What are adenoids?
The adenoids are lymphatic tissue located just behind the nasal cavity, where the nose meets the throat. They are part of the immune system and help defend against inhaled germs, especially in infancy and early childhood.
The adenoids reach their largest size at around 3–4 years of age, begin to shrink after the age of 7–8 and have largely disappeared by adulthood. That is why adenoid problems are mostly seen in preschool and primary school children.
Why do adenoids enlarge, and what are the symptoms?
Frequent upper respiratory tract infections, allergies, recurrent sinusitis and tonsillitis can cause the adenoids to enlarge. Enlarged adenoids block the back of the nose and make breathing through the nose difficult.
- A constantly blocked nose and mouth breathing
- Snoring, restless sleep, pauses in breathing during sleep
- A runny nose and postnasal drip
- A nasal-sounding voice
- A feeling of fullness in the ear, reduced hearing, recurrent ear infections
- Poor appetite, daytime tiredness and difficulty concentrating
Children who breathe through the mouth for a long time can develop an “adenoid face”, in which the mouth is constantly open and the face looks long and tired.
Adenoids and ear problems
The Eustachian tube, which ventilates the ear, opens into the area behind the nose. Large or frequently inflamed adenoids can block this opening, leading to fluid build-up in the middle ear and recurrent ear infections. Because long-standing fluid can cause temporary hearing loss and delayed speech, the ears are always assessed as well. More information is on the middle ear infection and grommets page.
How is it diagnosed?
The adenoids cannot be seen by looking into the mouth. Diagnosis involves:
- Endoscopic examination: the area behind the nose is examined through the nose with a thin camera; the size of the adenoids and the degree of blockage can be seen directly.
- Adenoid X-ray: in young children in whom endoscopy is not possible, a lateral X-ray of the area behind the nose may be requested.
- Ear examination and hearing tests: to check whether there is fluid in the middle ear.
Treatment: when is surgery needed?
First, the underlying infection or allergy is treated with medicine; nasal sprays can reduce the swelling of the adenoids. If nasal blockage, snoring, pauses in breathing during sleep, a nasal-sounding voice or ear problems continue despite medical treatment, adenoid removal (adenoidectomy) is recommended.
Enlarged adenoids and tonsils together can cause snoring and nasal blockage; if both problems are present, tonsil surgery and, if needed, grommet insertion can be carried out under the same anaesthetic.
How is the operation performed?
Adenoid removal is performed through the mouth under general anaesthesia and takes about 20 minutes; there is no cut in the skin. Your child goes home the same day.
Recovery
Most children recover from adenoid surgery within 2–3 days and soon return to their normal routine. If the tonsils were not removed at the same time, normal eating can resume the next day. In the first days there may be a mild sore throat, bad breath and a runny nose.
After surgery, nasal blockage and snoring decrease; in children whose sleep quality improves, daytime attention and energy, appetite and growth may also benefit.
What are the risks?
- Bleeding (rare)
- Risks related to anaesthesia
- A temporarily nasal-sounding voice or a change in the voice
- Rarely, regrowth of the adenoids
Removing the adenoids does not weaken immunity; according to research, it does not increase how often colds or infections occur. After surgery, many children are seen to have fewer infections.
How does the process work with Prof. Dr. Öner Çelik?
- Consultation: the nose, the area behind the nose, the tonsils and the ears are assessed together at the clinic in Suadiye.
- Decision: whether surgery is needed is discussed after considering together the response to medical treatment and your child’s sleep, ears and speech.
- Surgery: performed at Maltepe University Hospital; your child goes home the same day.
- Check-ups: healing and the ears are followed up at the clinic.
Details are on the your treatment in Istanbul page.
Frequently asked
What are the signs of enlarged adenoids?
A blocked nose, mouth breathing, snoring and recurrent ear infections are the most common signs. When medical treatment does not help, the adenoids are removed in an operation of about 20 minutes under general anaesthesia; the child goes home the same day and most recover within 2–3 days.
More detail: Adenoidectomy.
When should snoring in children be assessed?
Regular snoring and mouth breathing in children are most often linked to enlarged adenoids or tonsils and should be assessed with an ENT examination. The decision on surgery is made by considering how often the symptoms occur, the response to medical treatment and the effect on the child’s sleep, growth and speech development.
More detail: Paediatric ENT.
Do adenoids grow back after surgery?
Regrowth of the adenoids after surgery is rare; the operation is a lasting solution for most children. If an underlying cause such as allergy continues, medical treatment may be needed for nasal symptoms.
Does “adenoid face” improve after surgery?
After the adenoids are removed, breathing through the nose improves and the habit of keeping the mouth open lessens; facial development can be positively affected. How much it improves depends on the child’s age and how long the problem has lasted, which is why early assessment matters.
Until what age do adenoids grow?
Adenoids usually reach their largest size at around 3–4 years of age, begin to shrink after 7–8 years and have largely disappeared by adulthood.
References
- Rosenfeld RM et al. Clinical Practice Guideline: Otitis Media with Effusion (Update). Otolaryngol Head Neck Surg. 2016;154(1 Suppl):S1-S41.
- Niedzielski A et al. Adenoid hypertrophy in children: a narrative review of pathogenesis and clinical relevance. BMJ Paediatr Open, 2023. pubmed.ncbi.nlm.nih.gov
This content is for information only and does not replace medical advice. Every medical procedure requires an individual assessment and may carry risks. Results vary from person to person.
