The adenoids lie quite close to the Eustachian tube. This tube connects the back of the throat to the middle part of the ear. Swollen adenoids can block this tube, leading to a condition called secretory otitis media or, more commonly, glue ear. In this condition, fluid collects behind the eardrum causing deafness. This will reduce your child’s hearing until the blockage is relieved. Sometimes enlarged adenoids are responsible for causing recurrent ear infections.
What has gone wrong?
After a lot of repeated attacks of infection, the adenoids may remain enlarged. They may even keep infection trapped inside. You may notice that your child:
- has difficulty breathing through their nose and is a mouth breather
- talks as if the nostrils are pinched
- breathes noisily
- snores while sleeping.
Swollen adenoids can be linked with tonsillitis and are often removed as part of an operation to remove the tonsils, called an adenoidectomy and tonsillectomy. Having said this, adenoid infection does not cause tonsillitis or vice versa.
The aim of an adenoidectomy is to completely remove the adenoids. Your child will have a general anaesthetic and will be unconscious for the operation.
Removing the adenoids from the back of your child’s nose will enable them to breathe more easily through the nose. There will also be less chance of a blockage to the Eustachian tubes, which connect the back of the nose to the ears. An adenoidectomy can prevent further nose and ear problems.
Are there any alternatives?
There are no tablets or medicines that will permanently prevent enlarged adenoids. Antibiotics can make the swelling better but if the adenoids are infected frequently, antibiotics may not work well.
The only way to stop repeated attacks of acute infection is to remove your adenoids. The only way to treat large adenoids blocking the back of the nose is to remove the adenoids.
What if you do nothing?
Your child’s adenoids will eventually shrink away on their own, as they get older. Adenoids usually shrink away by the time a child reaches 12 or 13 years of age. However, until this happens, your child may continue to have problems with breathing and possibly with their ears and hearing.
Who should have it done?
If your child has large adenoids blocking the back of their nose, they should have them removed. An adenoidectomy should also be considered if your child has recurrent ear infections or glue ear.
Who should not have it done?
The following groups of children should not have the operation:
- Children who have problems with the roof of their mouths, called the palate. The floppy part at the back of the roof of the mouth is called the soft palate. This moves to block the nose from the mouth when we swallow so that food and drink does not come out of the nose. When we speak the soft palate also closes off the back of the nose. Some children have a short soft palate but nothing wrong is noticed because the soft palate rests against the adenoids to block off the nose when swallowing and speaking. In these children, if the adenoids are removed, the short soft palate can no longer close off the back of the nose. This causes a nasal type of speech and the possibility of fluids or food coming down the nose. Because of this risk, when assessing a child for possible adenoidectomy all surgeons will check the soft palate. If there is doubt about its movement, adenoidectomy will not be advised.
- Children with a blood disorder, such as haemophilia, which makes them bleed or bruise easily after minor injuries. It may still be possible to do the operation but the doctor will have to take a sample to test the clotting of the blood.
- Children who have other medical conditions that make a general anaesthetic unsafe.
Author: Mr Robert Ruckley MB. ChB. F.R.C.S. Consultant ENT surgeon.
© Dumas Ltd 2006