What is Adenoiditis?
The adenoids, also known as the nasopharyngeal tonsil or “adenoid pad,” are clusters of tissue at the back of the throat, where it meets the nasal cavity. These, along with some other types of tonsils, form a ring of tissue called Waldeyer’s ring which wraps around the upper section of the throat and nose area. This name was given by a German anatomist, Heinrich Wilhelm Gottfried von Waldeyer-Hartz, in the early 1900s. These tissue clusters, together, play a critical role in the body’s immune system during early life. When germs come into the mouth or nose, they meet the cells of Waldeyer’s ring and trigger the production of a key type of antibody, called IgA, which ‘remembers’ these germs for future encounters.
Adenoids are there from birth and grow larger as kids age, they are largest around age seven. Generally, throughout puberty and into adulthood, they shrink in size until they may be almost unnoticeable. However, when adenoids become inflamed, due to infections, allergies, or acid irritation from the stomach, this causes adenoiditis. Commonly occurring in children and teenagers, adenoiditis often appears alongside other medical conditions. Continued irritation can lead to enlarged adenoids, contributing to other complications, including issues with the Eustachian tube (the tube linking the throat to the ear) and repeated ear infections. Adenoiditis can either be short-term (acute) or long-term (chronic).
We can measure the size of adenoids using a scale from zero to four, where zero indicates the absence of adenoids, 1+ indicates less than 25% blockage of the nasal cavity, 2+ indicates 25-50% blockage, 3+ indicates 50-75% blockage and 4+ indicates more than 75% blockage. Blood is supplied to the adenoids by several arteries and drained by the pharyngeal veins. Both the vagus and glossopharyngeal nerves control the adenoids.
What Causes Adenoiditis?
There are several agents and pathogens that can cause inflammation in the adenoid tissue. Often, an infection in the upper part of the respiratory system, usually viral, can lead to acute adenoiditis. In this condition, bacteria can infect the tissues and increase in number.
The bacteria commonly found in the adenoid specimens include Haemophilus influenza, Streptococcus pneumoniae, Streptococcus pyogenes, and Staphylococcus aureus.
Different types of infections, often caused by numerous bacteria, can lead to chronic adenoiditis. This can contribute to frequent upper respiratory tract infections in children, and in most cases of children’s rhinosinusitis (nasal sinus inflammation), adenoiditis also plays a part.
Allergies are thought to be associated with adenoiditis and the subsequent enlargement of the adenoids. When allergens are breathed in through the nose, they touch the adenoid tissue. The adenoids then grow in order to respond to the allergens and to generate a type of antibody known as IgA.
Besides, chronic irritation from stomach acid, particularly in infants and young children, due to gastroesophageal reflux disease (GERD) may also play a role in adenoiditis and the growth of adenoids.
Risk Factors and Frequency for Adenoiditis
Adenoiditis is often discussed alongside other diseases like rhinosinusitis and adenotonsillar disease, which can make it difficult to find exact numbers on how many people suffer from adenoiditis alone. It generally affects children since this illness is connected to the adenoid tissue that shrinks during puberty. What is known is that it doesn’t seem to favor a specific gender, race, location, or socioeconomic status. However, there has been a link established between parents who smoke and their children developing adenoiditis.
In children, adenoiditis might be mistaken for bacterial sinusitis, so statistics for sinusitis in children can provide a hint towards the prevalence of adenoiditis. It’s estimated that children catch six to eight viral upper respiratory infections (URIs) each year. Out of those, 5 to 13% can become bacterial superinfections, causing sinusitis and potentially including adenoiditis as part of the illness.
Signs and Symptoms of Adenoiditis
Adenoiditis usually affects children before puberty who have recently suffered from an upper respiratory infection (URI). These children may also have a history of recurrent ear infections, blocked nose leading to mouth breathing, persistent ear infections, sleep-disordered breathing or obstructive sleep apnea, or gastroesophageal reflux disease (GERD).
Symptoms include:
- Pus-filled nasal discharge
- Nasal drip
- Nasal obstruction
- Snoring
- Fever
- Mouth breathing
- Bad breath
A doctor may conduct an indirect mirror exam to check for enlarged adenoids covered in secretions. This procedure can be hard to carry out in children. A more precise method involves using a flexible nasal and laryngeal endoscope, but it requires advanced training and the child and parents’ cooperation. In rare instances, if the adenoid is large enough, it can be seen beneath the edge of the soft palate.
If adenoiditis persists for a long time and leads to adenoid hypertrophy in early childhood, it could result in the development of “adenoid facies” or “long-face syndrome”. This condition stems from enlarged adenoids blocking the nasopharynx leading to breathing through the mouth, and that can cause craniofacial abnormalities such as a high-arched palate and a mispositioned lower jaw (retrognathic mandible).
Testing for Adenoiditis
Adenoiditis is diagnosed mainly based on symptoms. Your doctor might suspect adenoiditis if you show signs like possible ear infection, fever, runny nose with thick and smelly discharge, feeling of dripping in the back of the throat, difficulty in breathing through the nose, sore throat and bad breath.
To actually see the adenoids, your doctor may use tools like a laryngeal mirror or a nasal endoscope.
Sometimes, further tests are required. These may include:
– Rapid Strep test. If you have symptoms similar to a throat infection, your doctor may do a rapid Strep test. This not only confirms exactly what the illness is, but also helps your doctor choose the right antibiotics for treatment. Even if the test is negative, your doctor can assume that your symptoms are caused by a different bug that’s making you ill.
– Culture test. If your infection doesn’t improve even after antibiotics, your doctor might do a throat culture. This test can identify the exact bug causing the infection and helps the doctor choose the right treatment.
