Merck Manual

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Adenoid Disorders


Alan G. Cheng

, MD, Stanford University

Reviewed/Revised Feb 2024
Topic Resources

Enlarged and inflamed adenoids, common among children, can make breathing difficult and lead to sleep disturbances and recurring ear infections, sometimes with hearing loss.

  • Enlarged adenoids in children may result from infections.

  • Enlargement usually causes no symptoms but can occasionally cause difficulty breathing or swallowing and sometimes recurring sinus or ear infections (sometimes with hearing loss), or obstructive sleep apnea.

  • The diagnosis is based on nasopharyngoscopy.

  • Antibiotics may be used if a bacterial infection is present, and sometimes, if infections are recurring, the adenoids are removed.

Adenoids are collections of lymphoid tissue Lymphoid organs The immune system is designed to defend the body against foreign or dangerous invaders. Such invaders include Microorganisms (commonly called germs, such as bacteria, viruses, and fungi) Parasites... read more where the nasal passages connect with the throat. They help defend the body against infection by trapping bacteria and viruses entering through the throat and by producing antibodies. The adenoids are largest in children who are 2 to 6 years of age.

Locating the Adenoids

The adenoids are lymphoid tissue located behind the palate, where the nasal passages connect with the throat. The adenoids are not visible through the mouth.

Locating the Tonsils and Adenoids

Causes of Adenoid Disorders

Some preschool and adolescent children have relatively large adenoids that are not due to any problem. However, adenoids can become enlarged because they become infected with a virus or bacteria that cause throat infections (sore throat Sore Throat Sore throat is pain in the back of the throat. A sore throat can be very painful and is usually worsened by swallowing. Many people with a sore throat refuse to eat or drink. Sometimes pain... read more Sore Throat ). Ongoing exposure to children who have bacterial or viral infections, such as those who are often in child care centers, increases the risk of infection. In addition, allergies (such as seasonal allergies or year-round allergies), irritants, and, possibly, gastroesophageal reflux also can cause the adenoids to enlarge. Although extremely rare, cancer sometimes causes enlarged adenoids.

When enlarged, adenoids may block the nose or the eustachian tubes that connect the back of the throat to the ears. Usually, adenoids return to normal size once the cause of the problem is resolved. Sometimes they remain enlarged, particularly in children who have had frequent or chronic infections.

Symptoms of Adenoid Disorders

Most enlarged adenoids cause no symptoms. However, enlarged adenoids can give the voice a stuffy-nose quality (children sound as though they have a cold). Children with enlarged adenoids may have an abnormally shaped palate and position of the teeth. Children may also tend to breathe through their mouth and may also have chronic ear infections Chronic Middle Ear Infection in Children Chronic middle ear infection results from recurring infections that may damage the eardrum or lead to formation of a cholesteatoma, which in turn promotes more infection. Chronic middle ear... read more Chronic Middle Ear Infection in Children with hearing loss Hearing Loss Worldwide, about half a billion people (almost 8% of the world's population) have hearing loss. More than 15% of people in the United States have some degree of hearing loss that affects their... read more Hearing Loss , nosebleeds Nosebleeds Some people get nosebleeds rather often, and others rarely get them. There may be just a trickle of blood or a strong stream. If people swallow the blood, they often vomit it because blood is... read more , bad breath Bad Breath Bad breath is a frequent or persistent unpleasant odor to the breath. Certain diseases produce substances that are detectable on the breath, but these odors are typically mild and not considered... read more , and cough Cough in Children Cough helps clear materials from the airways and prevent them from going to the lungs. The materials may be particles that have been inhaled or substances from the lungs and/or airways. Most... read more .

Diagnosis of Adenoid Disorders

Treatment of Adenoid Disorders

  • Treatment of the cause

  • Sometimes adenoidectomy

If doctors think adenoids are enlarged because of allergies, it is treated with a nasal corticosteroid spray or other medications, such as antihistamines, taken by mouth. If the cause appears to be a bacterial infection, it is treated with antibiotics.

If children have persistent ear infections, doctors may recommend surgical removal of the adenoids (called adenoidectomy).

Doctors may recommend adenoidectomy for younger children who have the following:

Adenoidectomy does not seem to decrease the frequency or severity of colds or cough.

Although it requires general anesthesia, adenoidectomy usually can be done on an outpatient basis. Children typically recover from adenoidectomy in 2 to 3 days.

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