Adenoids

The adenoids are lumps of lymphoid tissue found at the very back of the nose where it joins with the mouth (the nasopharynx). Together with other patches of immune tissue, the adenoids and tonsils form a defensive circle known as Waldeyer's ring around the back walls of the mouth and nose. Though the adenoids start to regress around the age of seven and are all but absent in adults, those in young children can become very swollen due to repeated infection - this is known as adenoiditis. The glands may then block both the nose and the Eustachian tubes¹, leading to a number of problems.

Symptoms and Diagnosis

The blocked nose leads to snoring and, in severe cases, obstructive sleep apnoea (OSA). The blockage also changes the quality of the voice, giving a so-called 'adenoidal' voice similar to that experienced during a cold. The child is forced to mouth breathe, leading to cracked lips and a dry throat that makes the child vulnerable to throat and chest infections. The infected adenoids can also produce nasal, sinus and middle ear infections, the latter being prolonged as the infected ear often cannot drain via the Eustachian tube.

Though rare, adenoid cancer can present in a similar manner, though it usually presents as an asymmetrical swelling causing symptoms on only one side. Another disease that may mimic adenoiditis is a retropharyngeal abscess², which can produce snoring in the same manner but requires urgent surgical drainage, intubation³ and treatment with intravenous antibiotics. The abscess forms due to tracking of infection from the throat into the lymph nodes in the nasopharynx, and is dangerous due to both the effect on the airway and the risk of septicaemia⁴. Symptoms such as breathlessness at rest, increased dribbling, difficulty swallowing, high fever, torticollis (head tilting) and neck stiffness should alert doctors to this possibility.

The adenoids are not directly visible, but can be seen with the use of a nasal endoscope or using a 'dentist's mirror' at the back of the throat. An x-ray side-view of the soft tissues of the head and neck will also show up the enlarged adenoids and can help exclude the possibility of an abscess.

Treatment

Naturally, any child with worrying symptoms should be taken to see a doctor straight away.

While acute adenoiditis can be treated with antibiotics, chronically enlarged adenoids may not respond to treatment. In children with OSA or chronic inflammation of the nasal passage, an adenoidectomy can be performed to remove the immune tissue of the adenoids completely. An adenoidectomy may be performed alongside the insertion of a grommet⁵ in children with repeated ear infections or otitis media with effusions (OME, also known as 'glue ear'). A general anaesthetic is used, and the adenoids are burnt away using either the heat of a specially-shaped curette or the electric current from a diathermy device.

The procedure leads to a sore throat and can also cause temporary nausea and earache. Complications include incomplete removal of the glands, ear infection and bleeding. The operation can also cause a change of vocal character known as rhinolalia aperta in which the gap between the soft palette and the back of the throat becomes large enough to let a significant amount of air escape during speech. This usually resolves on its own, but may require therapy.

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¹ Drainage tubes leading from the middle ears to an exit at the back of the nose next to the adenoids.
² An abscess is a collection of infected pus.
³ The passing of a tube into the windpipe to protect the airway from obstruction.
⁴ Spread of infection to the bloodstream, in this case via the nearby carotid arteries.
⁵ A small piece of plastic that maintains a small hole in the eardrum, thus allowing an infection to drain.