“What the heck are adenoids, and why does the doctor want to remove them?”

The Pediatric Insider

© 2011 Roy Benaroch, MD

Let’s get this one thing straight first: you’ve only got one adenoid. I don’t know why it’s referred to in plural, but let’s put a stop to that right now. Just one. Adenoid.

Your adenoid is a blobby sort of tissue, way back behind your nose. Want to touch it? Just stick your finger waaaaaaay up your nose, back about as far as you’d have to reach to touch the back of your throat. Go ahead, try. (Better yet, don’t. I was kidding. Do not sue the nice doctor.) I’ll bet you never even thought your nasal cavity went back that far. Kind of cool. All the way back there, hanging off the back wall of your nasal cavity, sort of right in the middle of your head, is a little fleshy blob, the adenoid. It can’t be seen directly, but an ENT (ear, nose, and throat) specialist can snake a little scope up the nose to get a peek, or get an indirect view with an x-ray.

What’s it for? It’s made of the same kind of tissue as tonsils, so it presumably has something to do with the immune system. Like tonsils, it probably does its job very early in life, or even before birth. Removal of either tonsils or the adenoid in children does not seem to lead to any increased risk of infection—so basically, at least once your children are a year or so old, the adenoid doesn’t seem to do anything useful at all.

In fact, sometimes the dang thing just kind of gets in the way. The most common reason for removal of the adenoid is that it gets too big in some children, and dangles into the back of the nose. This makes it hard to breathe. During the day, kids with a huge adenoid often breathe through their mouths. It gets worse at night—when the muscles of the face and mouth relax, that big honking adenoid can drop down and cause loud snoring, interrupted breathing, and sleep apnea. This leads to fragmented, poor quality sleep, and sometimes grumpy kids and parents. Worse, chronic poor sleep can affect school performance, and can eventually cause permanent damage to the lungs and heart. Bad news. If your child has symptoms of trouble breathing at night or loud snoring (the kind you can hear from another room), you need to talk with the pediatrician about a referral for evaluation of both tonsils and the adenoid.

Another common reason to consider removal of the adenoid is to prevent ear infections. The adenoid is located right near the auditory (or “Eustacian”) tube, a connection to the middle ear. Some kids with recurrent ear infections are being re-infected by bacteria that hide on the knobby surface of the adenoid. The large adenoid may also at times physically clog up that auditory tube, preventing drainage of mucus from the middle ear—and that further increases the risk of infection. Removal of the adenoid does lead to fewer ear infections, and should be considered especially in children who’ve already tried more-conservative measures.

A little more controversial is the role of the adenoids in recurring sinus infections. Again, the knobby tissue itself may be chronically infected, which might serve as a “hiding place” for bacteria, allowing them to sneak back into the sinuses even after an infection is successfully treated. There’s also some evidence that chronic inflammation of the adenoid might lead to swelling and inflammation of the sinuses, which prevents good drainage and further contributes to infection. Studies of the effect of removing adenoids from children with recurrent sinusitis haven’t been super-impressive, but the procedure does seem to help at least some children. Recurring sinusitis can be a complex problem, and I don’t think there is a one-size-fits-all approach. Adenoid evaluation and removal is probably a good option in some cases.

If surgical removal is needed, it’s a pretty straightforward procedure with a short recovery in children. Sometimes removal of the adenoids is combined with tonsillectomy and maybe ear tubes as well, sort of an ENT trifecta. Work with your ENT to decide on the best approach to your child’s situation, and feel free to ask for a discount—especially if you already took the trouble to reach back there yourself. I said I was kidding!

Thanks to ace ENT Julie Zweig, MD of Northeast Atlanta ENT in Johns Creek and Lawrenceville for her help reviewing this article.

 

EDIT (12/16/2013): When reviewing this article, I don’t think I did a good job explaining that there are risks to adenoid surgery (as with any surgery.) Though the procedure is, as I said, “pretty straightforward with a short recovery”, there is a small but real risk of complications. The rate of complications is much higher when adenoidectomy is combined with removal of the tonsils.

 

 

 

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15 Comments on ““What the heck are adenoids, and why does the doctor want to remove them?””

  1. Billie Jean Says:

    You’re a day late and a dollar short Dr. Roy — our 2 year old had a T&A plus new ear tubes Monday. NOT an easy recovery. Not. At. All. I do wish drs would let mom’s know that the recovery is not a quick, easy one. Maybe it is for some kids, but for most, I’m guessing not so much. It’s more like “constant, at the hip attachment 24hours a day for days on end” trying to stay ahead of the pain and on top of their fluid intake. Do I feel the surgery was necessary? Absolutely. Do I wish someone would have told me the recovery period would be tough? Asolutely.

  2. Dr. Roy Says:

    Tonsillectomy has the most difficult recovery– kids after just ear tubes or adenoids seem to do fine. I hope your kiddo feels better soon!

