When to Subtract an Add-enoid?


Does your child’s snoring rival Grandpa’s? Does your son constantly breathe through his mouth? Does your daughter still have ear pain or infections even after having ear tubes? If these scenarios sound familiar, the problem may be related to your child’s adenoid.

Adenoid tissue is similar to tonsils and helps fight infections. While tonsils are located on either side of the throat, the adenoid can’t be easily seen. It is tucked away above the uvula, that dangly thing above the tongue.

Just like tonsils, the adenoid can get larger during infections. It often returns to normal size once the illness is over but in some children it is larger than average at baseline. Because of its location, a large adenoid can cause problems with sleeping, breathing and drainage of fluid from the ears. Adenoidectomy is the surgical removal of the adenoid and if indicated, may be beneficial.

Snoring is one of the many reasons children have poor sleep. An enlarged adenoid can block airflow causing the characteristic snoring sound. The blockage can be detected during a sleep study and if severe enough may be diagnosed as obstructive sleep apnea (OSA). Other signs of obstruction and poor sleep may be frequent nighttime awakenings, daytime fatigue, and even hyperactivity and inattention.  If your child has these problems, it is worthwhile discussing with your physician. Removal of an enlarged adenoid and/or tonsils by an ear, nose and throat doctor (ENT) can make OSA better.

Signs of obstruction may also be present during the day.  Children who only breathe through their mouths often do so because air doesn’t easily pass through their nose. They may have a “nasal/throaty” sounding voice and trouble smelling. Nasal sprays and other medicines may help, but sometimes adenoid removal is necessary.

An enlarged adenoid may also block the drainage of fluid from the ears and lead to more infections and hearing problems. If your child needs a second set of tubes, the ENT doctor may discuss removing the adenoid at the same time.

However, not all snorers, mouth breathers, and children with frequent ear infections need surgery. If your child is one of these, try not to lose sleep over it. Your primary physician can guide you through options.

Dr. Jeremy Pickell is a pediatric resident at Levine Children’s Hospital of Carolinas HealthCare System, and Dr. Shivani Mehta is a board-certified pediatrician at CHS Myers Park Pediatrics.