The adenoids, also known as the pharyngeal tonsils, are a collection of lymphoid tissue in the postnasal space at the back of the nose. They, along with the palatine and lingual tonsils, form Waldeyer’s ring, a ring of lymphoid tissue which helps to protect the aerodigestive tract against infection.
The adenoids are present are birth and enlarge in the first few years of life as the child is exposed to various new allergens and organisms. They tend to be largest between the ages of 3 and 5, and then slowly regress, so in most cases have virtually disappeared by adult life. In some cases they may persist into adult life.
The adenoids cause problems due to obstruction or recurrent infection.
Obstruction: The adenoids may cause problems due to their size. Obstructive problems tend to be worse in the first few years of life as this is when the adenoids are comparatively at their largest . As the child grows, the adenoids regress, the head enlarges and the problems due to the adenoids improve. Obstructive problems include:
Snoring and disturbed sleep
Obstructive sleep apnoea.
Obstruction of Eustachian tube leading to glue ear.
The adenoids may become enlarged due to infection or allergy, leading to obstructive symptoms. In addition, it is thought that the adenoids may become a focus of chronic infection which may spread to the ears causing middle ear infections or may disturb Eustachian tube function leading to glue ear.
If symptomatic, and it is felt that waiting for spontaneous regression is not appropriate, the adenoids can be removed surgically. This involves a general anaesthetic.
The commonest techniques are curetting, where the adenoids are cut and removed, and suction diathermy, where the adenoids are ablated using a mixture of cutting and coagulating diathermy. Curetting has the advantage of being quicker, and the bulk of the tonsils is removed, so recurrence is less likely. There is a small risk of bleeding postoperatively, and rarely this may require packing the postnasal space and leaving the packs in overnight.
Suction diathermy takes longer, but there is less risk of bleeding postoperatively. There can be some torticollis (neck stiffness) postoperatively, and patients are often given antibiotics to reduce this and to reduce the foul smell that can occur.
Surgery may also include tonsillectomy if the problem was OSA or recurrent infections.
If the patient has a submucous cleft palate, sometimes indicated by the presence of a bifid uvula, palatal closure may be abnormal, and if the adenoids are removed the patient may develop hypernasal speech and nasopharyngeal regurgitation of fluids and food, so the surgeon should check this before removing the adenoids.
Surgery is usually carried out as a daycase procedure. Adenoidectomy is usually associated with mild pain, and simple analgesia such as Paracetamol is usually sufficient. Children should stay off school for at least one week after surgery. There may be some neck stiffness and foul smell after suction diathermy, and antibiotics may be prescribed by some surgeons routinely.