Adenoids and adenoid removal

Adenoids are much like tonsils but while tonsils are found at the sides of your mouth, adenoids are found at the back of your nose. They protect your body by preventing harmful particles from inhaled air getting into your body. As beneficial as they may be, sometimes they become more bothersome by causing problems such as blockages and infections among other conditions. Mr Mike O’Connell specialises in a wide range of ear, nose and throat (ENT) procedures, and here he explains adenoid problems and adenoid removal.

What are adenoids?

Adenoids are similar to tonsils and are found at the back of the nose. They are more prominent during the first years of life but tend to disappear in most people by seven to ten years old. Adenoids, just like tonsils, are made of lymphoid tissue. This tissue forms part of the body’s immune system that protects it from infections.

Inhaled air that passes through the nose contains particles that stick to the adenoids. If the particles are harmful, a protective immune response starts. The adenoids are important, although not essential, to building up a child's protection system in the early years of life. Tonsils, which are found on either side of the mouth, perform a similar function.

Why have them removed?

Adenoids can cause a number of problems, mostly in children. Because they are found at the back of the nose, which is the main entry route for viruses that cause colds and flu, they are vulnerable to infection. Allergic responses to pollens and dust can also cause adenoid problems. Furthermore, viruses can reside in the adenoids, causing local infection, swelling and blockage of the Eustachian tubes to the ear.

What are the main adenoid problems?

Adenoids are removed when they are large enough to block the nose, resulting in difficulty breathing and a nasal voice (as if you had a permanent cold). Furthermore, they can block the Eustachian tubes to the ear. This causes deafness in children, commonly known as glue ear, and also allows the infection to reach the ear, resulting in ear infection (acute otitis media).

Sometimes adenoidal blockage of the nose is related to sleep apnoea, a condition in which patients have occasional difficulty breathing at night. It’s characterised by repeated breath-holding for up to 30 seconds. Very rarely, adenoids are biopsied for an unusual cause of swelling, but this is almost entirely restricted to adults. Also, they are a major producer of catarrh (excessive mucus build-up) or snot in children, but this usually settles in the first decade of life.

What are the symptoms of adenoid problems and swelling?

Symptoms of adenoid problems are:

• Acute ear infections – medically referred to as acute otitis media. These infections are found in very young children (from 12 months onwards). Symptoms are sudden earache on one or both sides, fever, tiredness and reduced hearing capability.
• Glue ear - this is the blockage of the Eustachian tubes at the back of the nose. Symptoms are hearing loss, poor speech and unsteadiness. This is more noticeable from three years old onwards and tends to resolve by seven to ten years old. Very few children carry glue ear to teenage life.
• Nasal blockage - large adenoids can block the back of the nose, so patients have "nasal" voices. This is unusual in adults where other problems cause nasal blockage.
• Catarrh (excessive mucus build-up) or green snot – this is often associated with enlarged adenoids, particularly in children.
• Snoring – snoring, particularly in children, is caused by large adenoids and can be very loud.
• Sleeping problems - in children, a condition known as obstructive sleep apnoea is common. Parents remark that their children "hold their breath" for up to 30 seconds and have repeated episodes during the night, which breaks up their sleep pattern resulting in daytime tiredness and reduced concentration. Such problems should be investigated. Similar symptoms are found in adults but for different reasons.
• Swollen neck glands – these are often associated with adenoid problems.
• A dry mouth or sore throat – this is also associated with adenoid problems.

What are the side effects of adenoid removal?

An adenoidectomy (the removal of adenoids under general anaesthesia) is a routine, low-risk procedure and fortunately, complications following surgery are rare. The main risks and side effects are:

• Bleeding - this can occur through the nose or mouth. Your doctor should be contacted if there are bleeding-related concerns. Occasionally, the patient will need to be readmitted to hospital.
• Fever - this indicates that there is a post-operative infection. However, these respond quickly to antibiotic treatment.

• Ear pain – this commonly settles in the first few days after surgery.

• Swallowing problems (dysphagia) – these are extremely uncommon.
• Bad breath - this usually reflects the method used to remove the adenoids and is more common when heat is used to vaporise the tissues (electrocautery). It settles quickly and sometimes requires a course of antibiotics.

At what age can adenoids be removed?

The removal of adenoids (an adenoidectomy) can be performed from the first year of life onwards, although it is rarely undertaken before a patient is two to three years old. The operation is uncommon in adults, partly because adenoids mostly disappear by the age of ten, and even if they don’t, they tend not to cause problems in adults.

Does breath stink after adenoid removal?

Bad breath is sometimes reported after an adenoidectomy, but only when electrocautery is used. This settles in the first few days but if it persists, a short course of antibiotics can help to resolve the problem.

Visit Mr Mike O’Connell’s Top Doctors profile to view his wide range of ear, throat and nose expertise and to book a consultation.