OVERVIEW

What is the function of adenoids?

Adenoids are essentially lymphoid tissue located in the nasopharynx behind the nasal cavity. They are part of the respiratory system's first line of defense, helping to combat infections from external pathogens and providing immune protection.
Adenoid tissue is not smooth—similar to tonsils, it has deep groove-like structures (crypts). This anatomical feature makes adenoids prone to trapping debris and bacteria. Once infected, inflammation tends to persist and recur.

What is adenoid hypertrophy?

Adenoids, also known as pharyngeal tonsils or nasopharyngeal tonsils, are lobulated lymphoid tissue located at the posterior nasopharyngeal wall^[1]. Due to their position at the junction of the nose, ears, and oral cavity, adenoid disorders can manifest as various symptoms affecting these areas.

Adenoid hypertrophy, or enlarged adenoids, refers to pathological hyperplasia of this tissue. It may lead to childhood chronic rhinosinusitis, secretory otitis media, and dentofacial developmental abnormalities. Clinical symptoms include nasal congestion, mouth breathing, and snoring. Severe cases may require adenoidectomy^[1].

Is adenoid hypertrophy common?

Yes.

The incidence of adenoid hypertrophy in children ranges from 9.9% to 29.9%^[2], meaning nearly 10–30 out of 100 children may be affected. Preschoolers aged 3–5 show the highest prevalence, with boys more frequently affected than girls^[3].

SYMPTOMS

What are the common symptoms of adenoid hypertrophy?

When adenoids enlarge to a certain extent, they can block the posterior nasal opening, leading to the following symptoms:

• Nasal congestion and difficulty breathing.
• Purulent nasal discharge and a nasal voice when speaking.
• Mouth breathing and snoring during sleep at night.
• Abnormal facial and dental development, resulting in characteristic "adenoid facies," including an open mouth, flattened and elongated midface, retracted upper lip, and narrowed hard palate leading to crowded upper teeth.

What complications can adenoid hypertrophy cause?

• Adenoid hypertrophy may lead to secretory otitis media, causing symptoms like hearing loss, ear fullness, and ear pain.
• Purulent secretions flowing downward can irritate the respiratory tract, triggering coughing or bronchitis.
• Adenoid hypertrophy may cause obstructive sleep apnea-hypopnea syndrome^[4], manifesting as snoring.
• Severely enlarged adenoids can also lead to difficulty swallowing, affecting eating and causing malnutrition and abnormal growth in children.

How do children with adenoid hypertrophy behave in daily life?

Children may not express their discomfort, so parents should be alert if their child shows signs like daytime inattention, turning up the TV volume, not responding to soft calls, or mouth breathing during sleep. These may be related to breathing difficulties, hypoxia, poor nighttime sleep quality, or hearing loss caused by adenoid hypertrophy.

CAUSES

What are the causes of adenoid hypertrophy?

The adenoids are present from birth and gradually enlarge as children grow. Under normal physiological conditions, they undergo the most significant hyperplasia between the ages of 2 and 6 and begin to shrink after the age of 10^[1]. This physiological adenoid hypertrophy does not require intervention, as it naturally regresses with age^[5].

However, some individuals may experience pathological adenoid hyperplasia due to factors such as upper respiratory infections, rhinosinusitis, immune factors, allergic predisposition, or gastroesophageal reflux. This can lead to corresponding symptoms in the ears, nose, and throat. In such cases, doctors diagnose it as "adenoid hypertrophy" and recommend treatment.

DIAGNOSIS

How is adenoid hypertrophy diagnosed?

The diagnosis of adenoid hypertrophy is typically based on a combination of clinical history. In other words, the doctor makes a preliminary assessment based on the patient's clinical symptoms. If adenoid hypertrophy is suspected, the following diagnostic methods are used for confirmation:

• Traditional examination: The doctor wears gloves and inserts a finger through the mouth to palpate the nasopharynx. However, this method is uncomfortable for children, and the doctor may not clearly observe the actual condition, making it difficult to track disease progression. It is now rarely used.
• X-ray lateral nasopharyngeal view: Advantages—intuitive and relatively objective in assessing the degree of adenoid hypertrophy, facilitating future comparisons. Disadvantages—involves some radiation exposure, though generally not a major concern.
• Nasopharyngeal endoscopy: A rigid or flexible endoscope is inserted through the nose, allowing the doctor to capture images via the lens and view them on a display. Advantages—direct assessment of adenoid obstruction in the posterior nasal cavity without radiation. Disadvantages—mild discomfort during the procedure, and the evaluation of adenoid enlargement may be subjective due to variations in endoscope angle and depth.
• Imaging examinations:
  • Multislice spiral CT: Provides clear images of adenoid tissue and surrounding structures, aiding in assessing disease progression and complications. Disadvantages—radiation exposure and higher cost compared to nasopharyngeal endoscopy. Patients should consider their doctor's advice and personal circumstances when choosing.
  • MRI (Magnetic Resonance Imaging): Offers imaging clarity similar to CT without radiation risks. However, some pediatric patients may not cooperate during the procedure, so selection should be based on individual cases.
• Pediatric polysomnography (PSG): Requires the child to stay overnight in a hospital with electrodes attached to monitor oxygen levels and detect sleep apnea. Some children may not show significant adenoid enlargement on X-rays or endoscopy but exhibit severe snoring or breathing pauses during sleep. In such cases, PSG is recommended to evaluate sleep-related hypoxia and guide treatment decisions.

