Enlarged Adenoids In Children: Symptoms, Removal & Treatment

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Adenoids in children are lymphatic tissues located at the back of the nose and throat (nasal passage). They are a part of the immune system and protect the body from the harmful pathogens (bacteria and viruses) that a child may inhale or swallow with air, food, and water. The main responsibility of the adenoids is to detect different germs and trigger an immune response (1).

Enlarged adenoids are adenoids that swell due to an infection. However, the swelling can also be caused by other reasons that may be unclear. When the adenoids drastically increase in size, they may interfere with the child’s breathing or flow of mucus, leading to complications. Hence, prompt diagnosis and treatment are essential.

Read on as we explain enlarged adenoids in kids, and their causes, symptoms, diagnosis, treatment, and management.

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Are Adenoids And Tonsils The Same?

Adenoids, also called pharyngeal tonsils, are one of the four sets of tonsils, which further include palatine tonsils, tubular tonsils, and lingual tonsils (2). All of these belong to the body’s lymphatic system and serve as the immune system’s first line of defense against infections. Adenoids are not easily visible through your mouth (3).

What Are Enlarged Adenoids?

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Swollen and inflamed adenoids are known as enlarged adenoids. Adenoiditis and adenoid hypertrophy are the other terms used for enlarged adenoids (4).

Causes Of Enlarged Adenoids

Enlarged adenoids may result from chronic adenoid infection (adenoiditis), allergies, and pollution. Some children may have enlarged adenoids from birth. Cancerous growth can also lead to such enlargements (5). Allergic rhinitisⁱXInflammation of the nose caused by an allergen leading to itching, sneezing, and watery eyes. is also associated with adenoid hypertrophy (6) (7).

Did you know?

AdenovirusⁱXA group of viruses responsible for various respiratory illnesses in humans and may rarely cause bladder or nervous system disorders. , influenza virus, mycoplasmaⁱXA bacteria that damage the respiratory lining in the throat, windpipe, and lungs and spreads through coughing and sneezing. , and cigarette smoke exposure are a few other factors that might cause enlarged adenoids (20).

Symptoms Of Enlarged Adenoids

Some of the symptoms of enlarged adenoids in children include (1) (4) (8) (9) (10):

• Breathing difficulties
• Difficulty in swallowing
• Blocked and stuffy nose
• Severe snoring
• Sleep apnea (repeated pauses in breathing during sleep)
• Restless sleep, bedwetting, and frequent waking up from sleep

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• Mouth breathing, causing dry mouth and lips
• SinusitisⁱXAn infection in which the tissues that line the sinuses (hollow, air-filled spaces in the skull) get swollen or inflamed.
• Middle ear infection, fluid build-up or ’glue ear,’ and ear pain

Milka, a mother and blogger, recounts the reasons behind her decision to have a tonsillectomy and adenoidectomy performed on her four-year-old son. She explains, “The poor little guy has had giant tonsils for most of his life, not a reason in itself to remove them surgically, according to most pediatricians. However, he’s been a recurring victim of sore throats (the dreaded tonsillitis), strep throats, halitosis (bad breath), poor appetite due to back-of-the-mouth obstruction, and drum roll… sleep apnea (i).”

Diagnosis Of Adenoiditis

Consult an ear, nose, and throat (ENT) specialist for the diagnosis of enlarged adenoids. The doctor will do a physical examination of the child’s ear, nose, and throat and palpate the neck along the jaw to check for any swellings.

The pediatric ENT specialist may also use an endoscope (a flexible telescope with a light and camera attached to it) to diagnose adenoiditis. An X-ray of the throat (very rarely done),  along with some blood tests, might also be needed for confirmation of adenoiditis (11).

Treatment Of Enlarged Adenoids

The severity of the condition determines the treatment to be given (11) (12).

• In less severe cases, the doctor may prescribe medications.

• Nasal steroid sprays may also be prescribed by the doctor to reduce swelling. This is sometimes done in conjunction with an antihistamineⁱXMedications that help relieve allergic symptoms. but is case-dependent.

• In cases of severe or chronic adenoid infections or recurrent sinusitis due to adenoid hypertrophy, adenoidectomy is recommended. It is a relatively simple procedure and may not pose a health risk. However, research has shown that adenoidectomy elevates the risk of upper respiratory tract infections by at least 11% in children. Additionally, as per a study published in the International Journal of Pediatric Otorhinolaryngology, the prevalence of adenoid regrowth after adenoidectomy was found to be 8%. Therefore, it is important to talk to your doctor about the procedure and go ahead only if the benefits outweigh the risks. Therefore, talk to your doctor about the procedure and go ahead only if the benefits outweigh the risks.

Note: The removal of the adenoids is known as adenoidectomy, while the removal of the palatine tonsils is known as tonsillectomy (4).

