Adenoid hyperplasia

Definition

Adenoid hyperplasia is an enlargement of the lymph glands located above the back of the mouth.

Description

Located at the back of the mouth above and below the soft palate are two pairs of lymph glands. The tonsils below are clearly visible behind the back teeth; the adenoids lie just above them and are hidden from view by the palate. Together these four arsenals of immune defense guard the major entrance to the body from foreign invaders, the germs we breathe and eat. In contrast to the rest of the body's tissues, lymphoid tissue reaches its greatest size in mid-childhood and recedes thereafter. In this way children are best able to develop the immunities they need to survive in a world full of infectious diseases.

Beyond its normal growth pattern, lymphoid tissue grows excessively (hypertrophies) during an acute infection, as it suddenly increases its immune activity to fight off the invaders. Often it does not completely return to its former size. Each subsequent infection leaves behind a larger set of tonsils and adenoids. To make matters worse, the sponge-like structure of these hypertrophied glands can produce safe havens for germs where the body cannot reach and eliminate them. Before antibiotics and the reduction in infectious childhood diseases over the last few generations of the twentieth century, tonsils and adenoids caused even greater health problems.

Demographics

The true incidence of adenoid hyperplasia is difficult to assess. What is clear, however, is that tonsillectomy and adenoidectomy (T and A), the surgical treatment for the condition, is the most frequently performed major surgical procedure in the United States. Information current in 2004 on the exact number of these procedures performed was difficult to obtain because they are routinely performed in outpatient settings. Adenoid hypertrophy does not appear to affect any gender or racial group more than another.

Causes and symptoms

Most tonsil and adenoid hypertrophy is simply caused by the normal growth pattern for that type of tissue. Less often, the hypertrophy is due to repeated throat infections by cold viruses, strep throat , mononucleosis, and in the past, diphtheria . The acute infections are usually referred to as tonsillitis , the adenoids getting little recognition because they cannot be seen without special instruments. Symptoms include painful, bright red, often ulcerated tonsils, enlargement of lymph nodes (glands) beneath the jaw, fever , and general discomfort.

After the acute infection subsides, symptoms are generated simply by the size of the glands. Extremely large tonsils can impair breathing and swallowing, although that is quite rare. Large adenoids can impair nose breathing and require a child to breathe through the mouth. Because they encircle the only connection between the middle ear and the eustachian tube, hypertrophied adenoids can also obstruct the tube and cause middle ear infections.

Diagnosis

A simple depression of the tongue allows an adequate view of the tonsils. Enlarged tonsils may have deep pockets (crypts) containing dead tissue (necrotic debris). Viewing adenoids requires a small mirror or fiberoptic scope. A child with recurring middle ear infections may well have large adenoids. A throat culture or mononucleosis test usually reveals the identity of the germ.

Treatment

It used to be standard practice to remove tonsils and/or adenoids after a few episodes of acute throat or ear infection. The surgery is called tonsillectomy and adenoidectomy (T and A). Medical opinions changed as it was realized that this tissue is beneficial to the development of immunity. For instance, children without tonsils and adenoids produce only half the immunity to oral polio vaccine . In addition, treatment of ear and throat infections with antibiotics and of recurring ear infections with surgical drainage through the eardrum (tympanostomy) has greatly reduced the incidence of surgical removal of these lymph glands.

Alternative treatment

There are many botanical/herbal remedies that can be used alone or in formulas to locally assist the tonsils and adenoids in their immune function at the opening of the oral cavity and to tone these glands. Keeping the eustachian tubes open is an important contribution to optimal function in the tonsils and adenoids. Food allergies are often the culprits for recurring ear infections, as well as tonsillitis and adenoiditis. Identification and removal of the allergic food(s) can greatly assist in alleviating the cause of the problem. Acute tonsillitis also benefits from warm saline gargles.

Prognosis

Hypertrophied adenoids are a normal part of growing up and should be respected for their important role in the development of immunity. Only when their size causes problems by obstructing breathing or middle ear drainage do they demand intervention.

Prevention

Prevention can be directed toward prompt evaluation and appropriate treatment of sore throats to prevent overgrowth of adenoid tissue. Avoiding other children with acute respiratory illness also reduces the spread of these common illnesses.

Parental concerns

Adenoid hypertrophy is a relatively common childhood condition. If a child has repeated ear infections, a physician, usually an ear, nose, and throat (ENT) specialist, will recommend treatment options. To alleviate the discomfort experienced by the child and to prevent secondary complication such as delayed speech that can occur if the child's hearing is compromised because of the accompanying ear infections, frequently a surgery called an adenoidectomy is performed.

When to call the doctor

Following an adenoidectomy, parents should call the doctor if any of the following occurs:

KEY TERMS

Eustachian tube —A thin tube between the middle ear and the pharnyx. Its purpose is to equalize pressure on either side of the ear drum.

Hyperplastic —Refers to an increase in the size of an organ or tissue due to an increase in the number of cells.

Hypertrophy —An increase in the size of a tissue or organ brought about by the enlargement of its cells rather than cell multiplication.

Strep throat —An infection of the throat caused by Streptococcus bacteria. Symptoms include sore throat, chills, fever, and swollen lymph nodes in the neck.

Ulcerated —Characterized by the formation of an ulcer.

unexpected bright red bleeding
fever over 101°F (38°C)
pain that is not relieved by pain medications

See also Tonsillitis .

Resources

WEB SITES

McClay, John E. "Adenoidectomy." eMedicine. Available online at http://www.emedicine.com/ent/topic316.htm (accessed November 8, 2004).

"Tonsils and Adenoids." Healthy Kids and Pediatrics. Available online at http://www.medicinenet.com/adenoids_and_tonsils/article.htm (accessed November 8, 2004).

"What are tonsils and adenoids?" Available online at http://www.itonsils.com (accessed November 8, 2004).

J. Ricker Polsdorfer, MD Deborah L. Nurmi, MS