Adenoids are two small glands composed of lymphoid tissue, similar to the tonsils and lymph nodes. The adenoids grow during childhood and begin to regress around the age of 8 years. When they grow large, they can cause obstruction of the passage of air breathed through the nose.
We were born with two adenoids, which are located at the most posterior point of the throat, specifically in the nasopharynx region, where the end of the nasal cavity and the pharynx are located. Unlike the tonsils, it is not possible to see the adenoids when opening the mouth, because these are above the palate (sky of the mouth).
Like tonsils and other lymph nodes, adenoids function to produce lymphocytes and antibodies, helping the body to defend itself against microorganisms that invade nasal and oral cavities. However, they are not essential and their surgical withdrawal does not seem to cause any problem to the patient's immune system.
Usually, adenoids are formed in the seventh month of life of the fetus, continuing its growth until approximately 5 or 6 years of age. From 8 to 10 years they begin to regress, disappearing completely into adulthood.
Every child has adenoid. As we have just explained, adenoid is not the name of a disease, but a gland that every human being possesses during childhood.
The problems with adenoids arise when they grow too much and begin to obstruct the passage of air through the nasal cavity. Large adenoids are popularly known as "spongy meat." The correct medical term is adenoid hypertrophy.
Adenoids generally become hypertrophied in children with repeated throat infections. It is common for the inflammation of the gland, called adenoiditis, to come accompanied by tonsillitis and pharyngitis.
Children with adenoid hypertrophy and/or recurrent adenoiditis usually present, in addition to the symptoms of respiratory distress which will be explained later, pictures of recurrent otitis media, chronic sinusitis and persistent rhinitis.
After some episodes of tonsillitis / adenoiditis, the adenoid itself may become lodged with some bacteria, serving as a source for future respiratory infections.
Normal-sized adenoids do not cause any symptoms and disappear in adolescence without causing any problems. However, in some children with recurrent respiratory infection, they may grow, becoming permanently hypertrophied throughout childhood.
Hypertrophied adenoids can obstruct the passage of air through the nasal cavity, causing changes such as noisy breathing, permanent breathing through the mouth, sleep apnea, nocturnal snoring, nasal voice, persistent coryza, and a plugged ear sensation.
Respiratory difficulties are more common at night, because when we sleep our muscles relax, thus increasing the obstruction of the airways by the hypertrophied adenoid. Children with large adenoids may have frequent nightmares, irregular sleep, turbulent sleep, and short episodes of respiratory arrest, called nocturnal apnea. The child sleeps badly and spends the day irritated, tired and sleepy.
Adenoid hypertrophy causes children to breathe persistently through the mouth, which leads to changes in the anatomy of the face and teeth, resulting in an appearance called adenoid facies. Children with adenoid facies characteristically have an elongated face, prominent incisor teeth, clustered teeth, poorly developed jaw, short upper lip, elevated nostrils, and an arched palate.
Hypertrophied adenoids begin to regress only after 7 years of age. As many children have complications from 2 or 3 years, this can often mean at least 4 years of recurrent infections, difficulty breathing, ineffective sleep and changes in facial anatomy.
The only treatment for large adenoids is surgery, called adenoidectomy. As the adenoids regress spontaneously with time, the indication of the surgery has to be well done, weighing the surgical risks with the complications caused by the obstruction of the airways.
Adenoid removal surgery is usually indicated in children with severe obstruction of the airways, especially in those of 3 or 4 years with difficulty sleeping, with otitis media and/or recurrent sinusitis. In milder cases, treatment is done with antibiotics and corticosteroids during crises (tonsillitis / adenoiditis), and there is no indication for surgery.
During the surgical procedure for removal of the adenoids, the tonsils are also often removed.
Adenoidectomy is a relatively simple and short surgery, but is done under general anesthesia. The procedure is done by the otorhinolaryngologist.
The patient is usually hospitalized for only 1 day. If all goes well, the child may return to school after 1 or 2 weeks (contact with children with respiratory infection should be avoided within the first 2 weeks after surgery).
