The enlargement of the pharyngeal tonsils is referred to as adenoids or adenoid vegetation , for which doctors also use the term hyperplasia. Enlarged tonsils can become a mechanical problem by constricting the nasopharynx and/or leading to chronic inflammatory changes that affect not only the pharynx, but also the lungs and middle ear.

Almost exclusively children between the ages of 3 and 7 are affected, since the pharyngeal tonsil tissue regresses during puberty , and in adults it has often completely disappeared. Adenoids are not a disease in themselves, they only become problematic when they cause health problems. In the vernacular, adenoids are incorrectly referred to as polyps .

Causes

The pharyngeal tonsils are located on the roof of the nasopharynx and, together with the palatine tonsils, belong to the lymphatic pharyngeal ring, which serves to defend against pathogens that have entered through the nose and mouth.

The defense function is taken over by lymph follicles, which are located in the tissue of the tonsils and become active as soon as they come into contact with pathogens.

Tonsil enlargement is due to the enlargement and increase in number of active lymph follicles, a complicated immunological process that sets in motion a vicious circle:

The inflammatory reaction that serves as a defense leads to an enlargement of the pharyngeal tonsils, which leads to a build-up of secretions in the tonsil tissue, which in turn promotes further inflammatory reactions.

Symptoms, Ailments & Signs

Adenoids can cause various symptoms and disorders in the nasopharynx. People who suffer from tonsil enlargement usually snore more and wake up more often. Disturbed sleep can lead to chronic fatigue. Affected children often lack concentration and perform worse at school than children without enlarged tonsils.

There is also often nasal speech that is mistaken for mumbling. An external feature is also the slightly open mouth. This phenomenon also occurs during the day and promotes inflammation of the mouth and respiratory tract. Those affected are also more prone to colds and coughs. In some cases, adenoids can cause hearing problems, such as hearing loss in one or both ears.

There is also an increased risk of middle ear infections and chronic inflammation of the nose and throat. In the worst case, chronic bronchitis develops, which manifests itself, among other things, in breathing difficulties, sputum, coughing , pain in the throat and general malaise. Based on this diagnosis, adenoid vegetation can be recognized and treated at an early stage. Failure to surgically remove the adenoids can result in developmental delays and problems with language development that often persist into adulthood.

Diagnosis & History

Adenoids can lead to obstruction of nasal breathing and secretion drainage through the nose, snoring and breathing disorders or breathing pauses during sleep.

The disturbed sleep makes the children chronically tired and lacks concentration. Breathing is mainly through the mouth, which is why the affected children often have their mouths open.

The obstruction of nasal breathing encourages chronic inflammation in the nasopharynx to the point of bronchitis and also affects the middle ear, for which normal nasal breathing is important for proper functioning.

The result is frequent middle ear infections , which in the worst case can lead to hearing loss, which impedes the children’s language development.

The general development of the children is also affected by the frequent infections and sleep disorders . The diagnosis is made by a clinical ENT examination, during which the pharynx is inspected.

Differential diagnosis

Diseases such as choanal atresia and juvenile nasopharyngeal fibroma must be excluded .

When should you go to the doctor?

Adenoids are a natural phenomenon and usually do not require any further medical clarification. However, if health problems occur as a result of the enlarged tonsils, a doctor should determine the cause and remove the polyps if necessary.

Proliferations of the adenoids require clarification as soon as symptoms such as nasal congestion, intense snoring or infection in the mouth and throat occur. If these side effects persist for more than a month, a doctor should be consulted.

Immediate medical attention is required if flu-like symptoms such as fever or earache develop. It is possible that an acute middle ear infection has already formed, which must be treated immediately. Apart from that, it is necessary to go to the doctor with adenoids if the enlarged tonsils affect the general condition or have a negative effect on the state of health in any other way.

The symptoms mentioned usually appear between the ages of three and six and are an indicator of enlarged tonsils. Whether treatment is necessary depends on the type and intensity of the symptoms and possible previous illnesses. In general, if adenoid vegetations are suspected, the responsible pediatrician should be spoken to so that further steps can be taken.

