Adenoids

Astrid Leitner studied veterinary medicine in Vienna. After ten years in veterinary practice and the birth of her daughter, she switched - more by chance - to medical journalism. It quickly became clear that her interest in medical topics and her love of writing were the perfect combination for her. Astrid Leitner lives with daughter, dog and cat in Vienna and Upper Austria.

More about the experts All content is checked by medical journalists.

Doctors refer to enlarged tonsils as adenoids, which usually appear in childhood. If the adenoid is very large, it narrows the nasopharynx so that affected children are no longer able to breathe through the nose, among other things. Read here what consequential damage occurs and how adenoids are treated!

ICD codes for this disease: ICD codes are internationally recognized codes for medical diagnoses. They can be found, for example, in doctor's letters or on certificates of incapacity for work. J35

Brief overview

• What are adenoids? Adenoids are the names of enlarged tonsils. They occur primarily in children and, if left untreated, often cause serious consequential damage such as jaw misalignment and hearing loss.
• Symptoms: mouth breathing, breathing disorders during sleep, runny nose, frequent infections of the upper respiratory tract, otitis media, deafness, impaired speech development, misaligned jaws, misaligned teeth
• Causes: Permanent inflammation due to recurring respiratory infections in childhood
• Risk factors: Adenoids occur more frequently in some families (familial cluster).
• Diagnostics: Typical complaints, nasoscopy, examination of the ears, hearing test, biopsy (only for adults).
• Treatment: An operation is usually necessary. After the tonsils are removed, the symptoms recede quickly. In rare cases, the tonsils grow back again.
• Prevention: No prevention possible.

What are adenoids?

Adenoids are the names of enlarged tonsils. Doctors also speak of "adenoid vegetations" or pharyngeal tonsil hyperplasia.

The pharynx is located in the middle of the back wall of the pharynx, the so-called roof of the pharynx. In contrast to the tonsils, it is not visible when the mouth is open. Together with the tongue tonsil and the two palatine tonsils, the pharyngeal tonsil is responsible for repelling pathogens that enter the body via the nose or mouth. They are made up of lymphoid tissue and are therefore part of the immune system. Normally, the almond is about the size of a blackberry.

Since the immune system of children is not yet fully developed, they often fall ill with respiratory infections - the immune defense in the throat then runs at full speed. The pharynx is often permanently enlarged and has no opportunity to return to normal. This is especially a problem with children between the ages of two and six, as the child's nasopharynx is already cramped.

However, an adenoid only has disease value when symptoms occur. This is the case when the enlarged pharynx closes the opening to the nasal cavity and / or the entrance to the middle ear. Affected children no longer breathe through their noses and may suffer permanent ear damage.

Some clinics classify adenoids into three grades according to their severity, depending on how much they narrow (obstruct) the nasopharynx:

Grade 1: nasal cavity free

Grade 2: nasal cavity partially obstructed

Grade 3: nasal cavity completely relocated

Who is affected?

Adenoids usually appear between the ages of two and six, and less often earlier or until puberty. They usually regress slowly after puberty. Adults only have very small tonsils, the pharynx has almost completely disappeared. Since the space in the throat is no longer so cramped due to physical growth, adenoids are extremely rare in adults.

Adenoids or polyps?

Enlarged tonsils are often mistakenly called polyps. True polyps, however, are mucous membrane growths in the paranasal sinuses (polyposis nasi), which usually only occur in adults.

Are adenoids dangerous?

If the pharynx is only enlarged without causing any discomfort, there is no danger from it. It heals with age and shrinks on its own after puberty.

Pharyngeal tonsils, which are greatly enlarged and close the opening to the nasal cavity or the entrance to the middle ear, can cause serious consequential damage if left untreated.

These include:

Impaired hearing: In the nasopharynx there is an open connection between the pharynx and the middle ear, the so-called Eustachian tube. If the entrance to this in the pharynx is closed by the enlarged pharyngeal tonsil, the middle ear is no longer ventilated. A permanent negative pressure is created in the ear, a feeling that is known from flying, for example.

The negative pressure causes fluid to collect in the middle ear, which means that the eardrum does not transmit the sound waves as usual. Conductive hearing loss develops, which severely restricts hearing.

Speech development disorders: If the hearing impairment remains unnoticed for a long time, it often leads to speech development disorders in children who are just learning to speak. These are often difficult to compensate for in later years.

Frequent otitis media: Another effect of the negative pressure in the ear is frequently recurring, sometimes very painful otitis media.

Frequent respiratory infections: The mucous membranes in the nose, mouth and throat play an important role in defending against pathogens. The permanent breathing through the mouth allows the mucous membranes to dry out and the nose does not have a filter function. As a result, affected children are significantly more susceptible to colds and other respiratory infections.

Breathing pauses: Children who breathe through their mouths usually sleep restlessly and snore. In extreme cases, breathing pauses (sleep apnea).

Malformations in the upper jaw and misaligned teeth: The constantly open mouth disrupts the normal growth of the upper jaw and causes misaligned teeth in the long term. Typically, a high, ogival palate develops.

Postoperative prognosis

After the tonsils have been removed, the prognosis is good: the symptoms usually improve immediately after the operation, 70 percent of all children are symptom-free in the long term. In rare cases, the adenoids (as opposed to the tonsils) grow back and require further surgery. Important to know: Although the pharyngeal tonsil is involved in the defense against disease in the nasopharynx, it is not as important as the palatine tonsil. If the enlarged pharynx is removed, there are no disadvantages for the child's immune system.

Symptoms

Many children live with enlarged tonsils without symptoms. Symptoms only arise when the adenoid is so large that it narrows the opening to the nasal cavity or the connection to the middle ear.

