Everything You Need to Know About Adenoiditis

What is Adenoiditis?

Adenoiditis is the inflammation of the adenoids, which are small, soft masses of lymphatic tissue located behind the nose, near the roof of the mouth. These glands play an important role in the immune system, especially in children, by helping to trap and destroy viruses and bacteria that enter through the nose and mouth.

The location of the adenoids makes them important in defending against infections, but also vulnerable to them. When infected, they can become swollen or inflamed, a condition known as adenoiditis. This can lead to symptoms such as nasal obstruction, sore throat, ear discomfort, and difficulty breathing, especially when lying down.

Symptoms of Adenoiditis

When the adenoids become swollen or infected, they can cause a range of symptoms, particularly in children.

• Nasal Congestion: Swollen adenoids can block the nose, making it hard to breathe through it.
• Mouth Breathing: Due to nasal blockage, individuals may resort to breathing through the mouth, especially during sleep.
• Snoring: Enlarged adenoids can cause noisy breathing or snoring during sleep.
• Sore Throat: Persistent mouth breathing can lead to a dry or sore throat.
• Difficulty Swallowing: Swollen adenoids may make swallowing uncomfortable or difficult.
• Ear Infections: Infected or enlarged adenoids can block the Eustachian tubes, leading to fluid buildup and ear infections.
• Persistent Runny Nose: A continuous runny nose, often with yellow or green mucus, can be a sign of adenoiditis.
• Swollen Neck Glands: Inflammation can cause the lymph nodes in the neck to swell.
• Sleep Disturbances: In severe cases, swollen adenoids can lead to obstructive sleep apnea, characterized by pauses in breathing during sleep.

What Causes Adenoiditis?

When the adenoids become infected or inflamed, it can lead to a condition known as adenoiditis.

• Viral Infections: Viruses such as adenovirus, rhinovirus, and paramyxovirus can cause adenoiditis.
• Bacterial Infections: Bacteria like Streptococcus pyogenes, Streptococcus pneumoniae, Moraxella catarrhalis, and various species of Staphylococcus, including Staphylococcus aureus, are known to cause adenoiditis.
• Allergies: Allergic reactions can lead to inflammation of the adenoids, contributing to adenoiditis.
• Gastroesophageal Reflux Disease (GERD): Exposure to stomach acids due to GERD can irritate the adenoids, leading to inflammation.
• Passive Smoking: Exposure to second-hand smoke can increase the risk of developing adenoiditis, especially in children.

Severity of Adenoids

Acute adenoiditis

Acute adenoiditis is a short-term infection where the adenoids become inflamed due to a viral or bacterial cause. It is more common in children and often occurs after a cold or upper respiratory infection. Symptoms may include:

• High fever
• Severe nasal obstruction
• Yellowish nasal discharge
• Mouth breathing
• Sore throat or ear pain

In infants, large adenoid symptoms can cause trouble breathing, especially while feeding or sleeping. Mild adenoid swelling may improve on its own, but severe cases may need medical attention.

Chronic adenoiditis

Chronic adenoiditis refers to long-lasting adenoid inflammation that may not go away completely, even after repeated treatments. This condition often leads to:

• Ongoing nasal congestion
• Snoring and mouth breathing
• Dry mouth, especially in the morning
• Recurrent sinus infections and sore throat

Children and adults with chronic adenoiditis may also develop complications such as:

• Rhinitis
• Chronic pharyngeal inflammation
• Lymphadenitis
• Upper airway cough syndrome (UACS)

Who is at Risk for Adenoiditis?

The adenoids play an important role in trapping germs and preventing infections, but they can themselves become inflamed, leading to discomfort and other symptoms. Certain factors can increase the risk of developing adenoiditis. These include:

• Frequent infections: People who experience recurring infections in the throat, neck, or head are more prone to developing adenoiditis.
• Tonsil infections: Infections of the tonsils often go hand in hand with issues affecting the adenoids. Those with tonsillitis are more likely to develop inflamed adenoids.
• Exposure to airborne viruses: Contact with viruses, bacteria, or other germs, especially those that spread through the air can trigger infections in the adenoids.
• Age and development: Adenoiditis is particularly common in young children. This is because adenoids are larger in early childhood and gradually shrink as a child grows older. By late teens, the adenoids typically become much smaller or may even disappear altogether.
• Nasal Obstruction and Enlarged Adenoids: Enlarged adenoids can cause nasal obstruction, making it difficult to breathe through the nose. This condition is more commonly seen in children but can affect adults too.

