Adenoids: what they are, symptoms and treatment

By Cristiano Antonino On Jan 19, 2023

Adenoids or also called pharyngeal tonsils are lymphoid tissue, located behind the nasopharynx, i.e., in less technical terms, at the back of the nose

There are also other tonsils, the palatine tonsils, located in the oral cavity at the back and sides of the mouth.

Finally, inside our mouth even more posteriorly and inferiorly there are two other, lesser known tonsils, present at the root of the tongue which are called lingual tonsils.

This rich lymphatic tissue constitutes, in medical language, ‘Waldayer’s ring’.

The main function of all these organs is defensive, because they protect the respiratory tract from atmospheric microorganisms or any insult that may enter the body through air and food.

Adenoids can become inflamed when the airways are affected by infections caused by viruses

Viruses such as Rhinovirus, and by bacterial biofilms, such as Group A Streptococcus beta-Hemolyticus, Streptococcus Pneumoniae, Mycoplasma and Chlamidia Pneumoniae Moroaxella Catharralis, Strepococcus Pyogenes, and Haemophilus Influenzae.

When they become acutely or recurrently infected, they can increase in volume and hypertrophy.

An unpleasant situation that can lead to the onset of various pathologies, caused precisely by the clogging of the retronasal respiratory space.

The consequence of having infected or inflamed adenoids is that they swell and make nasal breathing and middle ear ventilation very difficult.

The most frequent diseases of the adenoids are:

Infection – adenoids infected by bacteria, viruses or fungi.
Hypertrophy – permanently enlarged adenoids due to recurrent infections or allergic reactions.
Problems always related to these organs can also be hereditary or anatomical, and sometimes hypertrophy can already occur in the foetus, within the womb.

The typical symptoms of enlarged adenoids can be various, the main ones of which are listed below:

fever and rhinorrhoea with serous or mucus-purulent nasal discharge. Sometimes, in cases of acute infectious adenoiditis, rhinitis, otitis and sinusitis are also associated;
more or less apnoeic snoring is typical of diseases of the upper respiratory tract (rhinitis, pharyngitis, sinusitis etc.), in the case of hypertrophic adenoids it is permanent;
daytime sleepiness, a typical symptom of sleep-related disorders. It is no coincidence that adenoids are among the causes of Obstructive Sleep Apnoea Syndrome (OSAS);
sleep apnoea, pauses in ventilation during sleep;
open-mouth breathing, because nasal ventilation is physically impeded, the person reacts naturally and spontaneously by opening their mouth. This is a signal that may go unnoticed in toddlers. Keeping the mouth open is often interpreted by parents as a ‘vice’. Nothing could be further from the truth, as no child breathes with its mouth open if nasal resistance is not high. Usually in young children, the adenoids hypertrophy spontaneously around 10-12 years of age, but it is essential to understand whether during these years, which are so important for the child’s psycho-physical development, they are in a condition to alter their regular development;
development of an ogival palate (narrow palate due to the habit of breathing through the mouth), which often forces one to resort to orthodontic appliances to expand the palate;
nasal voice, caused by limited communication between the nose and pharynx. And this is a typical symptom in children that can sound the alarm of inflamed and exacerbated adenoids.

Adenoid hypertrophy can lead to certain complications:

recurrent otitis of the catarrhal type, caused by tubal occlusion (they can often cause perforation of the eardrum, with discharge of fluid from the ear or stagnation of phlegm in the middle ear) resulting in persistent hearing loss;
relapsing fever, caused by frequent infections, especially in the winter months;
in children, it also manifests itself through persistent lack of appetite;
altered palatine structure and dental malocclusion, caused by the respiratory alteration;
growth defects in weight and height.

What to do in the case of inflamed adenoids

In the presence of any of the symptoms listed above, it is necessary to contact the general practitioner or directly the ENT specialist.

Once a diagnosis of adenoiditis has been made, a number of measures can be taken, such as

daily nasal hygiene
clean the inside of the nose with physiological saline solution to be instilled several times a day. This is especially useful for young children who cannot blow their noses;
adopt a position to facilitate breathing at night. The use of a pillow under the mattress at head height may be helpful;
use night humidifiers in rooms with a dry atmosphere.
stay hydrated to keep any nasal secretions fluid and easier to clear;
practice aerosol with physiological saline solution or Sirmione water while waiting for treatment.

In the case of inflamed adenoids in young children, it is advisable to

facilitate chewing and swallowing when feeding, as without the use of the nose it is impossible to chew and breathe at the same time. This requires food that should not remain in the mouth for a long time. Specialists recommend swallowing foods that are easy to chew, such as vegetable purées, broths, velvety soups, and among main courses, eggs, cheeses and soft meats and fish, at medium or room temperature. Helping the intestinal bacterial flora is helpful in supporting the immune system, which is often affected by antibiotic therapy.

Nutrients such as the intake of vitamin C or ascorbic acid contained mainly in acidic fruit and raw vegetables such as peppers, lemon, orange, grapefruit, mandarin orange, parsley, kiwi, lettuce, apple, chicory, cabbage and broccoli are also recommended. Also vitamin D or calciferol, found mainly in fish, fish oil and egg yolk. Magnesium mainly contained in oil seeds, cocoa, bran, vegetables and fruits. Iron mainly in meat, fish products and egg yolk.

observing them while they sleep: this is necessary to establish the severity of the disorder (presence of apneas, duration, etc.);
drug therapy: varies according to age; young children do not tolerate the same drugs as adults. Generally, it consists of anti-inflammatory drugs and/or antibiotics and/or antihistamines. For viral infections, remission is usually spontaneous and occurs in about 48 hours;
if drug therapy does not produce the desired effects, a microbiological culture may be required to identify a specific drug. The bacteria most often involved are streptococci, moraxella and staphylococci.
surgery, to be used only when drug therapy fails. In children, some doctors recommend surgery before school age to avoid complications in learning and language development;
post-surgical rest, to avoid bleeding and/or infection. It lasts at least 7-14 days. The subject can drink fluids almost immediately and can use medication to limit pain.

