Adenoids are the small masses of lymphatic tissue located above the tonsils. They sit in the part of the throat that meets the nasal passage (naso pharynx). Like the tonsils, the adenoids help guard against upper respiratory tract infections. Adenoid disorders—also known as adenoidism or adenoiditis—occur when the adenoids become swollen, causing difficulties in breathing and swallowing. Although adenoidism is common in toddlers and young children, no one knows why. It is thought that adenoids become enlarged as a result of frequent colds or allergies.
WHEN SHOULD I SUSPECT THAT MY CHILD HAS AN ADENOID DISORDER?
Children with adenoid disorders characteristically breathe through their mouths and have nasal voices. They also may snore. Development of these or any other chracteristic symptoms should arouse your suspicions.
If a child has tonsillitis, her tonsils will appear larger and redder than usual. But adenoid disorders are much more difficult to detect. Adenoids, because of their location, cannot be seen by simply looking into the mouth. A special viewing instrument is needed.
WHEN SHOULD I CONSULT THE DOCTOR?
Don't worry about an occasional stuffy nose. Do consult a physician if symptoms such as runny nose, labored and noisy breathing, snoring or unusual sleep patterns persist.
A generation ago, "T&A" (surgical removal of the tonsils and adenoids) was performed on an almost routine basis. Even today it remains the most frequently performed childhood operation.
IS MEDICAL ATTENTION NECESSARY?
A doctor may first suggest waiting to see if a child outgrows the problem. Children's adenoids grow primarily in the early years—usually up to about age five. Then the adenoids gradually shrink. By puberty, most children's adenoids have disappeared.
If the swelling persists, the doctor may recommend antibiotic treatment to eliminate possible bacterial infection, which could be the cause of an adenoid disorder. It is important to follow the doctor's orders about the timing and size of antibiotic doses and to continue the medication for as many days as the doctor prescribes, even if problems have disappeared.
If the adenoid problem is caused by respiratory allergies, treatment may be aimed at reducing allergy symptoms. Allergy control may gradually reduce swelling in the adenoids.
WHEN DOES SURGICAL REMOVAL OF ADENOIDS BECOME NECESSARY?
If all other treatments fail and a child continues to suffer from an adenoid disorder, the doctor may recommend surgical removal of the adenoids (adenoidectomy). The operation should take place only after careful evaluation by an ear, nose, and throat specialist (an otolaryngologist). In general, children should not have the operation until they reach school age. If a bacterial infection has occurred, surgery should be delayed two to four weeks after it has cleared up.
WHEN SHOULD ADENOIDS BE REMOVED?
According to the American Academy of Pediatrics, adenoid surgery is recommended if:
• Blockage from the adenoids interferes with a child's normal breathing.
• Swollen adenoids make breathing uncomfortable and severely impair speech
In addition, adenoid surgery should be considered if:
• A child has had seven severe episodes of strep throat or some other type of sore throat accompanied by high fever, swollen lymph nodes and pus in the throat
• A child has had five serious sore throats (fitting the above description) in each of two separate years, or three serious sore throats in each of three separate years
• A child has had swollen glands in the throat for six months or more despite antibiotic treatment
• A child has recurrent ear infections that do not clear up even after treatment
• The child has sleeping difficulties
WHAT HAPPENS DURING ADENOID SURGERY?
First, an anesthesiologist administers general anesthesia so that the child sleeps through the operation. Then the surgeon—an otolaryngologist or a general surgeon—removes the adenoids using a small tool with a basket on the end. The adenoids are cut off and caught in the basket. Pressure is applied to minimize bleeding. Stitches are unnecessary. The surgery is usually over in less than 30 minutes.
SYMPTOMS OF ADENOID DISORDERS
• Stuffy nose
• Noisy breathing through the mouth
• Difficulty swallowing
• A nasal voice
• Loud snoring at night
• Periodic cessation of breathing while sleeping (sleep apnea)
• Raspy cough after waking in the morning
• Bad breath
• Swollen glands
• Repeated ear infections or sore throats
CARING FOR A CHILD AFTER ADENOID SURGERY
• Stay with the child as much as possible during hospitalization, which may be needed for one to three days after adenoid surgery.
• Administer acetaminophen (brand names include Tylenol, Tempra, Panadol and others) to relieve discomfort.
• A soft, bland diet is recommended. Avoid hot, spicy or coarse foods—chips, nuts, crackers—for about a week. Don't forget the ice cream!
• Most children are back to normal in two to three weeks, although they should avoid strenuous exercise for about a month.
