What is meant by adenoids?
Everyone has heard about tonsils, but what are adenoids?
You can easily see your tonsils, but where are the adenoids?
Adenoids are lumps of spongy lymphatic tissue situated right at the back of the nose at the roof of the mouth. You may be able to see your tonsils by standing in front of the mirror and opening your mouth wide but adenoids are not so easily visible. ENT Specialists use special mirrors and endoscopes to visualize the adenoids.
Adenoids are present from birth and can gradually increase in size to produce problems in children. It has mostly disappeared by the time your child is a teenager and for that matter adenoid problems are seen in children only.
Why does the adenoid enlarge?
Increase in size of the adenoid can occur on its own or due to inflammation [infection, allergy]
What are the effects of enlarged adenoids?
Since the adenoids are situated in the back of the nose and close to the orifice of the eustachian tube, adenoid hypertrophy or enlargement can have effects on the adjoining areas :-
Effect on Ear: The eustachian tube connects the middle ear to the nasopharynx [ back of the nose] and eustachian tube dysfunction can occur when there is adenoidal enlargement or when the adenoids are a seat of chronic infection. Eustachain tube dysfunction can lead to ear infection in children and fluid collection in the middle ear called glue ear. Fluid in the ear can produce hearing loss, ear discomfort, dizziness, tinnitus, aural fullness etc
Effect on the Nose and Sinuses: A large adenoids can block the back of the nose [called choanae] and produce nose block, nose congestion, collection of secretions, and increased nasal and sinus infections.
Effect on the Mouth and Throat: Enlarged adenoids produce mouth breathing in the child as a result of the nose block. Initially this may be only at night and parents will notice the child snoring .It is not normal for children to snore! In severe enlargement of the adenoids the child will breathe through the mouth in the day time also. Mouth breathing can affect the dentition of the child in an adverse way. When a child breathes in air through the mouth the important filtering and humidifying action of the nasally breathed air is lost and this predisposes the child to more frequent throat infections.
Effect on sleep and health: Since adenoids affect the normal breathing and this is more pronounced at night, sleep of the child may be affected with adverse effects on growth. In Sever cases sleep apnea can develop with serious effects on the lungs and even heart.
Could my child be suffering from adenoids?
If your child is suffering from:-
Frequent upper respiratory infection
Persistent or frequent running nose
Frequent or persistent nose block
Mouth breathing at night
Open mouth posture in daytime
Frequent ear infections
Recalcitrant ear fluid
More subtle effects of adenoids which are often not noticed by parents include:-
Swollen glands in the neck
Restlessness while sleeping
What are the complications of adenoids?
Since adenoids affect the breathing of the child and can also affect the ears, untreated it can have dangerous health consequences.
Enlarged untreated adenoids can produce
- Ear infections
- Ear Fluid
- Hearing loss due to ear affliction
- Recurrent Tonsillitis
- Recurrent Pharyngitis[Throat infections]
- Behavioral problems
Very Serious Complications due to adenoids
- Sleep apnea
- Pulmonary Hypertension
- Right Sided Heart Failure
How is adenoids diagnosed?
Clinical Suspicion and Consultation
The layman’s knowledge about the adenoids is quite dismal in majority of the cases and even though you as a parent are concerned about your child’s health ready and reliable information about health and diseases is hard to come by! Since the signs and symptoms of adenoids are so ubiquitous often the general physician or pediatrician may fail to think about adenoids and it is indeed the astute clinician who suspects the condition and makes a timely diagnosis in your child. Regarding the adenoids the adage Out of Sight, out of mind holds true .Awareness about the condition and being well informed can help you safeguard your child’s health against this common childhood condition.
Your Pediatrician may suspect adenoids if your child is suffering from
- Frequent colds
- Frequent Cough
- Post nasal drip
- Mouth breathing
- Ear infections
- Fluid in the ear
Your pediatrician will refer you to an ENT Specialist who will take a detailed history and examine your child Examination and tests Your ENT doctor can diagnose adenoids by examining your child.
