Adenoid and Adenoidectomy

Prof. Dr. John Mathai, MBBS, DLO, MS (ENT), Senior Consultant, ENT, KIMSHEALTH

Six-year-old Alpha (name changed) and her parents had come to my clinic with complaints of the child’s poor- quality sleep and pauses in breathing during sleep.

Her parents were concerned about her noisy breathing and recurrent ear infections. They also reported that Alpha’s nose was stuffy and runny most of the time and she spoke with a nasal twang. On physical examination, I found the child suffering from hypertrophy or enlargement of the adenoids.

What are adenoids?
An adenoid is lymphoid aggregation present in the nasopharynx. Put differently, they are glands behind the nose, on the roof of the mouth. Adenoids serve an important purpose, producing antibodies, particularly in young children.

Adenoid produces B cells which give rise to IgG and IgA antibodies and provide immunological memory in younger children. They act as the first line of defense in the immune system by helping protect the body from viruses and bacteria.

Symptoms of enlarged adenoids
Rhinitis (runny nose, sneezing, and stuffiness), rhinosinusitis (inflammation of the sinuses and nasal cavity) and recurrent otitis media (group of inflammatory diseases of the middle ear) as adenoid acts as a bacterial reservoir from which the infection enters the middle ear through the eustachian tube are some of the common symptoms. These apart, patients may also suffer from otitis media with or without effusion due to block and infection and obstructive sleep apnoea due to enlarged adenoids. Poor appetite due to a decreased sense of smell or olfaction is another symptom.

Hypertrophy kinds
Hypertrophy of the adenoid is classified into four grades. Grade I is enlargement when it occupies 1/3 rd of choana (posterior nasal aperture), Grade II when it occupies 1/3 rd  to 2/3 rd  of choana, Grade III when it occupies 2/3 rd to full of choana and Grade IV when there is complete chonal obstruction with extension of the
posterior part of the nasal cavity.

Management of enlarged adenoids
Enlarged adenoids are managed through a surgical procedure called adenoidectomy. Different techniques are available for adenoidectomy. Endoscopic adenoidectomy is the accepted procedure in major hospitals now. In this, an endoscope is used to visualise the adenoid and remove it in total using various instruments such as debrider or coblator. By doing endoscopic adenoidectomy, we can prevent regrowth of adenoid, if done properly.

Earlier adenoids were curated out or removed using currets. However, this is an outdated procedure now.