What Is Adenoiditis?
Everyone gets a sore throat from time to time, but sometimes the tonsils in your mouth can become infected. However, tonsils are not the only vulnerable glands in your mouth. Adenoids, located higher up in the mouth — behind the nose and roof of the mouth — can also get infected. Enlarged and inflamed adenoids, called adenoiditis, can make breathing difficult and lead to recurring respiratory infections. Adenoiditis is most common in children, but sometimes, it can affect adults as well.
What Are Adenoids?
Adenoids are a mass of tissue that, along with your tonsils, help keep you healthy by trapping harmful germs that pass through the nose or mouth. Your adenoids also produce antibodies to help your body fight infections. Unlike tonsils, which can be easily seen by opening your mouth, you cannot see the adenoids. A doctor has to use a small mirror or special instrument with a light to see the adenoids. Sometimes, doctors may order X-rays to see them more clearly.
While adenoids play an important role in keeping a person healthy, as you get older, adenoids become less important as your body is able to fight infection in other ways. In fact, adenoids often get smaller around age 5 or 6 and virtually disappear by the teen years.
Adenoiditis Symptoms
Symptoms of adenoiditis can vary depending on what is causing the infection but may include:
- Sore throat
- Stuffy nose
- Swollen glands in the neck
- Ear pain and other ear problems
- Postnasal drip
- Fever
When the nose is stuffy from swollen adenoids and related symptoms, it can be difficult to breathe through your nose. Other symptoms of adenoiditis related to nasal congestion or blocked airways include:
- Breathing through the mouth
- Speaking with a nasal sound, as if you are speaking with a pinched nose
- Difficulty sleeping
- Snoring or sleep apnea (a condition where you stop breathing for a short amount of time during sleep)
- Bad breath
Adenoiditis Causes
Even though adenoids help filter out germs from your body, sometimes they can get infected with bacteria. When this happens, they also get inflamed and swollen to cause adenoiditis.
Infection with bacteria or viruses is the most common reason you get adenoiditis. But other things can also cause your adenoids to swell or get inflamed. These include:
- Allergies
- Irritation
- Stomach acid
Usually, adenoiditis doesn't happen by itself. You may have other issues at the same time that cause your adenoids to swell. These include:
- Swollen and inflamed tonsils (tonsillitis)
- Sore throat (pharyngitis)
- Sinus or nasal inflammation (rhinosinusitis)
- Stomach acid flowing into your throat and larynx (laryngopharyngeal reflux or silent reflux)
Adenoiditis can happen for a short time or it may last longer depending on what's causing it. If you have irritation in your adenoids over a long time, it can cause your adenoids to remain larger. This condition is called adenoid hypertrophy.
In kids, the adenoids often get bigger early on before they shrink and disappear. But sometimes, adenoids keep getting bigger until they block your nasal passages and block airways.
Many types of infections can cause adenoiditis. It's common to have a respiratory virus before an acute bout of adenoiditis. Viral infections can make infection with bacteria more likely. The most common infectious bacteria in inflamed adenoids include:
- Haemophilus influenzae
- Streptococcus pneumoniae
- Streptococcus pyogenes
- Staphylococcus aureus
When adenoiditis is chronic, you'll often have multiple infections at once. You may also have infections that seem to go away and come back repeatedly.
Who Gets Adenoiditis?
Kids get adenoiditis most often. It isn't more or less likely based on:
- Gender
- Race
- Where you live
- Socioeconomics
It may be more likely when kids are around secondhand cigarette smoke or when parents smoke. But because adenoiditis usually goes along with other conditions, it's hard to know exactly how common it is. It's also hard to tell the difference between adenoiditis and bacterial sinusitis.
