What are adenoids?
Adenoids is a lump of soft tissue present in the back of the nose. It is composed of lymphoid tissue and is part of our immune system. Adenoids trap bacteria and virus from the air we breathe and helps protect our body. They can cause problems for the child when they become grossly enlarged, blocking the back of the nose. Adenoids can act as reservoirs of infection, causing repeated upper respiratory tract infections.
What causes enlarged adenoids?
Adenoids can enlarge temporarily in their effort to fight infection when it comes in contact with bacteria and virus present in the air. Allergies can also cause an increase in their size. Sometimes a vicious cycle forms when adenoids start acting as a reservoir for resistant bacterial biofilms causing repeated upper respiratory tract infections. In response to these recurrent infections, adenoids enlarge in size.
What are the symptoms of enlarged adenoids and adenoiditis?
Following are the symptoms your child will experience when he has enlarged adenoids
The child will have a nose block, and to compensate for this, he will start opening his mouth for breathing.
Mouth breathing causes evaporation of saliva from a child’s mouth. Saliva plays a protective role against bacterial growth in the mouth. Once saliva evaporates, bacterial overgrowth is seen, leading to bad breath from the mouth and recurrent ulcer formation in the mouth.
Your child may have noisy breathing or snoring when he sleeps in the night. He will keep rolling restlessly in the bed and can sometimes suddenly wake up from sleep gasping for breath. This sleep disturbance causes the child to become hyperactive in the morning. Chronic sleep disturbances cause learning, behavioural and growth problems in children.
Your child will suffer from recurrent upper respiratory tract infections. Medicines will provide temporary relief with recurrence a few days after completing medications.
Enlarged adenoids can cause the formation of fluid in the ears, also known as secretory otitis media. Children having this condition experience hearing loss. They are very sensitive to loud sounds and start closing their ears and crying when they hear a loud sound.
Also, these children develop a habit of picking their nose, and this causes repeated nose bleeds.
So is adenoidectomy necessary for your child?
The doctor will assess the need for surgery based on three things
- The severity of symptoms of child
- Duration of symptoms of child and
- Grading of adenoids on Xray or Endoscopy
If the symptoms child is experiencing due to enlarged adenoids are very severe, or if your child is getting incomplete relief with the medication provided or if your child’s symptoms are recurring after stopping medicines, your ENT doctor will advise X-ray nasopharynx for adenoids or nasal endoscopy. Once the X-ray or endoscopy is done, He will grade the adenoids based on how big they are and how much of the back of the nose they are blocking.
The grading of adenoids is as follows.
There are four grades of adenoids.
- Grade 1 is if adenoids block up to 25% of the back of the nose
- Grade 2 is if adenoids block 25 – 50 % of the back of the nose
- Grade 3 is if adenoids block 50 – 75 % of the back of the nose
- Grade 4 is if adenoids block the back of the nose entirely
Grade 1 and 2 adenoids usually respond well to medical management, and there is rarely a need for surgery. Children can outgrow them. Grade 3 and 4 adenoids can be tried with medical management if not given already. If the child does not improve, adenoidectomy must be done.
ENT doctors can advise adenoidectomy sometimes irrespective of adenoids size in the following conditions. Few children develop fluid in the ear, also known as secretory otitis media or develop a hole in the eardrum or develop retraction pockets in their eardrum, producing ear discharge. These children, irrespective of having lower grades of adenoids, will be advised adenoidectomy to cut off the source of infection to the ears. Adenoids harbour infections and pass them to the middle ear through the eustachian tube present in a very close vicinity. Enlarged adenoids also close the nose end of the eustachian tube, completely cutting off the ventilation to the middle ear leading to recurrent ear infections
What will happen if you ignore your doctor's advice for adenoidectomy?
Apart from the continuation of the above symptoms, the child’s face will start becoming long and narrow due to mouth breathing. He will develop crowded teeth and a gummy smile. I have many patients referred to me by dental doctors. Parents take these kids to dental doctors for application of braces for misarranged teeth. The dental doctor will refer the kid to an ENT doctor to correct the source of the problem – enlarged adenoids.
The children may develop fluid in the ear, a hole in the eardrum or a retraction pocket in the eardrum, causing ear discharge and hearing loss because of infection passing from the back of the nose into the ears.