Typical symptoms are:

• Permanent mouth breathing
• Frequent runny nose
• Snoring and paused breathing while sleeping
• Restless sleep
• Persistent nasal congestion
• Nasal speech
• Characteristic facial expression (Facies adenoidea): narrow pale face, mouth is open, tongue is visible, eyes are a little back

Children often do not notice an enlarged tonsils themselves, as it does not cause pain and over time they have got used to constantly breathing through their mouths.

Causes and Risk Factors

causes

The cause of adenoids is not fully understood. Doctors assume that recurring respiratory infections cause the immune system, and thus the tonsils, to run at full speed. The permanent inflammation prevents the tonsils from regressing naturally. Doctors speak of a "vicious circle": a "vicious circle" of inflammation, enlargement and renewed inflammation.

Risk factors

Adenoids are more common in some families. Doctors assume that affected families have a certain predisposition.

What does the doctor?

If the child suffers from repeated respiratory infections, the first way is to see the pediatrician. In the initial consultation, he asks about existing complaints and examines the child. Abnormalities such as nasal language, snoring or a facial expression typical of adenoids with an open mouth and a visible tongue (facies adenoidea) give the doctor initial indications of the diagnosis of "enlarged pharynx".For further examinations, he will refer the child to a specialist in ear, nose and throat medicine (ENT doctor).

Reflection of the posterior nasopharynx (postrhinoscopy): The pharyngeal tonsil is - even if it is enlarged - not visible through the open mouth. To examine them, the doctor will do a nasoscopy. To do this, he presses his tongue down with a spatula and inserts an angled mirror over his mouth. If the pharynx is greatly enlarged, it appears as a reddish, lobed, longitudinally furrowed structure.

Examination of the ear: The doctor then checks whether there is a tympanic effusion (fluid accumulation in the ear). For this he uses an otoscope; an instrument with which he observes the external auditory canal and the eardrum.

Hearing test: If a hearing impairment is suspected, a hearing test is necessary.

Biopsy: A tissue sample is usually only taken from adults. To do this, the doctor takes a small piece of the changed tissue under local anesthesia and examines it for changes under the microscope. This is necessary to differentiate the adenoid from a malignant tumor, which is very rare in adults

How are adenoids treated?

Wait

In mild cases, the doctor advises you to wait and see. In some cases, the adenoids and the associated symptoms resolve on their own. This is especially true for children who are about to reach puberty. Parents are advised to pay attention to whether the symptoms worsen and to see the treating ENT doctor as soon as necessary.

surgery

If the adenoid causes discomfort, an operation is usually necessary. It is important that the child is healthy on the day of the operation and has no infection. Otherwise, the doctor will postpone the procedure.

The operation is carried out either directly in the ENT doctor's office or on an outpatient basis in the hospital. As the procedure only takes around 20 minutes, a short anesthetic is sufficient. The doctor removes the pharynx (adenotomy) with a special instrument (Beckmann's ring knife) through the open mouth. The ablation of the pharynx is very low-risk and therefore also possible with small children. The risk of rebleeding is also much lower than, for example, with a palatine tonsil operation.

If there is fluid in the middle ear, the doctor sucks it up through a small incision in the eardrum (paracentesis). Under certain circumstances, he inserts a small tube (tympanic tube) into the eardrum so that the ear is better ventilated and the negative pressure escapes.

After the operation

Four to six hours after the operation, the doctor will check the surgical site again for bleeding. If there are none, the child is allowed to leave the practice or hospital.

Tips for the time after the operation:

Watch out for secondary bleeding: secondary bleeding rarely occurs, but quickly leads to a large amount of blood loss, as the tonsils are particularly well supplied with blood. It is therefore important not to leave the child alone, especially in the first 24 hours, and to observe them closely. Bleeding may not be noticed immediately because blood does not always drip from the mouth or nose: Children tend to swallow the blood. If the child swallows noticeably often, this is a warning signal for possible bleeding.

If you suspect a bleeding, take your child to the hospital immediately or call an ambulance service on the emergency number 112!

No physical exertion: No physical exertion and no frolic for three to five days.

Personal Care: No hot showers or baths for three to five days. If a ventilation tube has been inserted, no water may get into the ear!

School: Five to seven days after the operation, the child can go to school or kindergarten again. It is only allowed to participate in school sports after two weeks!

Eating / drinking: In the first few days after the operation, it is possible that you will have difficulty swallowing. Soft, mushy and cool dishes are particularly suitable. Hard foods such as bread crusts irritate the healing tissue and may trigger secondary bleeding. Also, make sure that your child drinks enough.

Check-up: If the attending physician does not recommend another (possibly earlier) appointment, the routine check-up will take place on the eighth day after the operation.

Painkillers: If the child suffers from pain after the operation, give your child a painkiller as an exception - but only in consultation with the doctor. Active ingredients such as ibuprofen or paracetamol are available in doses suitable for children. Talk to the attending physician about it.

Healing: It takes two to three weeks for the surgical wound to heal completely.

Other: Smoke irritates the mucous membranes and disrupts wound healing. Therefore, make sure that the environment is smoke-free. If the head is slightly raised when sleeping, this makes breathing easier.

Medication

Decongestant nasal sprays or nasal drops are not recommended for adenoids, as they only have a short-term effect and do not eliminate the cause. The doctor only prescribes antibiotics (drugs against bacterial infections) in exceptional cases, as respiratory infections are usually caused by viruses.

prevention

Adenoids cannot be prevented. Many children have enlarged tonsils up to school age. It is impossible to predict which child will actually suffer from symptoms. If adenoids run in the family, it is advisable to pay more attention to the typical symptoms.

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