Treatment & Therapy

Adenoids can only be eliminated by an operation in which the enlarged tonsil is peeled out with a special instrument. The procedure usually lasts only a few minutes and is performed under general anesthesia .

In contrast to the surgical removal of the palatine tonsils, which is associated with a certain risk of secondary bleeding, the removal of the pharyngeal tonsils is usually possible on an outpatient basis. The prerequisite is that the affected children do not have any serious underlying diseases or coagulation disorders , that reliable care is provided by guardians throughout the first 24 hours after the procedure and that the journey to the surgeon is not too far in the event of problems.

In the first few days, swallowing difficulties and swelling-related obstruction of nasal breathing and ear pressure are possible. Postoperative bleeding is extremely rare, accounting for 0.8% of all interventions, and even more rarely does it require medical intervention. Surgery is only performed if the affected children actually have serious health problems, often suffer from infections, have trouble sleeping and thriving , or suffer from severe respiratory diseases independent of adenoids, such as e.g. B. Asthma .

The operation is also not without controversy: Since the adenoid tissue recedes at the latest by the onset of puberty, it is quite possible that the problems caused by the adenoids will also disappear.

Outlook & Forecast

As a rule, this disease often leads to inflammation of the tonsils and colds. The affected person suffers from flu , cough , cold and thus a reduced quality of life. It is not uncommon for the disease to also affect snoring and make it worse. If necessary, the increased snoring can also lead to problems in a relationship and problems with the partner.

In some cases, speech also becomes slurred, which can lead to social and everyday problems. Furthermore, as the disease progresses, there is pressure on the ears and this often leads to hearing problems. However, the patient does not suffer a complete loss of hearing. Likewise, middle ear infections often occur, which make everyday life difficult. Children often appear tired and exhausted as a result of the illness and are no longer able to concentrate.

In most cases, it is possible to surgically remove the adenoids with no further complications or discomfort. The symptoms disappear completely after the procedure. Only in rare cases can bleeding occur after the procedure.

Prevention

The development of adenoids and their secondary diseases cannot be prevented by preventive measures, because ultimately they are the result of the normal immune defense of the lymphatic pharyngeal ring. However, frequent infections of the nasopharynx, middle ear infections, mouth breathing and sleep disorders should encourage parents to have the cause clarified by an ENT examination and to seek advice.

Aftercare

In the case of this disease, the person affected is primarily dependent on a quick and, above all, early diagnosis. This is the only way to avoid and limit further complications or complaints. If this is not treated, the symptoms of this disease usually continue to worsen.

For this reason, with this disease, a doctor should be consulted at the first signs and symptoms so that there are no further complications or symptoms. The earlier the doctor is contacted, the better the further course of the disease is usually. The treatment itself is usually carried out by means of a surgical procedure, which usually takes place without complications.

After the procedure, the person concerned should definitely rest and take care of his body. In any case, exertion or stressful activities should be avoided in order not to unnecessarily burden the body. Those affected are usually dependent on the help and care of the family or relatives so that there are no further complaints. As a rule, the life expectancy of the affected person is not reduced if the treatment is successful.

Outlook & Forecast

After the adenoids are surgically removed, most children have no further symptoms. If necessary, the regrowth of the tonsils should be surgically removed again during follow-up treatment. In the case of tympanic effusions, it may be necessary to treat long-term tympanic drainage.

You can do that yourself

The development of adenoids can best be prevented by a well-functioning immune system. A healthy lifestyle is particularly important for people with pre-existing conditions. This should include adequate exercise, a varied diet and enough sleep .

This gives the body the opportunity to effectively fight viral and bacterial pathogens and thus prevent the symptoms. If painful swelling occurs, it is advisable to see a doctor as soon as possible. With early treatment, the chronic course of the disease and the associated complications can possibly be avoided.

If symptoms already exist, those affected should primarily eat soft and cool food. This will help keep inflamed areas from irritating further. Strong seasoning of food should be avoided, as should the consumption of acidic products. Both can cause a sore throat. Ice cream, on the other hand, can help to relieve swallowing pain. Since smoking promotes inflammation, it should definitely be avoided.

When choosing a drink, fruit juices should be avoided, as the acid they contain irritates the throat. Anti-inflammatory liquids such as sage or peppermint tea are better .