Adenoids or adenoid vegetations are enlargement of the adenoids in the throat. They are a typical problem of childhood and can lead to various health disorders. It is not uncommon for adenoids to require surgical removal.
What are adenoids?
Waldeyer’s ring of pharyngeal adenoids consists of the lingual tonsil, palatine tonsil, and pharyngeal tonsil. Adenoids or adenoid vegetation is the term used to describe enlargement of the pharyngeal tonsils, for which physicians also use the term hyperplasia. Enlarged adenoids can become a mechanical problem by constricting the nasopharynx and/or leading to chronic inflammatory changes that affect not only the pharynx, but also the lungs and middle ear. Affected are almost exclusively children between the ages of 3 and 7, since the adenoid tissue regresses with puberty; in adults it has often disappeared completely. Adenoids do not represent a disease in themselves, they only become problematic when they cause health complaints. In common parlance, adenoids are incorrectly referred to as polyps.
Causes
The adenoids are located at the roof of the nasopharynx and, together with the palatine tonsils, are part of the lymphatic pharyngeal ring, which serves to defend against pathogens that have entered through the nose and mouth. The defense function is taken over by lymph follicles, which are located in the tissue of the tonsils and become active as soon as they come into contact with pathogens. The enlargement of the pharyngeal tonsils is due to the increase in size and number of active lymphoid follicles, a complicated immunological process that sets in motion a vicious circle:
The inflammatory reaction serving the defense leads to the enlargement of the pharyngeal tonsil, resulting in a congestion of secretions in the tonsillar tissue, which in turn promotes further inflammatory reactions.
Symptoms, complaints, and signs
Adenoids can cause various symptoms and discomfort in the nasopharynx. Individuals who suffer from enlargement of the adenoids usually snore more and awaken more frequently. The disturbed sleep can lead to chronic fatigue. Affected children often lack concentration and perform worse in school than children without enlarged adenoids. There is also often nasal speech, which is mistaken for mumbling. An external characteristic is also the slightly open mouth. This phenomenon also occurs during the day and promotes inflammation of the oral cavity and respiratory tract. Affected individuals are also more susceptible to colds and coughs. In some cases, adenoids can cause hearing problems, such as hearing loss in one or both ears. Accompanying this is an increased risk of middle ear infections and chronic inflammation of the nasopharynx. In the worst case, chronic bronchitis develops, which is manifested by breathing difficulties, sputum, cough, pain in the throat and general malaise, among other symptoms. Based on this diagnosis, adenoid vegetations can be detected and treated at an early stage. If the adenoids are not surgically removed, developmental delays and problems with speech development can occur, often persisting into adulthood.
Diagnosis and progression
Adenoids can lead to obstruction of nasal breathing and secretion drainage through the nose, snoring, and breathing disorders or pauses during sleep. As a result of disturbed sleep, children become chronically tired and unable to concentrate. Breathing is predominantly through the mouth, which is why affected children often have their mouths open. The obstruction of nasal breathing promotes chronic inflammation of the nasopharynx, including bronchitis, and also affects the middle ear, for whose proper functioning normal nasal breathing is important. The result is frequent middle ear infections, which in the worst case can lead to hearing loss, hindering children’s speech development. The general development of the children is also impaired by the frequent infections and sleep disturbances. Diagnosis is made by a clinical ENT examination, during which the throat is inspected.
Differential diagnosis
Diseases such as choanal atresia and juvenile nasopharyngeal fibroma must be excluded.
When should you see a doctor?
Adenoids are a natural phenomenon and usually do not require further medical clarification. However, if health problems arise as a result of enlarged tonsils, a doctor should determine the cause and remove the adenoids if necessary. Growths of the pharyngeal tonsils require clarification as soon as complaints such as nasally speech, intensive snoring or infection in the mouth and throat area occur. If these symptoms persist for more than a month, a doctor should be consulted. An immediate visit to the doctor is necessary if flu-like symptoms such as fever or ear pain occur. It is possible that an acute middle ear infection has already developed, which must be treated immediately. Apart from this, adenoids must be taken to the doctor if the enlarged tonsils affect the general condition or have a negative effect on the state of health in any other way. The above symptoms usually appear between the ages of three and six and are an indicator of enlarged adenoids. Whether treatment is necessary depends on the nature and intensity of the symptoms, as well as possible pre-existing conditions. In general, if adenoid vegetations are suspected, they should be discussed with the pediatrician in charge so that further steps can be taken.
