What are the adenoids?
Tonsils are made up of three different parts. The tonsils as we traditionally refer to them are the palatine tonsils. These occur on either side of the throat. If enlarged they look like two golf balls in the back of the mouth. In addition to the palatine tonsils there are also the tonsils and adenoids.
The adenoids lie in the back of the throat, however are too high up to be seen when looking into the mouth. Essentially they lie in the back of the nose (known as the nasopharynx) where there is a passage between the nose and the mouth. Due to this location, when adenoidectomy get enlarged, they can cause difficulty in breathing through the nose. The lingual tonsils lie on the back of the tongue (1).
What are the adenoids for?
The adenoids (and tonsils in general) have a role as immunological organs for the upper airway and digestive tract. This means they form part of the bodies defence mechanism against foreign material such as bacteria. They do this by producing antibodies and cells to kill / remove the foreign material.
adenoids removed and the other tonsils are in an ideal position to carry out this defence role as all the material entering the mouth or nose comes into contact with them.
Tonsils are most active as part of the bodies defence system between the ages of four and ten. After puberty the role of the tonsils decreases however doesn’t disappear.
What is the problem with adenoids?
The body’s natural response to injury (e.g. infection/inflammation, trauma) is to swell up. An infected cut will swell, so to will inflamed adenoids. The problem is that when they swell up enough they can obstruct breathing through the nose. This leads to chronic (i.e. long term) mouth breathing. Although this may sound relatively trivial it can have quite serious consequences. Children who have enlarged adenoids have difficulty breathing at night. Also because their bones are still growing and are ‘softer’ than adult bone the stresses put on the facial bones by chronic mouth breathing can lead to characteristic changes in their facial appearance. This will be discussed further in the ‘symptoms’ section. They are also at increased risk of ear infections (2).
- Children are most commonly affected.
- Males and females are affected equally.
What causes adenoid enlargement?
Enlargement of the adenoids is almost always caused by infection. 80 to 90% of these infections are viral, 10 to 20% bacterial and a very small number are fungal or parasitic.
Most of the bacterial infections are caused by an organism known as group A beta haemolytic Streptococcus. During the infection the adenoids will be swollen and painful. Generally however when the infection resolves the adenoids will decrease back to their normal size. Sometimes the adenoids don’t get smaller. This may be due to the infection being resistant to conventional treatment, or there may be another cause which is currently unknown.
Chronic (long-term) infection or recurrent infections can lead to chronic adenoid enlargement. Smoke exposure (‘passive smoking”) has also been implicated as a cause of enlarged adenoids in children.
What are the symptoms of inflamed adenoids?
People with acutely inflamed adenoids ( i.e. a new infection or worsening of a chronic infection) complain mainly of a sore throat and may or may not have an associated fever. Often when the adenoids are inflamed the other tonsils are also inflamed.
A runny nose, painful dry eyes, cough and sputum (phlegm) production may also be present associated with the infection.
People with enlarged adenoids, which are obstructing the airway, are unable to breathe through their nose (or have difficulty if the obstruction is not complete). This leads to chronic mouth breathing and problems sleeping. At night these people