Enlarged Adenoids in Children: Symptoms, Diagnosis and When Surgery Helps

Adenoids are a patch of tissue high in the throat, just behind the nose. Together with the tonsils, they are part of the lymphatic system, which clears away infection and keeps body fluids in balance. The adenoids and tonsils trap germs that come in through the mouth and nose.

Adenoids usually begin to shrink after about age 5, and by the teenage years they are almost gone — by then the body has other ways to fight germs.

Enlarged adenoids

Enlarged (swollen) adenoids are common in children. A child may simply be born with large adenoids, or they may swell while fighting an infection — and stay swollen after the infection is gone.

Problems they can cause

Swollen adenoids can make it hard to breathe through the nose, so a child may breathe only through the mouth, which can lead to:

• a dry mouth and bad breath;
• cracked lips;
• a runny nose.

They can also cause:

• loud breathing and snoring;
• restless sleep;
• sleep apnea, in which breathing repeatedly stops during sleep;
• ear infections.

Diagnosis

The provider will ask about your child's symptoms and medical history, check the ears, throat and mouth, and feel the neck. Because the adenoids sit higher than the throat, they can't be seen just by looking in the mouth. To check their size, the provider may use:

• a special mirror in the mouth;
• an endoscope — a long, flexible tube with a light;
• an x-ray.

Treatment

Treatment depends on the cause. If symptoms are mild, no treatment may be needed. Otherwise, a child may get a nasal spray to reduce swelling, or antibiotics if a bacterial infection is suspected.

Adenoidectomy

In some cases, surgery to remove the adenoids — an adenoidectomy — is recommended, when:

• the adenoids are infected again and again, sometimes also causing ear infections and fluid in the middle ear;
• antibiotics don't clear a bacterial infection of the adenoids;
• the enlarged adenoids block the airways.

If the tonsils are also a problem, they are usually removed at the same time (a tonsillectomy). Children usually go home the same day. Some throat pain, bad breath and a runny nose are normal afterward, and it can take several days to feel fully better.

Sources

Based on "Adenoids," MedlinePlus, U.S. National Library of Medicine; a work of the United States government in the public domain.