Adenoid Treatment
Treatment for enlarged or chronically infected adenoids that may affect breathing, sleep or ear health
What is adenoid treatment?
The adenoid is a pad of immune tissue sitting at the very back of the nose, where the nasal passages turn down into the throat. You cannot see it by looking in the mouth. It is largest between about three and seven years old and normally shrinks away by the teenage years, so this is a childhood problem that resolves in most children.
It causes trouble by occupying space. When it enlarges enough to fill the back of the nose, the child cannot breathe through the nose and switches to the mouth. Because the opening of the tube that ventilates the middle ear sits right beside it, the same enlargement interferes with the ears, so nose and ear problems in a small child so often arrive together.
Repeated colds and allergy keep it enlarged, and in some children it never gets the chance to settle between infections. The tonsils frequently enlarge alongside it, so a child is assessed for both together instead of one at a time.
What you might notice
- A child who breathes through the mouth and snores
- Difficulty following conversation
How it is diagnosed
The adenoid is out of sight on ordinary examination, so it is assessed either with a thin flexible endoscope passed along the floor of the nose, which most children tolerate better than parents expect, or with a soft tissue X-ray of the side of the neck. Endoscopy is more informative because it shows how much of the airway is blocked in real time.
The ears are examined and a tympanogram done, since the middle ear is so often involved, and hearing is measured in a way appropriate to the child's age. The tonsils are graded at the same visit.
A great deal of weight is given to what parents describe about the night: the position the child sleeps in, how restless they are, whether breathing appears to pause, and how they are in the morning. A video taken on a phone during sleep is genuinely useful and is worth bringing to the appointment. Where obstruction seems significant, a sleep study is arranged.
Recovery
A trial of a nasal steroid spray runs for six to eight weeks before it is judged, and technique matters as much as the drug: the spray should be aimed outwards towards the ear, not up the middle. Where allergy is a factor, treating that properly is part of the same plan.
If the tissue is removed, the operation is done through the mouth with no external cut and the child goes home the same day. The throat is mildly sore for three to five days, the breath is often unpleasant for a week, and there may be some bloodstained fluid from the nose for a day or two. Soft food and plenty of fluid see most children through.
Parents usually notice a quiet night within a week or two. Children are back at school in about a week and should avoid swimming and rough play for a fortnight. Where the tonsils were removed at the same time, recovery is considerably longer and follows the throat's timetable instead.
If it is left untreated
In most children this settles on its own as the tissue shrinks with age, so watching a child who is otherwise thriving is a reasonable plan and is often the right one.
The children who should not simply be watched are those whose sleep is disturbed by it. Persistent obstruction at night affects growth, daytime behaviour and progress at school, and it is regularly mistaken for an attention problem. Fluid trapped in the middle ear over the years speech is being built causes delay that can be difficult to make up.
Prolonged mouth breathing through the growing years also influences how the upper jaw and face develop, producing a long face with a high narrow palate and crowded teeth, and those changes do not reverse once growth is complete. That is the reason a child who mouth breathes every night is examined instead of left alone.
Questions about adenoid treatment
Can this be treated without an operation?
Often, yes. A nasal steroid spray used daily for six to eight weeks shrinks the tissue in a good proportion of children, and treating an underlying allergy properly adds to that. Technique matters: the spray should be aimed outwards towards the same side ear and not straight up the middle. The tissue also shrinks naturally as a child grows, so where a child is sleeping and growing well, watching with a spray is a reasonable plan and often all that is needed.
Will the tonsils be taken out at the same time?
Only if they are also causing obstruction, and that is assessed at the same visit. Where the adenoid alone is the problem, removing it is a short procedure with a mild sore throat for a few days. Where the tonsils are also large enough to narrow the airway in sleep, taking both in one anaesthetic avoids a second operation later, but the recovery then follows the throat's timetable, which means around two weeks of significant discomfort. Your surgeon should tell you clearly which of the two is planned.
Can the adenoid grow back?
It can, though it is uncommon. A small amount of tissue is sometimes left behind and can regrow in a young child, particularly one operated on before about the age of three or one with significant allergy. Where symptoms return, the back of the nose is examined again with an endoscope instead of assumed. In most children the tissue continues to shrink with age and the problem does not return.
Other ENT treatments
Management of recurrent or persistent tonsil problems, including medical treatment and surgery when indicated
Day CareTreatment for inflammation or infection of the sinuses, with surgery considered for selected persistent cases
Day CareTalk to a care coordinator about adenoid treatment
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one