Adenoids – Are they necessary?

The human body that proliferates from just a single cell has always fascinated every multi-cellular organism on the planet. The organs that make it up are a creation of awe by themselves. Each one compliments and aids the other in performing various functions for daily life survival. 

Every organ plays an important role right from the time we open our eyes till the time God closes them. Hang on!!! There are a few that gain importance at different stages of our life. One such is the Adenoids. 

Adenoids – An overview

Fixed at six

Adenoids are tissues that gain importance or play a role until age 6. These are also often confused with tonsils. However, they are different and unique in their own way. 

The adenoids are soft tissues that lie at the very back of the nasal cavity. Some of their important functions include:

• Provides immunity.
• Help to trap infection in children. 
• Reciprocates the functions of the lymphoid tissue. In these tissues, white blood cells circulate, and whenever a child experiences an infection, the tissues swell up. But the mechanism undergoes a change as one grows older. 

Disappearing act

This is because the adenoids tissues slowly begin to shrink as one move towards adolescence. They are also said to disappear or cease to function totally in adulthood. Therefore, compared to adults, children turn out to be poor victims of conditions of inflamed adenoids.

Let us take a quick look at how Adenoid tissue affects the little ones. When a child is affected by a bacterial infection or allergies, it causes inflammation of the adenoid tissues and leads to a condition called Adenoiditis. 

It causes difficulty in breathing due to obstruction. Children, therefore, resort to breathing through the mouth or experience difficulty in swallowing (based on the severity of the infection). 

Grades of Adenoids

Adenoids are categorized into 4 grades according to the percentage of the adenoid tissue that causes the blockage of posterior choana (as per NCBI article – PMC6078522).

Adenoid tissue grades	Description
Grade I	This adenoid tissue obstructs 0% to 25% of the posterior choana.
Grade II	This adenoid tissue obstructs 26% to 50% of the posterior choana.
Grade III	This adenoid tissue obstructs 51% to 75% of the posterior choana.
Grade IV	This adenoid tissue obstructs 76% to 100% of the posterior choana.

Complications of Adenoiditis

There are many complications of Adenoiditis. Here is the list of a few: 

Obstructive Sleep Apnea (OSA)

This causes the child to snore as there is intermittent blockage of airflow. Partial obstruction to increased upper airway resistance may lead to apnea (not breathing) for a few seconds. This condition can occur several times at night. 

Chronic middle ear infections

In children suffering from Adenoiditis, the Eustachian tube is blocked. In turn, there will arise difficulty in drainage of fluids, leading to recurrent sinus infections.

Adenoiditis in adults 

Though Adenoiditis does not affect adults generally, some with a chronic sinus infection, otitis media, allergic rhinitis, HIV and malignancy are exceptions (according to NCBI article – PMC3696153).

Diagnosis of Adenoiditis

Tests

The following tests are performed to diagnose Adenoiditis

1. X-ray/CT/MRI – to view sinuses and nasal cavity. 

2. Flexible endoscopy – It is one of the best tests that help detect the condition and confirm the grading of the adenoids. 

Treatments for Adenoiditis

Medical management includes symptomatic treatment with antibiotics.

• An adenoidectomy (tissues are removed completely) may be done after consulting an ENT specialist. Usually, they are removed totally along with tonsils. 
• In adults, only a tonsillectomy is performed. 
• In children (mostly older than 3), an adenotonsillectomy is performed.
• In individuals older than 14, adenoidectomy alone is done. The rate of adenoidectomy is about 1.5 times as high in boys as in girls, while tonsillectomy is almost twice as high in girls as seen in boys.

Quality of life in children with OSA does improve after adenotonsillectomy (as per JAMA network article – 482962). The recovery rate is around 2 weeks post surgery.

To ease throat pain, soft foods and cool drinks are given to those who have undergone surgery. But, oranges, grapefruits and other citric acid-containing foods, spicy and crunchy meals are to be avoided.

The advantage of the surgery is that there are no recurrent ear infections, and the patient sleeps better. There may be a minimal but permanent change in voice. Bleeding is rare, and at times snoring may persist. But largely, the benefits over-weigh the cons.

In conclusion

Adenoiditis may or may not present itself along with Tonsillitis. Though not severe, it should not be ignored, and you need to consult your doctor to grade and analyse the adenoids for the type of treatment to be provided.