Tonsils and adenoid, which we are all born with, are masses of tissue that are similar to the lymph nodes or “glands” found in the neck, groin, and armpits. Tonsils are the two masses on the back of the throat. Adenoid is high in the throat behind the nose and the roof of the mouth (soft palate) and is not visible through the mouth without special instruments.
Tonsils and adenoid are near the entrance to the breathing passages where they can catch incoming germs, which cause infections. They “sample” bacteria and viruses and can become infected themselves. Infection of the tonsils are called “tonsillitis” and infection of the adenoid is called “adenoiditis”
In this article, I’ll give informations about recurrent adenoiditis and its possible effect on your child as he/she grows older.
As I have already mentioned, we’re all born with large tonsils and small adenoid, but as we recognize the viruses and bacterias, they get infected and especially the adenoid gets larger and larger by time. Also allergies can cause the adenoid grow although there’s no infection.
The adenoid becomes quite visible by examination around 6-12 months of age, reaches its biggest amount at 3-7 years, and after 11 years they tend to get smaller and disappear around adolescence.
How does adenoid become infected?
When your child is exposed to an ill person/kid, he/she can have the virus from the air when the ill one sneezes or coughs. Or when the child touches a toy, cup or anything carrying the ill one’s secretions or being kissed by an ill person, the virus/bacteria can find a way to reach your child’s body after he/she sucks his/her thumb, eats something without washing his/her hands, bites his/her nail, etc, etc….Then the microbe locates at the tonsils or adenoid, grow in amount and does its trick which we all know: nasal drainage, coughing, stuffy nose, sore throat, fever, ear ache….
Especially if your child is in a day care center or has an older brother/sister going to a day care center or school, he/she gets more infected than the others. Studies suggest that the average child will get 8-10 colds per year, lasting 10-14 days each, and occurring primarily in the winter months. This means that if a child gets 2 colds from March to September, and 8 colds from September to March, each lasting two weeks, the child will be sick more than over half of the winter. At the same time, children in a day care environment, exposed to the exchange of upper respiratory tract viruses every day, are expected to have 3-10 episodes of otitis media annually. This is four times the incidence of children staying at home.
What is recurrent adenoiditis and why is it important?
The large adenoid, locating at the back of the nose (which is called nasopharynx) first of all causes stuffiness and breathing from the mouth which is not right for the physiology of respiration and dentition. The chronic mouth breather kids have a high arched palate, malformations of the face and improper alignment of the teeth in their older age. Also if the tonsils are large enough, the child might experience snoring and disturbed sleep (which is called “Obstructive Sleep Apnea”) that leads to daytime sleepiness and/or behavioral problems.
Locating very close to the eustachian tube (an aeration pipe between the ear and the nose), the infections affecting the adenoid also affects the ears. Therefore recurrent adenoiditis can lead to frequent ear infections (acute infectious otitis media), chronic serous otitis media (unresolving fluid inside the middle ear) and even hearing loss.
When should I take my child to a doctor?
If your child has symptoms like:
- Breathing through the mouth instead of the nose most of the time
- Nose sounds “blocked” when the child speaks
- Noisy breathing during the day
- Recurrent ear infections
- Snoring at night
- Breathing stops for a few seconds at night during snoring or loud breathing (sleep apnea), he/she most probably is having an enlarged adenoid or recurrent adenoiditis. You should take her to an Otolaryngologist (Ear, Nose and Throat Surgeon) to prevent future hearing, mental, facial growth and dentition problems.
What Should I Expect At the Exam?
Your physician will ask about problems of the ear, nose, and throat and examine the head and neck. He or she will use a kid-size endoscope or a flexible lighted instrument to see the adenoid. If the child does not cooperate with the physician for endoscopic examination, then X-rays are sometimes helpful in determining the size and shape of the adenoid.
What is the treatment for recurrent adenoiditis?
First step is the medical treatment. Regular irrigation of the nose with saline solutions, using cold vapour machines throughout the winter, using antibiotics if needed are some of the medical treatment methods.
But, if the recurrent adenoiditis causes sleep apnea, recurrent acute otitis media, chronic serous otitis media, facial growth and dentition problems, and recurrent lower respiratuary tract infections, then the removal of adenoid would be the best choice.
Cleft lip-palate and submucosal cleft palate are contraindications for this surgery.
Although there’s a lower age limit in tonsillectomy (which is 3 years), there’s in fact no lower or upper age limit for adenoidectomy unless the child is healthy and ready for anesthesia.
Adenoidectomy is an outpatient procedure and many patients are released after 2-3 hours.