It is important to note that while children are more susceptible to adenoiditis, adults can also develop it, especially if they have enlarged or inflamed adenoids due to factors like infections or allergies.

What are the Complications of Adenoiditis?

If left untreated:

If adenoiditis is not treated in time, it can lead to several complications. These complications are often due to persistent inflammation or infection in the adenoidal tissues, which can spread to nearby areas such as the ears, nose, sinuses, and respiratory tract.

Ear infections: Adenoids are located close to the Eustachian tubes, which help drain fluid from the middle ear. When adenoids become inflamed or enlarged, they can block these tubes, leading to fluid buildup and infections like otitis media. This may result in ear pain, fever, and hearing issues.

Glue ear (middle ear infection): Chronic inflammation can cause thick fluid to collect in the middle ear, a condition commonly referred to as glue ear. This often begins with blocked Eustachian tubes and can affect hearing, especially in children.

Sinus infections (sinusitis): Inflamed adenoids can block the nasal passages and sinuses, leading to trapped mucus and bacterial growth. This can cause facial pain, nasal congestion, and recurrent sinus infections.

Breathing and nasal problems: Enlarged adenoids may cause nasal obstruction, leading to mouth breathing, snoring, and disturbed sleep. In some cases, this may also affect speech and cause chronic nasal discharge.

Chest infections: In cases of severe or untreated adenoiditis, the infection may spread to the lower respiratory tract. This can result in bronchitis or pneumonia, especially in children with weak immunity.

Adenoiditis Treatment Options

Your treatment will depend on what is causing the adenoiditis and whether there are any complications.

Treating inflamed adenoids due to infection

If the cause is a viral infection, like the common cold, antibiotics are not needed. In most cases, the swelling in your adenoids will go down within 5 to 7 days as the virus clears on its own.

If your symptoms last longer or are caused by a bacterial infection, your doctor may prescribe antibiotics. Common adenoid medicines include:

• Amoxicillin
• Clarithromycin
• Azithromycin

If antibiotics work, your symptoms usually improve in 2 to 3 days. However, you will likely need to take the full 10-day course to ensure the infection clears completely and to prevent resistance. If the first medicine doesn’t work, your doctor may try a different antibiotic.

At-home care can also help ease symptoms. This may include:

• Saline nasal sprays or rinses to reduce nasal obstruction
• Pain relief medications if recommended by your doctor

Treating adenoiditis linked to allergies

If your adenoids are enlarged due to allergies, you may benefit from:

• Nasal steroid sprays
• Oral steroids (short-term)
• Antihistamines
• Saline rinses

These can reduce adenoid swelling and help relieve blocked nose and breathing issues, especially in children.

Treating adenoiditis caused by reflux

Sometimes, adenoids become inflamed due to acid reflux or GERD (gastroesophageal reflux disease). In such cases, treatment may involve:

• Changes to your diet
• Sleeping with your head elevated
• Acid-reducing medicines like H2 blockers or proton-pump inhibitors

When surgery is needed

If there are frequent or chronic infections, sinus problems, or trouble breathing despite medication, your doctor may suggest surgery to remove the adenoids. This is called an adenoidectomy. In some cases, the tonsils and adenoids are removed together, especially if both are enlarged or infected. This combined procedure is known as adenotonsillectomy.

Adenoidectomy is more common in children but may be recommended for adults with ongoing issues as well. It helps treat conditions like chronic adenoiditis, nasal obstruction, and enlarged adenoids affecting breathing or sleep.

Prevention of Adenoids

Preventing infections that lead to inflamed adenoids symptoms is key to reducing the risk of adenoid swelling and related issues such as nasal obstruction or chronic adenoiditis.

Here are some simple steps to help prevent adenoiditis:

• Maintain good facial and dental hygiene
• Wash hands regularly with soap and water
• Avoid touching your nose, mouth, or eyes with unwashed hands
• Stay away from people who are ill with colds or throat infections
• Use sanitisers or hand hygiene products when outside
• Keep surroundings clean to avoid exposure to allergens or pollutants