Treatment and therapy
Adenoids can only be removed by surgery, in which the enlarged tonsil is peeled out with a special instrument. The procedure usually takes only a few minutes and is performed under general anesthesia. In contrast to the surgical removal of the palatine tonsils, which is associated with a certain risk of postoperative bleeding, the removal of the pharyngeal tonsils is usually possible on an outpatient basis. The prerequisite is that the affected children do not have any serious underlying diseases or coagulation disorders, that reliable care by guardians is ensured throughout the first 24 hours after the procedure, and that the journey to the surgeon is not too far in the event of problems. In the first days, swallowing difficulties and a swelling-related obstruction of nasal breathing and ear pressure are possible. Postoperative bleeding is extremely rare, accounting for 0.8% of all operations, and requires medical intervention even less frequently. Surgery is only performed if the affected children actually have serious health problems, suffer from frequent infections, have difficulty sleeping and thriving, or suffer from severe respiratory diseases such as asthma independently of adenoids. Moreover, the operation is not without controversy: Since the revenge tonsil tissue recedes at the latest with the onset of puberty, it is quite possible that the problems caused by the adenoids will disappear with it.
Outlook and prognosis
As a rule, inflammation of the tonsils and colds occur relatively frequently in this disease. The affected person thereby suffers from flu, cough, from colds and thus a reduced quality of life. It is not uncommon for the disease to affect and increase snoring. If necessary, the increased snoring can also lead to discomfort in a relationship and to problems with the partner. In some cases, speech also becomes more slurred, which can lead to social problems and problems in everyday life. Furthermore, as the disease progresses, there is pressure on the ears, often leading to hearing problems. However, the patient does not suffer a complete loss of hearing. Similarly, middle ear infections often occur, making everyday life more difficult. Children often appear tired and listless due to the disease and can no longer concentrate. In most cases, it is possible to remove the adenoids through surgery, with no further complications or discomfort. The symptoms disappear completely after the surgery. Only in rare cases, postoperative bleeding may occur after the procedure.
Prevention
The development of adenoids and their sequelae cannot be prevented by preventive measures, because ultimately it is the result of the normal immune defense of the lymphatic pharyngeal ring. However, frequent infections of the nasopharynx, middle ear infections, mouth breathing, and sleep disturbances should prompt parents to clarify the cause by an ENT examination and seek advice.
Follow-up
The person affected by this disease is primarily dependent on a quick and, above all, an early diagnosis. Only this will prevent and limit further complications or discomfort.If this does not result in treatment, the symptoms of this disease usually continue to worsen. For this reason, a doctor should be consulted at the first signs and symptoms of this disease, so that there are no further complications or complaints. The sooner the doctor is contacted, the better is usually the further course of the disease. The treatment itself is usually performed by surgery, which usually takes place without complications. After the operation, the patient should rest and take care of his body. Efforts or stressful activities should be avoided in any case, so as not to put unnecessary strain on the body. Those affected are usually dependent on the help and care of their family or relatives, so that no further complaints arise. As a rule, the life expectancy of the affected person is not reduced if treatment is successful.
Outlook and prognosis
After the adenoid is surgically removed, most children are free of further symptoms. It may be necessary to surgically remove the regrowth of tonsils again during follow-up treatment. If there is tympanic effusion, it may be necessary to treat with long-term tympanic drainage.
What you can do yourself
The development of adenoids can most likely be prevented by a well-functioning immune system. Especially for people with pre-existing conditions, a healthy lifestyle is a good idea. This should include sufficient exercise, a varied diet and sufficient sleep. This gives the body the opportunity to effectively fight viral and bacterial pathogens and thus prevent the symptoms. If painful swelling occurs, it is recommended to see a doctor promptly. Early treatment can possibly prevent the chronic course of the disease, with its associated complications. If symptoms are already present, those affected should give priority to eating soft and cool foods. This helps to avoid further irritation of inflamed areas. Strong seasoning of food should be avoided, as should the consumption of acidic products. Both can lead to a sore throat. Ice cream, on the other hand, can help to relieve swallowing pain. Since smoking promotes the formation of inflammation, it should be avoided at all costs. When choosing a drink, fruit juices should be avoided, as the acid they contain irritates the throat. Anti-inflammatory liquids such as sage or peppermint tea are better suited.
