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 older individuals in a similar manner, though it usually presents as an asymmetrical swelling causing symptoms on only one side. Another disease that produces problems in this area is a retropharyngeal abscess2, which forms in the space behind the throat due to the spread of infection via the lymph nodes. Symptoms such as high fever, difficulty breathing, dribbling, difficulty swallowing, torticollis (head tilting) and neck stiffness differentiate this from a simple sore throat, and indicate the need for intravenous antibiotics along with visualisation of the abscess with a view to drainage.
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.
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 grommet3 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.