Adenoid hyperplasia

Definition

Adenoid hyperplasia, or sometimes also commonly called adenoid hypertrophy or enlarged adenoids, is the overenlargement (or, unusual growth) of the lymph glands (lymphatic tissue) located between the nose and the back of the mouth. The tissues are similar in characteristics to the tonsils.

Demographics

The condition is one that occurs quite frequently in childhood. The adenoidal tissue is small at birth and grows until children attain adolescence. Normally, it then begins to atrophy (shrink). However, in some cases the tissue continues to grow abnormally, resulting in adenoid hyperplasia.


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 humans breathe and eat. In contrast to the rest of the body's tissues, lymphoid tissue reaches its greatest size in mid-childhood (around five years of age) and recedes thereafter (generally by seven years). 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 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 past few generations, tonsils and adenoids caused greater health problems.



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 times gone by, 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 condition is quite rare. Large adenoids can block air passages and, thus, impair nose breathing and require a child to breathe through the mouth. Snoring during sleep may occur, along with frequent nasal congestion/nasal discharge when both awake and asleep. Fatigue, uneasy and restless sleep, daytime sleepiness, lessened appetite, bad breath, dry and cracked lips, nasally sounding voice, and fever may also occur. Because they encircle the only connection between the middle ear and the Eustachian tube, hypertrophied adenoids can also obstruct it and cause middle ear infections. Such infections are caused by abnormally high bacterial counts and build up of fluids in the middle ear. These fluids can drip onto sensitive vocal cords, which may lead to irritations and coughing.

Diagnosis

A simple tongue blade depressing 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 smallmirror or fiber optic endoscope. X rays of the skull, along with computed tomography (CT) and magnetic resonance imaging (MRI) scans, taken laterally can show the adenoids. Achild with recurringmiddle ear infections maywell have large adenoids. Athroat culture or mononucleosis test will usually reveal 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). Opinion 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. When performed today, the procedure is usually used to correct nasal obstructions and reduce chronic middle ear infections and fluids.

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. Alternative treatments should be used with care, as the benefits of many such treatments have not been confirmed by scientific research.

Prognosis and prevention

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 could be concentrated toward timely evaluation and appropriate treatment of sore throats to prevent overgrowth of adenoid tissue. Avoiding other children with acute respiratory illness will also reduce the spread of these common illnesses.