Adenoiditis Diagnosis
You can start with your primary care doctor. If your doctor has concerns or you're having problems that come back often, you should see an otolaryngologist or ear, nose, and throat (ENT) specialist. Depending on other related symptoms or conditions you may also see:
- Sleep specialist
- Allergist
- Immunologist
- Gastroenterologist
Physical exam
Your doctor may diagnose adenoiditis based on your symptoms, which may include:
- Signs you also have an ear infection
- Fever
- Thick and opaque discharge from your nose
- Postnasal drip
- Blocked nasal passages
- Sore throat
- Bad breath (halitosis)
Tests for infection or allergy
They may use a special mirror or endoscope to look at your adenoids. Your doctor also may order other tests to find a cause including:
- Rapid strep test
- Laboratory cultures
- Allergy skin tests
Your doctor may want to figure out what's causing your adenoiditis to decide on treatment. For example, if you have strep, you'll take antibiotics. It can also help to figure out if you're getting recurrent strep infections and may need to have your adenoids taken out.
Blood count tests can help to decide if you may have another condition. Your doctor may consider testing for HIV or other conditions if you have other signs indicating that your immune system isn't working well.
Skin testing can help check if you are allergic to anything in the environment, which might explain your adenoiditis.
Imaging tests
Most of the time your doctor won't order other imaging tests. But they may want to look deeper into your sinuses for signs of infection or to see if you have adenoid hypertrophy. Imaging tests include:
- X-ray of your neck
- CT of your sinuses
Sleep study
A sleep study can check if you have sleep apnea.
Adenoiditis Treatment
Your treatment will depend on what's causing your adenoiditis and any related complications you may have.
Treating adenoiditis and infection
If your adenoiditis might be coming from a run-of-the-mill virus, such as the common cold, you probably won't need any treatment. You shouldn't take antibiotics to treat a viral illness. Often, the swelling in your adenoids will go away within five to seven days as you get over the virus.
If your symptoms don't go away or you have a bacterial infection, adenoiditis is treated with antibiotics. Antibiotics used to treat adenoiditis may include:
- Amoxicillin
- Clarithromycin
- Azithromycin
If adenoiditis is related to a bacterial infection and the antibiotic is working, it should help your symptoms get better within two to three days. You'll likely take the medicine for 10 days to make it less likely to come back and help prevent the bacteria from becoming resistant to treatment. If the first round of antibiotics doesn't work, your doctor may suggest you try a different one.
Other steps you take at home also may help, such as saline sprays or nasal rinses.
Treating adenoiditis and allergies
If you have allergies, it may help to use:
- Nasal steroid sprays
- Steroids
- Antihistamines
- Saline sprays or rinses
Treating adenoiditis and reflux
If you have adenoiditis and your doctor thinks it's related to acid reflux or gastroesophageal reflux disease (GERD), they may suggest:
- Changes to your diet
- Sleeping with your head elevated
- Medicine such as H2 blockers or proton-pump inhibitors
Adenoiditis and surgery
If you or your child has frequent infections, including ear and sinus infections, if antibiotics don't help, or if your child has ongoing breathing problems, the doctor may refer you to a specialist (an otolaryngologist or ear, nose and throat doctor) who can discuss surgery to remove the adenoids. This procedure is called an adenoidectomy.
The specialist may also recommend the tonsils be removed at the same time since adenoiditis and tonsillitis often go hand in hand. Surgery to remove the tonsils is called a tonsillectomy.
Discuss the pros and cons of surgery with your doctor to decide if it's a good idea or if there are other options you might try first.
What Happens During an Adenoidectomy?
An adenoidectomy is performed by a doctor who specializes in ear, nose, and throat surgery. It occurs in a hospital or outpatient surgical center under general anesthesia, meaning you're put to sleep. The tonsils and/or adenoids can be removed through the mouth so no additional incisions are made except for where the tissues are removed. Your doctor may do other procedures, such as putting tubes in the ears to drain fluid and relieve pressure.
Most people can go home following the procedure. But you should expect to be in the surgical center for around four or five hours after the surgery for monitoring. Your doctor can give you more specific instructions as to what to expect.
Recovery From Adenoidectomy
After surgery, your child may feel nauseous until the anesthesia completely wears off. In the week following the adenoidectomy, your child may experience the following:
- Sore throat. Your child's throat may be sore for 7-10 days following the procedure, and eating can be uncomfortable.
- Fever. Your child may have a low fever several days after the surgery. If the fever gets higher than 102 F, call the doctor. Seek medical attention if fever is accompanied by other symptoms such as lethargy, nausea, vomiting, decreased urine output, headache, or stiff neck.