TREATMENT

When should you seek medical attention for adenoid hypertrophy?

A common cold can also cause symptoms such as nasal congestion, runny nose, mouth breathing, and snoring, but a cold usually resolves within one to two weeks, and the corresponding symptoms will significantly improve.

If symptoms like nasal congestion, mouth breathing, and snoring persist after the cold has healed, or if the child exhibits hearing loss or difficulty concentrating, timely medical attention and appropriate treatment are necessary.

Another situation is if you notice frequent and loud snoring during the child's sleep at night, it is also advisable to seek a medical examination.

Which department should you visit for adenoid hypertrophy?

Adenoid hypertrophy is more common in children, and patients usually choose to visit pediatrics or otolaryngology departments. It is best to consult an otolaryngologist.

How is adenoid hypertrophy treated?

Recommendations are as follows:

1. General treatment: Strengthen immunity by exercising regularly, maintaining a balanced diet, avoiding recurrent colds and other upper respiratory infections, and avoiding secondhand smoke. If allergic rhinitis or asthma is present, it is best to identify the allergens causing symptoms and avoid exposure to them.

2. Medication:

   • Corticosteroid nasal sprays: Such as mometasone furoate, budesonide, or fluticasone propionate nasal sprays. Although these are hormonal medications, their systemic effects are minimal when used locally in the nose.
   • Decongestants: Such as ephedrine-based nasal drops, but these should only be used temporarily to relieve nasal congestion. Continuous use should not exceed one week, and long-term use should be avoided.
   • Antibiotics: May be used in the early stages if secretory otitis media is present, generally for no more than one week.
   • Saline nasal sprays or rinses: If the nasal cavity is dry, has excessive crusts, or excessive mucus, nasal rinsing at home can help relieve congestion and improve breathing^[1-4].

3. Surgical treatment: Clinically, most children with adenoid hypertrophy can be cured through conservative treatment alone, and adenoidectomy is generally not required. However, a small number of children may need surgery^[1].
   These children mainly include:

   • Those with long-term mouth breathing, snoring, or even breath-holding, and confirmed sleep apnea.
   • Those with significant hearing loss.
   • Those whose adenoid hypertrophy leads to recurrent nasal or sinus infections or frequent colds.
   • Those who show poor response to medication and require surgical treatment.

How long should conservative treatment for adenoid hypertrophy be tried before considering surgery?

There is ongoing debate both domestically and internationally, and no consensus has been reached. The child's own immunity plays a crucial role in treatment efficacy. If recurrent colds occur during treatment, the effectiveness of conservative treatment may be compromised.

Based on literature and clinical experience, the following recommendations are made:

• If there is no improvement or symptoms worsen after two weeks of standardized medication, and the child is significantly affected (e.g., sleep snoring, hypoxia, mouth breathing, further hearing decline, or sinusitis/ asthma due to purulent secretions), surgery should be considered^[6].
• If symptoms improve with medication, conservative treatment can be continued for 8 to 12 weeks under regular follow-up. If no improvement is seen, surgery may be considered.
• For children under four years old, a thorough evaluation by an otolaryngologist is needed before deciding on surgery.

Do adenoids and tonsils have to be removed together for adenoid hypertrophy?

Many children have both enlarged tonsils and adenoid hypertrophy, and sometimes both are removed in the same surgery. However, simultaneous removal is not mandatory and depends on a comprehensive assessment of the impact of both conditions on the child.

Are there any side effects after tonsillectomy and adenoidectomy for adenoid hypertrophy?

Currently, tonsillectomy and adenoidectomy are minimally invasive procedures performed with low-temperature plasma devices, resulting in minimal bleeding, short surgery times, and quick recovery—usually within about two weeks.

Some parents worry about reduced immunity after surgery. While the tonsils and adenoids are immune organs with certain protective functions, if recurrent purulent tonsillitis or adenoid hypertrophy causes sleep snoring, hypoxia, daytime inattention, or hearing loss, the pros and cons must be weighed.

Additionally, no clinical data prove that children who undergo surgery have weaker immunity. As the child grows, the immune system matures, and the functions of the tonsils and adenoids are compensated by other organs.

Therefore, parents are advised to follow the doctor's recommendations and choose the most suitable treatment for their child.

Can adenoids regrow after removal?

There is a certain chance of recurrence, with a recurrence rate of up to 5.75% in children aged 5–8 (about 5–6 out of 100 children in this age group)^[7].

Due to the nature of adenoids—lymphoid tissue without a complete capsule—only most of the glandular tissue is removed during surgery. Lymphoid tissue may regrow, but it will not return to its pre-surgery size. If no symptoms recur, close observation and conservative treatment are sufficient, and repeat surgery is usually unnecessary.

DIET & LIFESTYLE

What should children with adenoid hypertrophy pay attention to in daily life?

Repeated colds may worsen adenoid hypertrophy, so it's important to prevent colds, clean the nose frequently, reduce nasal congestion and runny nose, and minimize irritation to the adenoids.

Additionally, keep children away from environmental pollutants like secondhand smoke to avoid respiratory irritation. In terms of diet, reduce the intake of spicy, greasy, and irritating foods, eat more seasonal fresh vegetables and fruits, and drink plenty of water to stay hydrated.

PREVENTION

Can adenoid hypertrophy be prevented?

Engaging in active physical exercise, strengthening physical fitness, and reducing the occurrence of colds can help prevent adenoid hypertrophy to a certain extent.