Care and treatment

After a careful specialist examination and ascertaining the presence of inflamed adenoids, a variety of medical therapies can be proposed, ranging from natural therapies such as nasal washes to aerosol therapy (with mucolytic and cortisone drugs), from nasal decongestants and antihistamines to the use of antiphlogistic drugs.

Of course, in cases with acute inflammation of the middle ear, antibiotic and cortosonic drugs are used.

How to prevent adenoid hypertrophy

Prevention, as with any pathology, is very important even in the case of adenoids so as not to reach levels of infection that require the use of more aggressive drugs and, in the most serious cases, recourse to surgery.

It is therefore crucial to pay attention to symptoms, especially in younger children.

To prevent acute adenoiditis, immunostimulant drugs (e.g. bacterial lysates) are generally prescribed, and more recently topical drugs (e.g. Resveratrol) have been introduced, which reduce the viral load responsible for 50-80% of respiratory first airway infections.

Thermal therapies are also curative: sulphurous and bromine and iodine-salt waters are the most indicated.

Natural remedies

Prevention or in cases of mild inflammation can also be done through natural remedies such as herbal teas based on:

chamomile (matricaria recutita L.), provides relief to oedematous mucous membranes, thanks to its anti-inflammatory, sedative, bactericidal and antifungal properties;
echinacea (Echinacea angustifolia) has antiviral, immunostimulant, antibacterial and anti-inflammatory properties. It can be taken in syrup or tablet form.
propolis, antimicrobial, antifungal, antiviral activity (also in the form of sucking tablets).
spirea (spirea meadowsweet), shows anti-inflammatory and calming effects (the extract contains antipyretic salicylates and).
mint (Mentha piperita), has balsamic, decongestant and anti-catarrhal properties.
bitter orange (Citrus aurantium L. var. amara), which has disinfectant, decongestant and anti-inflammatory properties;
eucalyptus (Eucalyptus globulus Labill), which contains anti-inflammatory, expectorant and balsamic molecules.
balsamic essential oils diffused in the environment mainly menthol, and eucalyptol.

Drug treatment for viral adenoiditis

If the prescribed therapy involves the administration of medication, in the case of viral adenoiditis the administration of analgesics and antipyretics such as

salicylates: acetylsalicylic acid (e.g. aspirin ®), contraindicated under the age of 14;
propionic acid derivatives: ibuprofen (e.g. Moment ®), naproxen (e.g. Xenar ®), ketoprofen (e.g. Ketodol ®), dexketoprofen (e.g. Enantyum ®) and flurbiprofen (e.g. Benactiv throat ®)
acetic acid derivatives: ketorolac (e.g. Toradol®), diclofenac (e.g. Dicloreum®) and indomethacin (e.g. Indoxen®)
sulfonylidics: nimesulide (e.g. Aulin®);
enolic acid derivatives: piroxicam (e.g. Brexin®), meloxicam (e.g. Leutrol®), tenoxicam and lornoxicam;
phenamic acid derivatives: mefenamic acid (e.g. Lysalgo®) and flufenamic acid;
selective COX-2 inhibitors: celecoxib (e.g. Artilog®) and etoricoxib (e.g. Algix®);
antipyretic analgesics;
paracetamol: e.g. Actigrip®, Buscopan compositum®, Codamol®, Efferalgan®, Panadol®, Tachipirin®, Zerinol®.

Antibiotic drugs can be used for bacterial adenoiditis:

Amoxicillin and clavulanic acid: e.g. Augmentin®, Clavulin®;
Cefalosporin: e.g. Cefaclor®, Cefixoral®, Cefporex®.

What are the indications for surgical therapy?

The clinical indications for adenoidectomy are:

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recurrent adenoiditis with recurrent or chronic rhinorrhoea (mucus-pus discharge from the nose);
obstructed nasal breathing with forced oral breathing (open mouth) and snoring at night, especially if aggravated by apnoea episodes;
sleep disorders, with sudden awakenings, nocturnal enuresis (bed-wetting) and daytime sleepiness;
recurrent otitis with tubal occlusion, and decreased hearing ability (conductive hearing loss) that persists for 6-12 months;
growth and behavioural disorders as a consequence of poor blood oxygenation (chronic cerebro-tissue hypoxia) manifested by psycho-motor agitation, restlessness, inattention, irritability, etc.; and
feeding difficulties and speech abnormalities (nasal voice, speech delay, dyslalia with altered pronunciation of certain consonants);
dental and palatal growth abnormalities resulting in facial dysmorphism.

Beware, it is very important to know that a late diagnosis can lead to tubal narrowing and/or closure, resulting in chronic ear suffering and hearing damage, which can sometimes be permanent.

In children, recovery is not always achieved despite the use of medical therapy.

In this case, the specialist will recommend surgical removal of the adenoids by adenoidectomy.

The operation is performed under general anaesthesia.

Generally, and even in the smallest cases, the hospital stay is short; it is a one-night operation.

Adenoid hypertrophy is often curable with medical therapy

In more advanced cases complicated with chronic serous otitis media and recurrent otorrhea that are resistant to medical therapy, a myringotomy with the insertion of a ventilation tube (neo-tube) inserted through the tympanic membrane may be necessary in order to re-establish normal organ function.

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