What are enlarged adenoids?

My five-year-old son has difficulty breathing. At first, I thought it was asthma. I took him to the paediatrician, and was told that he has enlarged adenoids. I have never heard about adenoids. What are they?

Adenoids are a single clump of tissue at the back of your nose, which is also called the nasopharynx.

To find them, a paediatrician or ear, nose and throat surgeon can look up the back wall of your throat. Adenoids are located about 2.5cm above your uvula (which is the little pendant-shaped tissue that hangs down from your soft palate).

In children, adenoids usually shrink after age five and disappear when they turn into teenagers.

Are they the same as tonsils?

No. Your tonsils are two pieces of tissue which are located on either side of your throat - in the left and right grooves of your palate. They abut against either side of your tongue and are located far at the back of your throat.

What are adenoids useful for? Why do they exist?

Adenoids serve the same purpose as your tonsils - they consist of lymphoid tissue which contains lymphocytes. These are extremely important in producing antibodies to fight off infections.

Your adenoids and tonsils are not the only places where lymphoid tissue exists, of course. It also exists in your gut.

Adenoid tissue can temporarily swell during an infection because the lymphocytes proliferate (become more numerous) as your body tries to fight off the bacteria or virus.

How would I know if I have enlarged adenoids?

Enlarged adenoids are mostly a childhood disease. They can cause:

·Difficulty in breathing through your child's nose, and reduction of his sense of smell

·Noisy breathing

·Mouth breathing

·Your child may talk as if his nostrils have been pinched


·Sleep apnoea (this is what happens when your child sleeps, and stops breathing for a few seconds, only to start breathing again)

·Frequent "sinus" infections

·Frequent middle ear infections

The paediatrician suggested that I should have my son's adenoids removed. I am hesitant. Won't they shrink on their own when he gets older?

Surgery is only necessary if these enlarged adenoids are really bothersome to your child, and especially if medications like antibiotics cannot control them.

Surgical removal of your child's adenoids is called adenoidectomy. This is usually recommended when:

·Your child has difficulty breathing. It's very distressing to your child to keep experiencing this. Your child's sleep, eating and schoolwork may be affected.

·Your child has sleep apnoea. This disrupts his sleep and can make him tired, sleepy during the day and irritable. He can also fail to concentrate and lose focus. When sleep apnoea continues for a long time, your child's growth and development may be affected - including physical development (e.g. face and teeth structures).

·Your child has recurrent infections, especially that of the middle ear, and sinus. If his adenoids are perpetually swollen, they can block the Eustachian tube - the tube that connects the middle ear to the throat. Bad middle ear infections can lead to hearing loss.

Yes, your child's adenoids will regress one day. But if you have to wait years and years for this to happen on its own, it might not be worth the price your child has to pay.

The paediatrician also suggested that I should have my son's tonsils removed together with his adenoids. Is this common?

Yes, it's quite a common thing for tonsillectomy to be done with adenoidectomy, but only if your child's tonsils are enlarged or giving trouble too.

Very often, when doctors leave the tonsils in during an adenoidectomy, the tonsils themselves become enlarged and give rise to obstruction.

Is this adenoidectomy procedure very difficult? Must it be done under general anaesthesia? I'm afraid about my son going under GA at so young an age.

General anaesthesia is nowadays very safe, so don't worry. The actual procedure itself is quite simple and takes only five to 15 minutes. But your son has to be put under GA because it is quite distressing for a child to have to go under the surgical knife while awake for so long, especially since it involves his mouth and throat.