- Mouth breathing. Mouth breathing and snoring may occur after the surgery, due to swelling in the throat. Breathing should return to normal once the swelling goes down, usually 10 to 14 days after surgery. Seek medical attention if there is difficulty breathing.
- Pain. Some throat and ear pain is normal for a few weeks following surgery. The doctor should prescribe medicine to help control pain.
- Scabs in the mouth. Thick, white scabs will develop where the tonsils and/or adenoids were removed. This is normal and most scabs fall off in small pieces within 10 days after surgery. Do not let your child pick at the scabs. These scabs may also cause bad breath.
Tips to ease recovery following adenoidectomy
- Feed your child soft foods, such as scrambled eggs, Jell-O, soup, and popsicles. Lukewarm or slightly chilled foods are best.
- Make sure your child drinks plenty of fluids to avoid dehydration.
- Have your child rest as much as possible for the first few days following surgery. Your child should be able to return to school once they can eat regular foods again, no longer need pain medication, and sleep soundly through the night.
Adenoidectomy: Warning Sign
If you notice bright red blood coming from your child's mouth or nose, call the doctor right away or take your child to the emergency room. This may indicate the scabs have come off too soon. Small spots of blood in the nose or in the saliva may be expected. Also, if breathing becomes so difficult that your child is wheezing, making loud noises while breathing, or drooling, seek immediate medical care. This may be a sign of excessive swelling in the surgical area and should be looked at immediately.
Surgery should never be taken lightly. Make sure you have all your questions answered before making a decision. If you have any doubts, seek a second opinion from another qualified doctor.
Adenoiditis Complications
Adenoiditis can go away on its own depending on the cause. When treatment is needed, it usually gets better. Surgery to remove the adenoids is typically effective for chronic or recurrent cases of swollen adenoids and adenoiditis.
If you have adenoiditis from an infection that isn't going away and you don't treat it, a biofilm could form. Biofilms are slimy layers of microbes that form on surfaces. A biofilm can cause you to keep getting adenoid infections and lead to other problems.
When enlarged adenoids cause breathing difficulties or obstructive sleep apnea, they can lead to other problems if left untreated. In kids, these may include problems with:
- Sleep
- Thinking
- Learning
- Emotions
- Behavior
Adenoiditis Prevention
It's hard to prevent adenoiditis since any kind of virus, bacterial infection, or allergy can cause it. If you think you or your child has adenoiditis that isn't going away or keeps coming back, see a doctor to get a diagnosis. Treatment can help avoid adenoiditis complications or symptoms that can affect your quality of life.
Takeaways
Adenoiditis is a condition in which adenoids get swollen and inflamed for many different possible reasons, including infection, allergies, or acid reflux. If you have symptoms that aren't going away or keep coming back, it's important to see a doctor to confirm its diagnosis and treat it based on the cause. In some cases, your doctor may suggest surgery to remove adenoids and avoid complications that may affect sleep, mood, and quality of life.
Adenoiditis FAQs
Are tonsillitis and adenoiditis the same?
No. These are not the same condition. But it's not uncommon to have tonsillitis and adenoiditis at the same time.
What is the pathology of adenoiditis?
The pathology of adenoiditis involves inflammation in the adenoids, typically due to infection, but other things can also cause it. The condition can be acute or chronic, depending on how long it lasts and how severe it is.
Is adenoiditis contagious?
It depends on what's causing it. If adenoiditis is caused by a viral or bacterial infection, you may be able to spread the illness to other people. But people react to infections differently. Not everyone who is exposed will necessarily develop adenoiditis.
What are the long-term risks of adenoid removal?
Removing adenoids may help if you're having recurrent problems or adenoid infections that don't go away. But there's evidence that removing adenoids and tonsils can lead to more risk for respiratory, infectious, and allergic diseases later. One study linked adenoid removal to an increased risk for chronic obstructive pulmonary disease (COPD), upper respiratory tract disease, and conjunctivitis.
Can adenoid removal help with sleep apnea?
Yes. If enlarged adenoids play a role in your obstructive sleep apnea by blocking nasal passages, taking them out should help.