What is Adenoid? What Are Its Symptoms? How Is It Diagnosed and Treated?

Adenoid hypertrophy can make it difficult for you to breathe through your nose, causing you to sleep with your mouth open. Located between the nose and the back of the throat, these glands swell and block the airway, leading to problems such as snoring, sleep apnea, and shortness of breath. Especially in children, adenoid symptoms can cause significant problems ranging from developmental delays to concentration disorders. In this article, we will discuss in detail what adenoid is, its symptoms, and how adenoid treatment is performed.

What is Adenoid and What Does It Do?

Anatomical Location of the Adenoid

The adenoid is a mass of tissue located behind your nose that resembles a bunch of grapes. This structure, whose medical name is adenoid, is found right behind the nasal cavity in the nasopharyngeal region posterior to the soft palate. This region is called the nasopharynx and is positioned at the junction of the nose and throat.

Unlike your tonsils, you cannot see the adenoid when you open your mouth. The adenoid is located in a hidden area above the tonsils and behind the uvula. In fact, the adenoid and tonsils are parts of a structure called Waldeyer's lymphatic ring. This ring forms a defensive system protecting your body by encircling the entrance of the throat in a circular shape.

Its Role in the Immune System

The adenoid is a lymphoid tissue where lymphocytes, which are important elements of your immune system, take görev. It helps in antibody production by trapping bacteria and viruses entering through the nose. Specifically, it works as a defense organ where harmful substances and microorganisms that may enter your body via the respiratory tract are trapped and destroyed.

The adenoids are B-cell lymphoid structures contributing to secretory immunity. They trigger the production of immunoglobulins and lymphokines by contacting inhaled and swallowed antigens. It is an important defense mechanism during childhood, and the immune function of the adenoid is most active between the ages of 4 and 10.

The adenoid begins to grow from birth and reaches its largest size between the ages of 3 and 5. It generally starts to shrink after the age of 7 and is significantly regressed by the age of 10-12. After puberty, it shrinks and usually disappears completely in adulthood.

What is Adenoid Hypertrophy?

Adenoid hypertrophy is the excessive growth of the lymphoid tissue in the nasopharyngeal region. This condition is called adenoid hypertrophy or adenoid vegetation. It means the volumetric expansion of the adenoid, which is composed of multiple tissue pieces resembling a bunch of grapes rather than a single solid entity.

The adenoid may grow due to frequently recurring adenoiditis, allergies, or hereditary factors. The adenoid, which is on the front lines of body defense, may temporarily swell while fighting infections. However, recurrent infections, allergies, and other factors can cause chronic hypertrophy.

The part that grows in the adenoid is not normal functioning immune system cells, but rather supporting tissues between the immune system cells. The growth of these causes the immune system cells that fight microbes to decrease and become dysfunctional. Accordingly, the adenoid tissue, whose duty is to defend the body against microbes, can conversely become a reservoir harboring microbes and allergens on it.

What Are the Symptoms of Adenoid Hypertrophy?

The symptoms of adenoid hypertrophy vary depending on how much the tissue is swollen and to what extent it blocks the airway. Nasal congestion, snoring, and mouth breathing are the most common complaints. While some children experience mild symptoms, severe respiratory problems may occur in others.

Adenoid Symptoms in Children

Adenoid symptoms in children usually become prominent in the preschool period. Your child, who has difficulty breathing through the nose, constantly keeps their mouth open and begins to speak with a nasal tone. Bad breath, dryness of the lips, and night sweats are other frequently seen symptoms.

Recurrent upper respiratory tract infections and chronic sore throat are signs that the adenoid has become a reservoir for microbes. Consequently, frequent antibiotic use can lead to tooth decay. Symptoms such as fatigue, lack of attention, and loss of appetite can also negatively affect your child's school success.

Adenoid Symptoms in Adults

Adenoid hypertrophy in adults manifests in the same way as the conditions seen in children. Upper respiratory tract infections, allergies, and exposure to air pollution can cause the adenoid to grow in adults as well. Conditions such as allergic asthma accelerate this process.

Symptoms Related to Sleep and Breathing

Mouth breathing and snoring are direct consequences of the adenoid blocking the airway. Holding breath during sleep, namely sleep apnea, causes your blood oxygen level to drop. Breath-holding episodes lasting for a few seconds can be experienced during nighttime sleep.

Wheezing and nasal flaring are clear signs of labored breathing. Therefore, your child may wake up tired in the morning and show daytime sleepiness. Bedwetting problems at night may also develop due to impaired sleep quality.

Symptoms in the Ear and Throat Region

The adenoid is located right next to the eustachian tube, which delivers air to the ear. Particularly for this reason, recurrent middle ear infections and fluid accumulation in the ear are common. Hearing loss, a feeling of fullness in the ear, and earache may occur.

In the throat region, sore throat, difficulty swallowing, and swelling in the neck glands are observed. Your voice tone changes and you speak as if you have a cold. Additionally, you may experience a tickling sensation and discomfort in the throat.