– Other tests. If needed, your doctor may order a complete blood count test and HIV test.
If your adenoiditis is linked to allergies, an allergy test may help your doctor choose the best treatment for you.
Imaging tests can also be helpful in certain cases. This may include:
– Lateral neck X-ray: This can confirm if the adenoids have grown too big.
– Sinus X-ray or CT scan: These can identify an infection in the sinuses.
However, these are rarely used in routine cases. For anyone whose enlarged adenoids make them snore, a sleep study might be recommended to rule out another condition known as obstructive sleep apnea.
Treatment Options for Adenoiditis
Adenoiditis, an infection of the adenoids at the back of the throat, often occurs alongside conditions like sinus or throat infections. For this reason, treatment usually follows similar guidelines to those set for these conditions.
If a healthcare provider believes the adenoiditis is due to a common viral infection like the common cold, they may hold off from prescribing antibiotics. These types of infections usually clear up within five to seven days on their own.
If symptoms persist or the infection shows signs of being bacterial (like a high fever or yellowish discharge from the nose or throat), then antibiotics could be the first choice of treatment. The go-to antibiotic is often Amoxicillin, chosen for its effectiveness against many types of bacteria and minimal side effects. If Amoxicillin isn’t helping, or if a patient is allergic to penicillin (which Amoxicillin is derived from), antibiotics like cefdinir, cefuroxime, clarithromycin, or azithromycin might be used instead. These should provide relief within two to three days. The full course of antibiotics should be taken for ten days to avoid the infection coming back and to prevent bacteria from developing resistance.
Meanwhile, using saline sprays or rinses can reduce symptoms by washing away the bacteria and the mucus where they thrive.
If adenoiditis is linked to allergies, the patient might be given treatments like nasal steroid sprays, oral steroids, or antihistamines to see if symptoms ease. If these work, further allergy testing might be useful, followed by treatments to modulate the patient’s immune response. Saline sprays and rinses may also help in these cases.
Sometimes, adenoiditis can be linked to LPR/GERD, a type of reflux disease. Here, making changes to diet and lifestyle, and possibly using medications like H2 blockers or proton-pump inhibitors, can help manage symptoms.
In cases where adenoiditis doesn’t improve with antibiotics or keeps coming back, a referral to a specialist (an otolaryngologist) might be needed for further evaluation and potential surgery. These surgeries could include removing the adenoids (adenoidectomy), possibly alongside removing the tonsils (tonsillectomy), myringotomy (a procedure to drain fluid from the ears), or sinus surgery.
Most specialists will choose to remove the adenoids alongside tonsils to prevent future infections. Similarly, if a patient needs multiple procedures to balance ear pressure due to swollen adenoids blocking the Eustachian tube (which connects the middle ear to the throat), removal of the adenoids might be the preferred approach.
What else can Adenoiditis be?
When determining the cause of a health issue, doctors may need to rule out various conditions that have similar symptoms. In this case, they will need to consider:
- Common cold or flu caused by a virus
- Sinus infection (Sinusitis)
- Inflammation of the nose and sinuses (Rhinosinusitis)
- Growth in the nose called polyps (Nasal polyposis)
- Infection in the throat (Pharyngitis)
- Inflammation of the tonsils (Tonsillitis)
- Allergies that vary according to the seasons or environment
- Cancer in the upper part of the throat (Nasopharyngeal neoplasm)
- A condition where stomach acid comes up into the throat (Laryngopharyngeal reflux)
- A type of cancer that affects the lymph nodes (Lymphoma)
- A condition affecting the immune system (HIV)
It’s critical for physicians to evaluate these potential diagnoses and use appropriate testing methods to ensure an accurate diagnosis.
What to expect with Adenoiditis
Medical treatments for adenoiditis are typically successful. However, for those with recurring issues, an adenoidectomy, which involves removing the enlarged or infected adenoid tissue, offers a definitive solution.
Possible Complications When Diagnosed with Adenoiditis
Ignoring adenoiditis can cause chronic infection in the adenoids and develop a biofilm that could spread the infection to nearby structures like the sinuses, throat, tonsils, and middle ear.
An overgrowth of the adenoids, known as adenoid hypertrophy, is often involved in complications related to adenoid diseases. Overgrown adenoids can block the passage of air through the upper part of the throat, which may result in mouth breathing, snoring, and Obstructive Sleep Apnea (OSA). OSA can be a severe, life-threatening disorder if not treated, potentially impacting thinking skills, emotions, and behavior in children. Removing the adenoids can increase the air flow, reducing blockages and possibly eliminating OSA altogether.
Enlarged adenoids can also block the openings of the Eustachian tubes, which connect your throat to your ears. If the Eustachian tubes don’t function properly, it can create negative pressure in the middle ear and possibly retract the eardrum. This can then lead to fluid buildup in the middle ear, which might result in hearing loss, speech difficulties, and an increased susceptibility to bacterial infections.
Prolonged adenoiditis and subsequent adenoid hypertrophy can contribute to the appearance known as adenoid faces, or long-face syndrome. Large adenoids can obstruct the passage in the upper part of the throat, forcing open-mouth breathing. This open-mouth breathing can then lead to abnormal growths of the face, such as a high-arched palate and a small lower jaw.
Preventing Adenoiditis
Adenoiditis, inflammation of the adenoids, is a common health problem in children. It’s often hard to avoid because pathogens and allergens that can cause this condition are frequently encountered in everyday life. However, it’s crucial to seek medical care quickly if adenoiditis appears, and certainly before it turns into chronic adenoiditis or adenoid hypertrophy, where the adenoids become overly large. If left untreated, these conditions can cause serious health problems and even reduce your child’s quality of life.