Point to consider

Increasing fluid intake and using throat lozenges may also help alleviate pain and swelling (20).

What Happens During An Adenoidectomy?

Surgical removal of adenoids is done under general anesthesia. It is performed through the child’s open mouth and involves no cuts through the skin. The procedure usually takes around 30 minutes, and the child wakes up from anesthesia in the recovery room within 45 minutes or one hour after surgery.

Note that the child should not eat or drink for a few hours before the surgery as advised by your treating doctor (13)

Experts say

On average, children whose adenoids (and even tonsils) have been removed do not have any more illnesses than those who have adenoids (1).

Risks Of An Adenoidectomy

Adenoidectomy is a relatively safe procedure, and the risks involved are rare. However, no surgery is totally risk-free, and that applies to the said procedure as well. Your child might experience problems with anesthesia or mild post-operative pain. Additionally, there may be a risk of developing infections, bleeding, alterations in vocal quality, and issues with persisting ear infections, nasal drainage, and breathing problems even after surgery.

Adenoids are located far back in the nasal passage, which makes 100 percent removal of the adenoid tissue quite impossible. Rarely, the tissue may grow back and continue to cause problems. In such cases, surgery may be required for a second time (14).

Care To Be Taken After Adenoidectomy

Making the child feel comfortable after the surgery and providing all the necessary care will help in speedy postoperative recovery. Here are a few pointers you should keep in mind.

• Give the child all the prescribed medications on time.

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• Avoid medications that contain aspirin and ibuprofen, as these can cause bleeding (13) (15).

• Keep your child well-hydrated throughout the day. Avoid carbonated drinks.

• Give the child soft foods, such as soup, puddings, fresh fruit juices, popsicles, and mashed potatoes, in the initial days.

• Encourage them to avoid nose blowing and vigorous spitting for the first few days after the surgery.

• Discourage them from playing any contact sports for the first week following adenoidectomy.

• Use a cool-mist humidifier to soothe the child’s stuffy nose.

• Attend the follow-up appointment that is given after the surgery.

Recovery From Adenoidectomy

Complete recovery usually takes two to three weeks, but children can go to school and do their routine activities after a few days following adenoidectomy. Most children can eat and drink fluids normally within a few hours after the surgery, and there are no strict dietary restrictions post adenoidectomy.

Some children may experience an upset stomach, a mild fever, or vomiting during the first 24 hours after surgery, and a sore throat during the initial days. Neck soreness, bad breath, and snoring might also be present in some children until three weeks after surgery (1).

When To See The Doctor Post Adenoidectomy?

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Consult a doctor if you notice the following complications or conditions in your child after adenoidectomy.

• If vomiting and upset stomach persists for more than a day after surgery

• If the child shows signs of dehydration, such as dry and sticky lips, sunken eyes, and no urination for more than eight hours

• If bleeding occurs after the first day of surgery — the presence of small spots of blood in the nose or saliva for 24 hours following the surgery is common

• If your child coughs out bright red blood or blood clots

Note: Children with a history of cleft palateⁱXA congenital condition where there is a split or opening in the roof of the mouth due to incomplete joining of the tissues. or neuromuscular disorders may be prone to speech abnormalities after adenoidectomy (16).

What Is The Long-Term Outlook For Swollen Adenoids?

Enlarged adenoids are common in children. If you notice any symptoms of adenoid it is, consult the doctor. It is a treatable condition, and in some cases, may resolve with simple antibiotic medications prescribed by the doctor.

Point to consider

Ensure your child takes the full prescribed dose of antibiotics to prevent the infection from returning (8)

Infographic: How To Identify Enlarged Adenoids In Children

Adenoids help protect the nose and throat from inhaled pathogens; however, when they swell and become large, they can lead to various problems in children. Read through the infographic below to learn about various symptoms of enlarged adenoids in children to help you identify them early and get them treated promptly.

Illustration: Momjunction Design Team

From snoring to the appearance of an adenoid face, enlarged adenoids can cause several complications in children. Learn how to identify it and explanation of surgical treatments in this video.

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Dr. Wayne HoughMBChB, MMed, FC Paeds

Dr. Wayne Hough is a pediatrician with around six years of experience in the field. He is currently based in the Northern Suburbs of Cape Town in South Africa. Dr. Hough got his medical degree from the University of Stellenbosch. He then worked at the Tygerberg Children's Hospital before completing his pediatric training and qualification from the South African College...more

Dr. Ritika ShahBDS, CLC

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Ghazia ShahMSc, MA, BEd

Ghazia is a scientist-turned-writer with three years of research experience in Cancer Biology. She did her masters degree in Biotechnology at the University of Kashmir and bachelors in Education at the same university. Ghazia then delved deeper into the science of language with a masters in English. With a Functional English certificate from Indira Gandhi National Open University (IGNOU), she...more