Enlarged Adenoid

Adenoid is a tonsil located in the upper posterior wall of the nasopharynx. Unlike two tonsils located in the oral cavity, the adenoid is lees known as it is not visible by naked eye and it usually causes no problems. However, the adenoid tissue may cause certain troubles in children.


Functionally, the adenoid tissue has the same purpose as the oral tonsils – protection against infections. Tonsils work as a first-line defense position that destroys microorganisms that have entered our airways in inhaled air. Adenoid tissue is located very closely to opening of Eustachian tubes. Eustachian tube is the only connection between the middle ear and nasal cavity. This is very important as you can read below.


Enlargement of adenoid may have unclear cause, or it is related to frequent infections of the upper respiratory tract. Repeated infections lead to growth of lymphoid tissue in the tonsil and its enlargement.


Enlarged adenoid may narrow the nasal cavity, typically in horizontal position when sleeping.  The child begins to snore during sleep in breathes by mouth when awake. The child tends to have opened mouth and therefore, it may have dull facial expression. The sleep quality is unsatisfactory, the child is tired, annoyed and may repeatedly fall sleep during the day.


In addition, the adenoid may close the openings of Eustachian tube on one or both sides of the nasopharynx. As the tube is the only communication between the middle ear and nasopharynx, various impurities and products of local mucosa may accumulate in the middle ear. Such condition is a great for bacterial presence and the child suffers from repeated middle ear infections. These are quite painful (strong ear pain) and they are associated with accumulation of pus in the cavity of the affected middle ear.




Diagram - Enlarged adenoid pressing the mouth of the Eustachian tube



If there is suspicion of enlarged adenoid, it is advisable to perform basic otolaryngologic examination. The doctor can use special tools (such as little mirrors) to observe the adenoid and to evaluate its size.


The only proper solution is otolaryngologic surgical intervention, during which the hyperplasic tissue is removed. This procedure can be performed either in total or local anesthesia (however, total anesthesia is preferred).


Jiri Stefanek, MD  Author of texts: Jiri Stefanek, MD
 Contact: jiri.stefanek@seznam.cz
 Sources: basic text sources