March 29, 2015

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Adenoids in Children

What are adenoids?

Adenoids are tonsil-like glands located at the back of the nose. Although the exact function of adenoids is not understood, it may be related to some sort of protection from infection, but people can live normally without them.

What happens to the adenoids?

Children are born with adenoids which are quite small. As a child grows, so do the adenoids, reaching their maximum size when the child is 10 to 12 years old. From that point on, the adenoid tissue starts to shrink on its own. It's during the growth phase that adenoids may cause problems.

What are the symptoms of enlarged adenoids?

Enlarged or "hypertrophied" adenoids can block a child's nasal passages and result in:

  • nasal congestion,
  • mouth breathing and/or
  • increased snoring
In severe cases, where the adenoids block the nasal passage completely, they can cause sleep disturbances. Another clue is a child who is tired all the time as a result of interrupted sleep related to the nasal blockage, which typically worsens at night. Very rarely, these complications can be quite dangerous, causing sleep apnea, failure to grow, and even heart failure. Fortunately, however, in the vast majority of children with enlarged adenoids, the main symptoms are just a chronically stuffy nose and/or mouth breathing. Also, it is important to note that enlarged adenoids are not the only cause of persistent nasal congestion in children.

Do enlarged adenoids cause behaviour problems?

Enlarged adenoids block the nasal passage and in this way can interfere with sleep. There is no question that children who do not get enough sleep can exhibit behaviour problems because they are tired. Some of the questions that doctors may ask during the evaluation of a child with possible enlarged adenoids are How is he/she doing at school? Always tired? Any behavioural or listening problems? It is important to understand that enlarged adenoids do not cause ADHD (Attention Deficit Hyperactivity Disorder) or other similar conditions. However, these behavioural symptoms may mimic ADHD, or even worsen the symptoms of an ADHD child.

How does one confirm that the adenoids are enlarged?

Aside from the symptom history, the best way to assess the size of the adenoids is to do a simple X-ray of the neck region, because the adenoids are hidden behind the nose and cannot be seen by direct physical examination. This X-ray reveals two very important details: whether the adenoids are enlarged and, importantly, to what degree they block the nasal passage.

How are enlarged adenoids treated?

The only treatment for enlarged obstructing adenoids is to surgically remove them. Antibiotics and other medications do not help. The decision to remove the adenoids must come from weighing the benefits of waiting for the adenoids to shrink on their own against the degree of disruption to a child's life and health. Obviously, in extreme cases, the decision to remove the adenoids is easy to make. In children without the extreme symptoms, the decision is usually made on a case-by-case basis, with consultation among the parents, their pediatrician and an ear, nose and throat (ENT) specialist.

Is there a relationship between large adenoids and ear infections?

The relationship between enlarged adenoids and recurrent ear infections is controversial. We know that chronic nasal blockage can contribute to increased rates of ear infections and persistence of fluid in the middle ear area, but there are no definitive studies to support the removal of adenoids in all children with recurrent ear infections. Practically speaking, experts agree that in a child with recurrent ear infections removal of enlarged and obstructing adenoids may help reduce the number of ear infections.

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