The term ‘Adenoids’ refers to a lump of lymphoid tissue at the back of the nasal cavity, right above the soft palate. This is the junction between the nose and the throat. This tissue, like the tonsils, is responsible for the production of white cells that help us fight infection.
Adenoids in children cause problems because of their size and because they become infected. In children aged between 2 and 4 years the adenoids are relatively big compared to the small size of the space at the back of the nose (so-called postnasal space). Sudden expansion of the adenoids can occur following colds. Children with certain skull configurations, such as in Down’s syndrome, can have a relatively small postnasal space.
Infection of the adenoids occurs often when young children start attending playschool or if older siblings bring infections home from school. The lymphoid tissue at the back of the nose swells and starts producing mucopus. Often, tonsils may swell up as well at the same time.
One immediate problem of adenoid size is nasal obstruction, with snoring at night, mouth-breathing, shortness of breath on exertion or bad breath (halitosis). Such children are often restless at night due to inadequate oxygenation and adopt a particular posture with their head extended, in order to maximize air entry. Long-term dental problems associated with growth of the upper jaw are also possible.
Thick mucopus dripping back into the throat causes irritation of the larynx (voice-box) with chronic cough in spite of the doctor hearing a clear chest. This cough is usually worse at night. Accumulated mucupus often provokes vomiting in the morning. Poor appetite is also a feature.
An important associated feature of enlarged infected adenoids may be ‘glue ear’, where thick fluid accumulates and persists behind the ear-drums. Glue ear is thought to be associated with malfunction of the Eustachian tubes connecting the back of the nose to the middle ear cavity. This condition causes transient recurrent earache, hearing loss, impaired speech development, behavioural abnormalities and poor school performance.
Although most doctors would give long-term antihistamine syrup to help such children, surgical removal of the adenoids is carried out when symptoms persist with persistent breathing problems or cough. Other procedures may be carried out at the same time, such as insertion of ventilation tubes in the eardrums (grommets) if persistent glue ear is present.
Adenoidectomy is a short procedure usually lasting less than 15 minutes. It is carried out through the mouth under general anaesthesia. Children are admitted and discharged the same day. 4 to 6 hours of starvation are required pr-operatively so if children are admitted early in the morning straight after wakening there is only a short wait till surgery. After-effects include a sore throat for approximately 24 hours. After the operation red sauces and oranges are avoided for a few days as they may irritate the throat. Simple analgesics like paracetamol may be taken. Otherwise most foods are allowed.
As mentioned above, children having these problems are between 2 and 4 years of age, although they occasionally may be younger, depending on the other indications for surgery.
©Mr. Adrian M Agius