grows in babies and children. After the age of 5, it begins to shrink and usually disappears completely by adulthood.

How Does Adenoid Enlargement Occur? Why Does It Happen? What Are the Symptoms?

The adenoid is part of the Waldeyer ring, which consists of various tissues: the adenoid, two tonsils, two tubal tonsils (located at the opening of the Eustachian tubes), and one lingual tonsil (found at the base of the tongue). These structures, which form the Waldeyer ring, play a significant role in the immune system. Microorganisms entering from the outside can cause the adenoid to enlarge.

Adenoid enlargement refers to the swelling of the adenoid. This condition is more commonly seen in children. As children’s immune systems strengthen and they develop methods to combat illnesses, the adenoid typically begins to shrink. However, in some cases, the adenoid continues to grow.

Factors Influencing Adenoid Enlargement:

• Allergies: Colds, allergic rhinitis, and seasonal allergies can lead to adenoid growth.
• Respiratory Infections: Viruses that settle in the respiratory tract can cause the adenoid to enlarge, as well as affect the throat.
• Excessive Exposure to Chemicals: Spending time in dusty areas, places with chemical exposure, or smoky environments can contribute to adenoid enlargement.
• Genetics: Some individuals may have an enlarged adenoid that begins growing in the womb and continues after birth.

An enlarged adenoid manifests with certain symptoms:

• Breathing through the mouth
• Noisy breathing or snoring during sleep
• Sleeping with the mouth open
• Nasal congestion and a nasal voice
• Runny nose or post-nasal drip
• Bad breath
• Ear fullness

Individuals with enlarged adenoids may experience difficulty breathing, wheezing, and nasal blockage during upper respiratory infections, both while awake and asleep.

Additionally, children with upper airway obstruction due to adenoid swelling may have an increased risk of sleep apnea, which can reduce the secretion of growth hormone. Since growth hormone is linked to the sleep-wake cycle, growth and development delays may occur in these children.

Common Health Issues Caused by Enlarged Adenoids:

• Frequent respiratory infections
• Middle ear infections
• Changes in mouth and dental structure due to mouth-breathing during sleep
• Growth delay

Adenoid Enlargement Treatment and Adenoid Surgery

Doctors may perform a physical examination, sleep studies, nasal endoscopy, or culture tests to diagnose adenoid issues.

During the physical examination, the doctor will check the patient’s throat, ears, and neck and inquire about their medical history. If enlarged adenoids are causing sleep problems and snoring, sleep studies may be needed. Nasal endoscopy involves inserting a tube through the nose to examine the adenoid's size and inflammation. The tissue collected from the area can be tested to identify any bacterial infections.

Once an adenoid diagnosis is confirmed, the patient's overall condition is evaluated. For those frequently exposed to factors that cause adenoid swelling, antihistamines or nasal corticosteroid sprays may be recommended. If the adenoid has swelled due to a bacterial infection, antibiotics are prescribed.

If medication does not reduce the adenoid size or if recurrent swelling occurs, or if there’s no clinical improvement, adenoid surgery may be necessary. This procedure is known as an adenoidectomy.

Certain conditions need to be observed in a patient to consider adenoid removal, such as:

• Sleep apnea
• Persistent nasal congestion
• Sinusitis
• Difficulty breathing

If these symptoms persist, adenoid surgery may be recommended.

Adenoid surgery can now be performed on all age groups. It is often done together with a tonsillectomy and is the most commonly performed surgical procedure in children.

Adenoid surgery is done under general anesthesia and typically takes 30-40 minutes. The adenoid is accessed through the mouth with a tool and removed. Although complications are rare, some patients may experience bleeding, sore throat, or nasal congestion after surgery.

Diet after Surgery:

• Day of Surgery: The patient should consume liquids like milk, water, and juice.
• Day 1 Post-Surgery: Soft foods like purees, yogurt, and pudding can be added.
• Day 2 Post-Surgery: The patient can eat soft-cooked vegetables, pasta, and similar foods.
• Day 3 Post-Surgery: Normal food, avoiding hard items, can be reintroduced.
• Day 4 Post-Surgery: Normal diet can be resumed.

After surgery, it is advised to avoid blowing the nose and strenuous activities for a week.

If high fever, vomiting, nosebleeds lasting over 10 minutes, severe neck pain, or difficulty moving the neck occur, a doctor should be contacted.

Adenoids in Children

Adenoids start to form around the third month of fetal development and complete their growth by the seventh month. They reach their largest size between ages 4-6 and usually disappear in adulthood. Adenoids often grow due to exposure to bacteria and viruses from an early age, leading to frequent upper respiratory infections in children. Enlarged adenoids can impact the development of the head, neck, and face in children, causing nasal and pharyngeal breathing issues, dental problems, cardiopulmonary complications, lung blockages, and sleep apnea.

Due to blocked breathing, enlarged adenoids lead to mouth breathing in children, creating a typical "adenoid face." This includes a long, thin face, a forward-growing upper jaw, high palate, misaligned teeth, and sunken areas around the eyes. Adenoid growth from infancy can cause developmental delays, reduced intelligence, and other issues. Symptoms like a nasal voice, difficulty controlling breathing while reading aloud or singing, and chronic nasal congestion are signs of adenoid enlargement in children. In infants, noisy breathing, nasal discharge, and difficulty breathing while breastfeeding or drinking from a bottle can indicate adenoid enlargement. Parents noticing these signs should promptly consult an ENT doctor. Adenoidectomy can now be performed at any age with an appropriate diagnosis.

In conclusion, the adenoid is a vital gland that protects the body from external threats and supports our health. Addressing and treating adenoid enlargement can improve quality of life and contribute to the full development of children, preventing future health issues.