Causes of Adenoid Hypertrophy and Its Effects on the Body

Factors Causing Adenoid Hypertrophy

Recurrent infections are one of the most common causes of adenoid hypertrophy. Upper respiratory tract infections of viral or bacterial origin constantly trigger your immune system and lead to the swelling of the adenoid. This condition is seen more frequently, especially in children attending nursery or kindergarten.

If there is a history of adenoid hypertrophy in the family, this problem may also occur in your child due to genetic factors. Common allergic reactions in the nasal cavity, such as allergic rhinitis, cause chronic inflammation in the adenoid. Exposure to chemicals such as cigarette smoke and polluted air irritates the adenoid, laying the groundwork for its growth. Structural problems in the upper respiratory tract anatomy can also accelerate this process.

Effects on Respiration and Sleep Quality

Adenoid hypertrophy blocks the airflow coming from the nose, making it difficult to reach the trachea. Accordingly, you are forced to breathe through your mouth, and this condition leads to snoring and sleep apnea during sleep. Sleep apnea means sudden cessation of breathing during sleep and causes your blood oxygen level to drop.

Restless sleep and frequent awakenings cause daytime fatigue or hyperactivity. Problems such as lack of attention, difficulty concentrating, and struggle in the learning process arise. In children, this situation negatively impacts school performance.

Effects on Growth and Development

Growth hormone secretion largely takes place during sleep. Sleep disorders seen in children experiencing adenoid problems reduce the level of secreted growth hormone. As a result, a slowdown in height growth and irregularity in weight gain are observed.

Nasal congestion and swallowing difficulties reduce your appetite and lower food intake. Children who have difficulty eating get tired faster, and this situation can lead to nutritional deficiencies. When impaired sleep quality and nutritional problems come together, the immune system weakens, and frequent illnesses are observed.

Effects on Dental and Jaw Structure

Breathing through the mouth for a long time causes developmental disorders such as narrowing of the upper jaw. High-arched palate, contact disorders on the chewing surfaces of teeth, and dental caries are common. This situation leads to a characteristic facial appearance known as "adenoid facies".

Adenoid facies present with a long and narrow facial structure, high palate, forward growth of the upper jaw, and constantly open mouth. Additionally, hollows under the eyes and flatness in the midface region occur.

Effects on Ear Health

The adenoid is located in a region close to the opening of the eustachian tube. The enlarged adenoid blocks this channel, leading to ventilation disorders in the middle ear. Fluid accumulation in the middle ear cavity causes hearing loss and frequent ear infections.

Microbes in the adenoid can pass to the middle ear and lead to infection. Untreated middle ear effusion negatively affects the development of your child's hearing center, articulation, and school success.

How is Adenoid Diagnosed?

Your ear, nose, and throat specialist will first listen to your complaints and evaluate your medical history to diagnose adenoid. Symptoms such as mouth breathing, snoring, and recurrent ear infections are taken into consideration.

Physical Examination and Evaluation of Symptoms

Your doctor examines your nose and throat region in detail. However, the adenoid is generally not visible when looking directly through the mouth. Therefore, additional examination methods are needed for a definitive diagnosis.

During the physical examination, the glands in your neck are checked, and whether there is fluid accumulation in your ear is observed. Your history of nasal congestion, mouth breathing, and snoring is recorded. Changes in your facial and dental structure are also evaluated.

Endoscopic Examination Method

Your nasal cavity and nasopharyngeal region are examined in detail with the help of a thin, flexible camera. This method is quite effective in determining the size of the adenoid and how much it blocks your airway. Thanks to the endoscopic examination, the nature of the tissue is also observed, and differential diagnosis is made for conditions such as tumors, infections, or cysts.

Fiberoptic cameras are inserted through your nostrils to look at the nasopharyngeal region. No special preparation is required for the endoscopy procedure and it is not painful. Endoscopic examination is generally well tolerated in children. Palpation (finger examination) should not be performed as it is extremely traumatic.

Imaging Techniques and Tests

In some cases, a lateral cephalometric X-ray may be taken to support the diagnosis. The relationship between adenoid size and airway size is evaluated in radiological imaging. Especially in children, as long as compliance with endoscopic examination is achieved, taking X-rays is avoided due to the disadvantage of radiation.

During imaging, adenoid measurement is compared with the nasopharyngeal distance, and the adenoid-nasopharynx ratio is calculated. If there are frequent middle ear infections and hearing loss, hearing tests may be requested. The relationship between adenoid hypertrophy and ear problems is investigated with tests such as tympanometry.

How is Adenoid Treatment Performed?

The treatment approach is determined based on the size of the adenoid, the severity of symptoms, and your general health status. While medical treatment may be sufficient in mild cases, surgical intervention may be required in advanced cases. Your doctor shapes the treatment plan according to your age and the duration of symptoms.

Medical Treatment and Allergy Control

Medical treatment is usually the first step in hypertrophies related to infection. Antibiotics, nasal sprays, and allergy medications can reduce the swelling in the adenoid. However, medical treatment generally provides temporary relief, and adenoid hypertrophy does not completely disappear.

