Adenoids & Tonsils: What happen when they enlarge in children I Dr Ankit Parakh, Child Pulmonologist

What are Adenoids?
Tonsils and adenoids are similar to lymph nodes found in the other part of the body. Tonsils can be seen as small lumps in the throat (as in the figure). Adenoids are similar to the tonsils but at the back of the throat and high up. Adenoids cannot be seen through the nose or the mouth.
Normally the adenoids are small in size but sometimes they can be enlarged and can block the breathing airway (as shown in the accompanying figure).

What symptoms will we find if adenoids are increased in size?
If adenoids are enlarged they would make breathing through the nose difficult. They can also lead to breathing difficulty during sleep.

Other signs could be:
Chronic mouth breathing (due to nasal block)
Unclear speech (more nasal sounds)
Regularly runny nose
Frequent ear infections
Snoring during sleep

Pauses in breathing & occasionally stoppage of breathing for a few seconds at night during sleep. This condition is called as sleep apnea.

Which investigation would help us to diagnose Adenoids?
Xray of the neck is a useful investigation to pick up an adenoid hypertrophy. It also helps us to assess the size of the adenoid.
Some children might need additional tests h4ke a nasal endoscopy for diagnosis.

What are the problems associated with enlarged adenoids?
1. Children with adenoids can have problems with speech development, persistent mouth breathing leading to changes in the facial appearance and dental problems h4ke teeth malocclusion.

2. Since the enlarged adenoids can obstruct the Eustachian tube (a tube connecting the ear and nose), children are more predisposed to ear infections. Some children would get a condition known as “Glue Ear”. In this a sticky fluid get accumulated in the ear and lead to hearing impairment. These issues need to evaluated carefully.

3. The other extremely important problem associated with adenoid enlargement is Sleep Apnea. Sleep apnea is a highly under-recognized problem with adenoid enlargement. The details can be found in the obstructive sleep apnea section.

How does a sleep study help?
Many children with adenoid enlargement do not have any problems related to ears or speech. They would be just be snoring at night.

In such situations it is extremely important to assess whether the child has sleep apnea or not. It is important to understand that the size of the adenoid on the Xray and clinical symptoms cannot predict whether a child has sleep apnea.

Sleep study is useful in such situations to assess sleep apnea. This would help to decide further management.

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..................................................................................................................................................................... Dr Ankit Parakh, Senior Consultant Pediatric Pulmonology, Allergy & Sleep Medicine
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