Adenoids in a Child: What They Are, Signs and Causes

Parents attribute a child's stuffy nose to a cold, but sometimes the cause lies deeper — in the nasopharynx. Let us explain what adenoids are, how they manifest, and why one child simply snuffles in their sleep while another is offered surgery by an otorhinolaryngologist.

What adenoids are and where they are located

The adenoids are an area of lymphoid tissue high in the pharynx, just behind the nose. Together with the palatine tonsils, they are part of the lymphatic system and trap microbes that enter through the mouth and nose.

The pharyngeal tonsil lies in the vault of the nasopharynx, as part of the lymphadenoid pharyngeal ring. It cannot be seen on a routine examination of the throat; special instruments are needed to examine it.

An adenoid resembles an acoustic filter deep in a hall: while it is normal, air passes freely, but when it grows, the nose sounds dull, as if a singer were singing with a pinched nose. It is the overgrowth of tissue — adenoid vegetations — that is considered pathological.

Signs of adenoids in a child

An enlarged tonsil blocks nasal breathing, and the child switches to mouth breathing. This leads to dry mouth, cracked lips, a runny nose and bad breath.

• constant nasal congestion and mouth breathing;
• dry mouth, cracked lips, bad breath;
• noisy breathing, snoring, restless sleep, sleep apnea;
• recurrent otitis and gradual hearing loss.

At night, snuffling and snoring appear, and sleep becomes restless. During the day, mucous or purulent discharge and a chronic dry cough are added.

Adenoiditis: inflammation of the adenoids in children

Adenoiditis is inflammation of an already enlarged pharyngeal tonsil. It can be acute, subacute or chronic, and sometimes coexists with inflammation of the palatine tonsils.

The acute form causes fever and a sharp impairment of nasal breathing. In the subacute course, the only symptom remains a morning cough, while in the indolent course hearing declines gradually.

Complications are related to the patency of the nasopharynx: sinusitis, including maxillary sinusitis and frontal sinusitis, otitis, and hearing loss due to impaired patency of the Eustachian tubes.

Why adenoids enlarge

The causes vary: sometimes a child is born with enlarged adenoids, but more often the tissue enlarges when it fights an infection and remains enlarged after recovery. Overgrowth is promoted by diseases that inflame the nasal mucosa and tonsils — measles, scarlet fever, influenza, and acute and chronic inflammation of the upper respiratory tract.

Adenoids are most often found between the ages of 3 and 7. After the age of five, the tissue usually begins to shrink and almost disappears by adolescence.

Adenoids in children under one year and at 2 years

Sometimes a child is born with already enlarged adenoids. Adenoids are most often observed between the ages of 3 and 7.

It is difficult to perform a classic examination with a mirror through the mouth on an infant. Here a flexible endoscope is used: it is the least traumatic and is recommended for young children.

How a doctor identifies adenoids and when an appointment is needed

The otorhinolaryngologist asks about symptoms, examines the ears, throat and oral cavity, and palpates the neck. The tonsil cannot be seen through the mouth, so its size is assessed with a special mirror, a flexible endoscope with a light source, or an X-ray.

Endoscopy is considered the gold standard; digital examination, nasopharyngeal radiography and computed tomography are also used. The degree is described by how much of the vomer the tissue covers: the upper part, two-thirds, or almost all of it.

An appointment is needed for persistent congestion, snoring and sleep apnea, recurrent otitis and sinusitis. Absolute indications for removal are apnea and complete absence of nasal breathing that do not respond to conservative treatment, persistent hearing loss lasting longer than three months, and recurrent purulent otitis.

Enlarged adenoids alone are not a reason to call an ambulance. Call 103 or 112 if the child has difficulty breathing, swelling of the throat or oral cavity, difficulty speaking, or cannot swallow or open their mouth.

This text is for reference: it explains the picture but does not replace a doctor's consultation.

This content is for reference and does not replace a doctor's consultation. Medical disclaimer