Adenoids can by diagnosed by
•Post nasal Mirror examination
If your child is cooperative a painless quick nasal endoscopy may be all that is required to clinch the diagnosis
Dr Sonia uses a real time video endoscope to visualize the adenoids situated at the back of the nose. Using endoscopy one can judge the presence of the adenoids, the amount of blockage produced by the adenoids and also assess for other contributing conditions in the nose such as turbinate hypertrophy, allergic mucosal swelling, nasal polyps, and deviated nasal septum. Using endoscopy we can even avoid taking an X-ray many a times.
Sometimes your child may require an X-ray of the Nasopharynx [area behind the nose where the adenoids are situated] to assess the presence and severity of adenoids.
An otoendoscope or otoscope is used by ENT Specialists to examine the ears: this will reveal the condition of the ear drum and the middle ear. Children with adenoid enlargement can have fluid in the middle ear and in long standing cases ear drum affliction in the form of retraction of the ear drum.
Hearing and Middle ear function Tests: These tests are simple tests ordered if there is suspicion of ear involvement in your child. In the young child even a mild hearing reduction can have severe consequences hence the need to promptly assess and treat such conditions.
How are adenoids treated?
Treatment of adenoids takes into consideration a constellation of clinical factors including
•Symptom of the individual child
•Duration of symptoms
•Previous treatment history
•Presence of ear involvement and its severity
•Severity of the adenoid problem
•Size of the adenoids
•Allergy tendency [Atopy]
•Nasal endoscopy findings
•Presence of tonsillar involvement
Medical treatment is with medications to reduce inflammation and is given for a short period. Surgical removal [called adenoidectomy] may be recommended if medical treatment fails or the adenoid condition is severe. Not every child requires surgery.Your ENT Specialist will explain to you the choices and factors involved in recommending a particular treatment modality for your child.
What is adenoidectomy?
Adenoidectomy is the surgical removal of the adenoids situated at the back of the throat. How is adenoidectomy performed?
There are several techniques to do an adenoidectomy.
•Endoscopic Adenoidectomy – the endoscope and special endoscopic instruments are used to precisely remove the adenoids
•Adenoidectomy with curettes- curettes are small devices used to literally spoon out the adenoids. Adenoidectomy with curettes is a simple, fast and economic surgical technique. •Adenoidectomy with LASER- LASER use produces relatively fast healing.
•Adenoidectomy with Microdebrider- A microdebrider is a powered instrument which can suck the enlarged adenoid tissue.
•Endonasal Adenoidectomy- Is adenoidectomy performed through the nose using specialized instruments. You can discuss the various options with your ENT Surgeon who will explain to you the benefits of each technique and help you make a decision which is best for your child.
What should I know about adenoidectomy?
•Adenoidectomy is a fairly simple surgery and one of the commonest surgeries done in children.
•There is no cutting in the neck or mouth in adenoidectomy. In fact there is no “knife” involved.
•It is a stitch-less, scar-less surgery.
•It is performed under General anaesthesia and your child will not have any pain whatsoever during the procedure.
How long should my child stay in the hospital after adenoidectomy?
Depending on the individual case hospital stay varies but in the majority of the cases your child can be taken home the same day or at the most the next day. Discuss with your ENT Surgeon what the recommendation is in your particular case.
What are the precautions after surgery?
Your child will be able to talk, eat and play normally. In fact anyone seeing your child will not know any such procedure has been done as there are no external cuts or stitches involved in this surgery. Dr Sonia usually recommends avoiding very hot food and drinks for a few days after the procedure. He can bathe, play in a normal fashion. In case your child required an adeno-tonsillectomy or a myringotomy grommet along with it additional precautions will be required[Discuss them in detail with your ENT Surgeon].
What is the success rate for the surgery?
Adenoidectomy has excellent results and tremendous benefits for your child’s health. Timely decision making to avoid the complications of enlarged adenoids is essential to safeguard your child’s breathing , hearing and optimal development.