  3. Terrence Says:

    my daughter has some occassion snoring during nose block. She frequently caught with nose block. based on such description and a look with a head microsope, an ENT immediately recommend to remove her tonsil and adenoid and insert grommet (he diagnosed there is glue ear. We are concern if the diagnosis is too fast and operation recommendation is the only way.

  4. Ashley Says:

    I just got my tonsils removed today along with my adenoid, and it was such an easy recovery. My throat doesnt hurt that bad, it has been only 12 hours since the surgery and i just ate a steak. I have not even bled at all. I just hate the snotty stuff in the back of my throat but my nurse said not to cough or it might make me bleed and to just swallow it but i has not really made it all the way out of my throat yet.

  5. Ashley Says:

    forgot to mention i am 17

  6. Ashley Says:

    i meant to put “it has not” but accidentally put “I has not.”

  7. Shana Says:

    My daughter has haad some speech delay. The last couple of years of speech thereapy they do the “air thingy” puff of air to measure pressure. (Not sure of the name?) Her reading was way under the charts. I procrastinated long enough and a couple of days ago we er to see the ENT (Ears, nose, throat) doc. They preformed a speech test in the booth. Her hearing was normal. They said that she can’t hear low pitches. A little hearing loss is what he said and looking in her ears he said yep it looks like there is a little fluid in there and started talking about the adenoid removal. I know the article said its not a one size fits all. Just asking whats the degree in which you do the surgery. She doesn’t have sleep issues snoring heavy breathing. Just has some fluid in there. I’d like her to keep all her “noids” if possible. But I also want her hearing to be better. (still with the thought that he said “a little” and “a little hearing loss.”

  8. Shana Says:

    *reading means results from the puffer thingy not like read a book. ;)

  9. Dr. Roy Says:

    Shana, I’m not sure I’m in a good position to second-guess the recommendation, but I do think you ought to seek a second opinion from another ENT.

  10. Deborah Soto Says:

    I had my tonsils along with with my adenoid taking out three years ago. I was in my late 40 when I did this. I had sleep apnea, snoring real bad and sleep disordered. My ear, nose and throat doctor say I would need the surgery to feel much better. I end up having the surgery. I reqret it now because I have chronic sinus, breathing problem, sinus infection and snoring more then I ever did before. I been seeking help for this problem for three years now after that surgery. I am suffering with this sinus. Help


  11. I have a 2 yr old that the pediatrician recommended having a speech and hearing eval he failed the speech the hearing they said mild if any but he does have a speech delay my husband who is a pharmacist suggested taking him to an ent we did and i believe he was way to quick to recommend surgery i don’t care if he is one of the best at nationwide childrens this is my baby going under anesthesia he did do the camera thing and showed me there was 70% blockage in one nostril and like 90% in the other from the other and some fluid in his ear he want’s to put tubes in and remove adenoids next tue he say’s i will see an improvement in speech but i’ve heard so many horror stories of hearing loss and tubes falling out and more then anything i’m scared to death of him being under anesthesia at 2 yrs old

  12. Dr. Roy Says:

    Elizabeth, if your child has delayed speech and hearing problems, you really need to have this addressed, and soon. Your child can benefit tremendously from having his hearing improved, and stands a much better chance of speaking well with normal hearing. I urge you to discuss you situation with your pediatrician so you can get a good assessment of the risks and benefits of the suggested therapy. Best of luck!

  13. christina Says:

    I had my tonsils removed at 28 years old and ate ice cream to numb it. The best way I can tell how it felt for me was like having a severe case of strep throat. it wasnt as bad as they made it about to be for me but then again everyone is different

  14. Kasia Kieltyka Says:

    My son is 2 years and 3 months old. I just came from the ENT office. My doctor sent me to the ENT because my son has had 3 Croup episodes already and two were within a month of each other in the summer months. Basically he has only been sick three times, each time getting croup. She thought that he may have laryngomalacia. The ENT does not think so. He says his problem is his adenoids. My son snores and has trouble eating dinner. He eats breakfast foods and softer items but refused to eat dinner. The ENT thinks the food issues are related to his adenoids size. We are schedule for adenoid removal. I do have a question. He says that 30-40% of kids who have their adenoids out also need their tonsils out. His are larger but not too big but the ENT thinks this maybe because he took steroids twice recently and they can shrink the tonsils. He says it’s up to us if we want them removed. The recovery time is longer ~2 weeks vs 1 week, it’s more painful and due to his young age requires a hospital stay. At the same time if he needs them taken out later on – it’s another surgery and a longer more painful recovery. I don’t know what to do? Should he have his tonsils out too or should we hope that he is in that 60% that don’t? I read many instances online where only the adenoids were removed and then they needed their tonsils out or wished they had them out if they didn’t need surgery as they had frequent strep etc.

  15. Dr. Roy Says:

    Kasia, the question of whether your child needs a tonsillectomy has to be answered by you and your doctors, who know him best. I can’t specific medical advice for your child, because I haven’t examined him, and I am not his doctor. Please ask these questions of your own pediatrician and specialist.


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