Steroid-containing nasal sprays are an effective method in reducing the size by decreasing swelling and inflammation in the adenoid. These sprays generally require long-term use and should be applied regularly under doctor supervision. The determined dose should be paid attention to keep side effects at a minimum level in children.

In adenoid enlarged due to allergic causes, staying away from allergens and applying allergy treatment can be beneficial. This treatment includes antihistamines, corticosteroid sprays, and environmental modifications. Quitting smoking at home and allergy control are important steps.

Adenoid Surgery (Adenoidectomy)

Adenoidectomy is the surgical removal of the enlarged lymphoid tissue located in the nasopharyngeal region. This operation is a procedure performed through the mouth, usually lasting less than 30 minutes, and does not require hospitalization. It is performed under general anesthesia, and no skin incision is required.

During the surgery, the adenoid tissue is removed with the help of special curettes. The procedure is completed within 20-30 minutes. The surgeon checks the nasopharyngeal cavity with an endoscope and ensures that no remnants of the adenoid are left behind.

Surgery Criteria and Process

Surgery is applied especially in children experiencing snoring, sleep apnea, ear infections, and nasal congestion. Adenoid surgery is mostly performed on children between the ages of 1 and 7. When a child reaches the age of 7, their adenoids begin to shrink.

Chronic nasal congestion, constant mouth breathing, sleep apnea, and recurrent ear infections are the main criteria for surgery. Surgery is deemed necessary in cases of 4 or more purulent nasal discharges per year, middle ear fluid accumulation lasting longer than 3 months, and growth retardation.

Post-Surgery Recovery Period

The recovery period is approximately 1 or 2 days. Children usually return to their normal lives within a few days after the operation. Mild pain and nasal congestion lasting a few days may be seen after surgery.

Rest should be ensured for the first few days, and strenuous activities should be avoided. Soft, warm, and easily swallowed foods should be preferred; hard, hot, spicy, and acidic foods should be avoided. Consumption of plenty of fluids, especially water and natural fruit juices, is recommended.

The medications recommended by the doctor should be used regularly and on time. If symptoms such as high fever, foul-smelling discharge, severe pain, or bleeding are observed, a doctor should be consulted immediately. A 3-5 day resting period is usually sufficient to return to school or kindergarten.

Frequently Asked Questions About Adenoid

There are many questions families wonder about the adenoid. In this section, we aim to clear the question marks in your mind by answering the most frequently asked questions.

Do babies have adenoids?

The adenoid is a structure that is present in every human from birth. Adenoid hypertrophy is generally not very common in 4-month-old babies. However, if there is a hereditary disease in the family, growth can rarely be seen. Adenoid hypertrophy is more common, especially in children older than 6 months. When your baby is exposed to cigarette smoke or air pollution, swelling in the adenoid may occur.

Do all children have adenoids?

Yes, every child has an adenoid, but it does not always cause problems. Size and immune response vary from person to person. While it shows no symptoms in some children, it can lead to serious problems in others.

Does the adenoid shrink over time?

The adenoid usually begins to shrink towards puberty and almost completely disappears in adult ages. However, if it affects breathing or hearing during childhood, it needs to be treated without waiting.

When is adenoid surgery performed?

Surgical treatment is recommended if there is mouth breathing, severe snoring, sleep apnea, frequent middle ear infection, or fluid accumulation in the ear. Surgery also comes to the agenda in case complaints persist despite medical treatment. Surgical intervention is generally performed between the ages of 1 and 7.

Can one have adenoid surgery a second time?

No, adenoid surgery is not performed a second time. Since the adenoid is completely removed in the first surgery, a repeat surgery is out of the question.

Does immunity weaken if the adenoid is removed?

Although the adenoid is part of the immune system, its removal does not negatively affect immune functions. There are other lymphoid tissues in the body that undertake a similar task.

Do adenoids cause ear problems?

Yes. The adenoid is located in a region close to the opening of the eustachian tube. Accordingly, by creating an obstruction, it can lead to fluid accumulation in the ear, decreased hearing, and frequent middle ear infections.

Does drinking milk at night enlarge the adenoid?

Children should not be given milk to drink right before going to sleep at night. This situation causes adenoid hypertrophy, allergic diseases, and the formation of reflux.

Does adenoid hypertrophy cause a cough?

Discomfort and a tickling sensation in the throat are observed depending on the size of the adenoid. Therefore, this condition may cause a cough.

What happens if left untreated?

Untreated adenoid hypertrophy can lead to developmental problems, sleep disorders, changes in facial shape, and attention deficit. Ear infections constantly recur and speech problems arise.

Adenoid in Summary

Adenoid hypertrophy directly affects your child's sleep quality, growth, and quality of life. Do not ignore symptoms such as nasal congestion, snoring, and ear infections. Thanks to early diagnosis, the problem can be easily resolved with medical treatment or surgery if necessary.

If you suspect symptoms in your child, consult an ear, nose, and throat specialist. With the right treatment, your child can breathe easily, sleep with high quality, and maintain healthy development. Accordingly, when the adenoid problem is intervened in a timely manner, you are protected from long-term complications.